"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" 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|459.94||||459.94|161.44|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|459.94||||459.94|275.96|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA [141500]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|459.94||||459.94|96.59|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR OPTIONS [203501]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|459.94||||459.94|197.77|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|459.94||||459.94|298.96|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|||459.94||||459.94|137.98|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131500]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|459.94||||459.94|220.54|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|459.94||||459.94|344.96|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|459.94||||459.94|195.93|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|459.94||||459.94|230.43|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|459.94||||459.94|197.77|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|459.94||||459.94|413.95|413.95|96.59 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|459.94||||459.94||| 10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|459.94||||459.94||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|||10.00||||10.00|3|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|||10.00||||10.00|3|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|||10.00||||10.00|3|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|||10.00||||10.00|3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|||10.00||||10.00|3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|||10.00||||10.00|3|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|||10.00||||10.00|3|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.60||||64.60|38.76|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.60||||64.60|41.99|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|GEHA [1415]|GEHA [141500]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CORESOURCE [1315]|CORESOURCE [131500]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CHAMPVA [1240]|CHAMP VA [124000]|64.60||||64.60|48.45|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|||64.60||||64.60|19.38|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.60||||64.60|30.98|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.60||||64.60|13.57|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UMR [2035]|UMR OPTIONS [203501]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.60||||64.60|27.78|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MULTIPLAN [1680]|IHC HS [168011]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HEALTHNET [1495]|HEALTHNET [149500]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|TRUSTMARK [2030]|STARMARK [203000]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64.60||||64.60|27.52|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.60||||64.60|27.78|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64.60||||64.60|32.36|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.60||||64.60|22.67|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.60||||64.60|58.14|58.14|13.57 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MULTIPLAN [1680]|HMA [168003]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AETNA [1015]|AETNA ACO WILCO [101532]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.60||||64.60||| 100611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC 1 % TOPICAL GEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.60||||64.60||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|||10.00||||10.00|3|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|||10.00||||10.00|3|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|||10.00||||10.00|3|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUVOXAMINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10126|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|||10.00||||10.00|3|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|||10.00||||10.00|3|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYCOPYRROLATE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|||10.00||||10.00|3|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10149|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.54|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.54|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.54|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.54|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.54|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.54 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|||10.00||||10.00|3|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.31||||12.31|6.17|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.31||||12.31|5.24|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.31||||12.31|4.32|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.31||||12.31|4.32|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.31||||12.31|6.17|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.31||||12.31|5.29|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.31||||12.31|7.39|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.31||||12.31|7.39|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.31||||12.31|5.29|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.31||||12.31|5.29|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.31||||12.31|2.59|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.31||||12.31|2.59|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.31||||12.31|5.9|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.31||||12.31|5.9|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.31||||12.31|8|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.31||||12.31|8|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|||12.31||||12.31|3.69|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|||12.31||||12.31|3.69|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.31||||12.31|5.24|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.31||||12.31|5.29|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.31||||12.31|9.23|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.31||||12.31|9.23|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GEHA [1415]|GEHA [141500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GEHA [1415]|GEHA [141500]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.31||||12.31|11.08|11.08|2.59 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.31||||12.31||| 10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.31||||12.31||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10236|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYUREA 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|231.56||||231.56|173.67|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|231.56||||231.56|173.67|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|||231.56||||231.56|69.47|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|||231.56||||231.56|69.47|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231.56||||231.56|150.51|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231.56||||231.56|150.51|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231.56||||231.56|111.03|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231.56||||231.56|111.03|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231.56||||231.56|48.63|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231.56||||231.56|48.63|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231.56||||231.56|99.57|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231.56||||231.56|99.57|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231.56||||231.56|138.94|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231.56||||231.56|138.94|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|231.56||||231.56|98.64|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231.56||||231.56|81.28|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|231.56||||231.56|98.64|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231.56||||231.56|99.57|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231.56||||231.56|81.28|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|231.56||||231.56|116.01|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231.56||||231.56|99.57|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|231.56||||231.56|116.01|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231.56||||231.56|208.4|208.4|48.63 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231.56||||231.56||| 1027|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE DIPROPIONATE 0.05 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231.56||||231.56||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.46||||58.46|29.29|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.28||||128.28|55.16|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.46||||58.46|20.52|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.46||||58.46|24.9|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.46||||58.46|25.14|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.28||||128.28|45.03|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.28||||128.28|76.97|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.46||||58.46|35.08|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MULTIPLAN [1680]|HMA [168003]|128.28||||128.28|44.9|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.28||||128.28|55.16|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.46||||58.46|25.14|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MULTIPLAN [1680]|HMA [168003]|58.46||||58.46|20.46|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.28||||128.28|184.44|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.46||||58.46|55.33|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.46||||58.46|12.28|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.28||||128.28|26.94|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.28||||128.28|61.51|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.46||||58.46|28.03|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.28||||128.28|83.38|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.46||||58.46|38|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|||128.28||||128.28|38.48|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|||58.46||||58.46|17.54|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.28||||128.28|54.65|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.28||||128.28|64.27|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|128.28||||128.28|96.21|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|58.46||||58.46|43.85|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.28||||128.28||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GEHA [1415]|GEHA [141500]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GEHA [1415]|GEHA [141500]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.46||||58.46|52.61|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.28||||128.28|115.45|184.44|12.28 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.46||||58.46||| 10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GEHA [1415]|GEHA [141500]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GEHA [1415]|GEHA [141500]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CORESOURCE [1315]|CORESOURCE [131500]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CHAMPVA [1240]|CHAMP VA [124000]|128.28||||128.28|96.21|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CHAMPVA [1240]|CHAMP VA [124000]|58.46||||58.46|43.85|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|||58.46||||58.46|17.54|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|||128.28||||128.28|38.48|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.46||||58.46|38|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.28||||128.28|83.38|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.28||||128.28|61.51|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.28||||128.28|26.94|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.46||||58.46|12.28|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.46||||58.46|55.33|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.28||||128.28|184.44|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR [2035]|UMR OPTIONS [203501]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR [2035]|UMR OPTIONS [203501]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.46||||58.46|25.14|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.28||||128.28|55.16|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MULTIPLAN [1680]|HMA [168003]|58.46||||58.46|20.46|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MULTIPLAN [1680]|IHC HS [168011]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MULTIPLAN [1680]|HMA [168003]|128.28||||128.28|44.9|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MULTIPLAN [1680]|IHC HS [168011]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHNET [1495]|HEALTHNET [149500]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHNET [1495]|HEALTHNET [149500]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|TRUSTMARK [2030]|STARMARK [203000]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.46||||58.46|28.03|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|TRUSTMARK [2030]|STARMARK [203000]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.28||||128.28|76.97|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.46||||58.46|35.08|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.46||||58.46|20.52|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CORESOURCE [1315]|CORESOURCE [131500]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.46||||58.46|29.29|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.46||||58.46|24.9|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.28||||128.28|64.27|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.28||||128.28|45.03|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.28||||128.28|54.65|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.46||||58.46|25.14|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.28||||128.28|55.16|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.46||||58.46|52.61|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.28||||128.28|115.45|184.44|12.28 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.28||||128.28||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.46||||58.46||| 10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.28||||128.28||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.46||||58.46|29.29|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.46||||58.46|20.52|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.46||||58.46|24.9|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.46||||58.46|35.08|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|58.46||||58.46|20.46|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.46||||58.46|25.14|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.46||||58.46|55.33|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.46||||58.46|12.28|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.46||||58.46|28.03|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.46||||58.46|25.14|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.46||||58.46|38|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|||58.46||||58.46|17.54|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|58.46||||58.46|43.85|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.46||||58.46|52.61|55.33|12.28 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.46||||58.46||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.46||||58.46||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|202.00||||202.00|151.5|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|202.00||||202.00|151.5|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|202.00||||202.00|151.5|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|||202.00||||202.00|60.6|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|||202.00||||202.00|60.6|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|||202.00||||202.00|60.6|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.00||||202.00|131.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.00||||202.00|131.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.00||||202.00|131.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.00||||202.00|96.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.00||||202.00|96.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.00||||202.00|96.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202.00||||202.00|42.42|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202.00||||202.00|42.42|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202.00||||202.00|42.42|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202.00||||202.00|5.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202.00||||202.00|5.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202.00||||202.00|5.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202.00||||202.00|5.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202.00||||202.00|42.42|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.00||||202.00|96.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.00||||202.00|131.3|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|||202.00||||202.00|60.6|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202.00||||202.00|121.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202.00||||202.00|121.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202.00||||202.00|121.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202.00||||202.00|121.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202.00||||202.00|70.9|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202.00||||202.00|70.9|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|202.00||||202.00|86.05|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|202.00||||202.00|101.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|202.00||||202.00|86.05|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|202.00||||202.00|101.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202.00||||202.00|70.9|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|202.00||||202.00|86.05|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|202.00||||202.00|151.5|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|202.00||||202.00|101.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202.00||||202.00|70.9|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202.00||||202.00|86.86|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|202.00||||202.00|86.05|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|202.00||||202.00|101.2|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202.00||||202.00|101|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202.00||||202.00|101|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202.00||||202.00|101|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202.00||||202.00|101|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202.00||||202.00|181.8|181.8|5.3 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202.00||||202.00||| 10323|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202.00||||202.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.55||||391.55|187.75|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|331.55||||331.55|158.98|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|196.00||||196.00|93.98|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|196.00||||196.00|127.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|331.55||||331.55|215.51|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|458.67||||458.67|298.14|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|391.55||||391.55|254.51|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||391.55||||391.55|117.46|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||458.67||||458.67|137.6|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||196.00||||196.00|58.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|||331.55||||331.55|99.46|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|458.67||||458.67|219.93|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|391.55||||391.55|293.66|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|196.00||||196.00|147|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|331.55||||331.55|248.66|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|458.67||||458.67|344|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|391.55||||391.55|13.25|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|391.55||||391.55|166.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|196.00||||196.00|98.2|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|458.67||||458.67|197.23|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|196.00||||196.00|98|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|331.55||||331.55|116.37|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|458.67||||458.67|275.2|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|331.55||||331.55|165.78|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|196.00||||196.00|84.28|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|331.55||||331.55|166.11|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|391.55||||391.55|234.93|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|196.00||||196.00|68.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|331.55||||331.55|10.6|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|196.00||||196.00|83.5|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|331.55||||331.55|142.57|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|391.55||||391.55|168.37|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|196.00||||196.00|84.28|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|458.67||||458.67|160.99|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|391.55||||391.55|82.23|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|458.67||||458.67|195.39|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|391.55||||391.55|168.37|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|196.00||||196.00|117.6|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|331.55||||331.55|69.63|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|458.67||||458.67|197.23|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|196.00||||196.00|5.3|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|458.67||||458.67|96.32|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|331.55||||331.55|141.24|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|391.55||||391.55|352.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|391.55||||391.55|196.17|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|331.55||||331.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|458.67||||458.67|15.9|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|196.00||||196.00|176.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|458.67||||458.67|229.79|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|391.55||||391.55|195.78|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|331.55||||331.55|298.4|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|331.55||||331.55|198.93|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|458.67||||458.67|229.34|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|331.55||||331.55|142.57|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|196.00||||196.00|41.16|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|391.55||||391.55|137.43|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|458.67||||458.67|412.8|412.8|5.3 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|458.67||||458.67||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|196.00||||196.00||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|391.55||||391.55||| 10328|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 76 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|458.67||||458.67||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LABETALOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|||10.00||||10.00|3|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|||10.00||||10.00|3|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPHILUS, BULGARICUS 100 MILLION CELL GRANULES PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|||10.00||||10.00|3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|||10.00||||10.00|3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|||10.00||||10.00|3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|||10.00||||10.00|3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|||10.00||||10.00|3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|||10.00||||10.00|3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|||10.00||||10.00|3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|||10.00||||10.00|3|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10403|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 88 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|||10.00||||10.00|3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|||10.00||||10.00|3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|||10.00||||10.00|3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|||10.00||||10.00|3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 112 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|||10.00||||10.00|3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|||10.00||||10.00|3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|||10.00||||10.00|3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|||10.00||||10.00|3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 137 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|||10.00||||10.00|3|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|111.63||||111.63|83.72|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|||111.63||||111.63|33.49|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|||111.63||||111.63|33.49|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111.63||||111.63|72.56|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111.63||||111.63|72.56|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111.63||||111.63|53.53|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111.63||||111.63|53.53|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111.63||||111.63|23.44|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111.63||||111.63|23.44|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111.63||||111.63|23.44|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|111.63||||111.63|83.72|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111.63||||111.63|48|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|111.63||||111.63|83.72|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111.63||||111.63|48|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111.63||||111.63|48|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111.63||||111.63|53.53|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111.63||||111.63|72.56|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|||111.63||||111.63|33.49|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111.63||||111.63|66.98|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111.63||||111.63|48|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111.63||||111.63|39.18|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111.63||||111.63|66.98|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111.63||||111.63|47.55|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111.63||||111.63|39.18|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111.63||||111.63|55.93|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111.63||||111.63|66.98|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111.63||||111.63|55.93|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111.63||||111.63|48|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111.63||||111.63|39.18|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111.63||||111.63|48|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111.63||||111.63|55.93|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111.63||||111.63|47.55|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111.63||||111.63|47.55|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111.63||||111.63|100.47|100.47|23.44 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111.63||||111.63||| 10434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111.63||||111.63||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|||10.00||||10.00|3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|||10.00||||10.00|3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|||10.00||||10.00|3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|||10.00||||10.00|3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETHANECHOL CHLORIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|||10.00||||10.00|3|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|||10.00||||10.00|3|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10443|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIOTHYRONINE 5 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|||10.00||||10.00|3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|||10.00||||10.00|3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|||10.00||||10.00|3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|||10.00||||10.00|3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|||10.00||||10.00|3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10449|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|||10.00||||10.00|3|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|||10.00||||10.00|3|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10454|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 300 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10455|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE ER 450 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|339.88||||339.88|144.79|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|339.88||||339.88|170.28|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|339.88||||339.88|119.3|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|339.88||||339.88|203.93|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|TRUSTMARK [2030]|STARMARK [203000]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|HEALTHNET [1495]|HEALTHNET [149500]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MULTIPLAN [1680]|IHC HS [168011]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|339.88||||339.88|146.15|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|UMR [2035]|UMR OPTIONS [203501]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|339.88||||339.88|71.37|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|339.88||||339.88|146.15|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|339.88||||339.88|162.97|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|339.88||||339.88|220.92|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|||339.88||||339.88|101.96|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|CHAMPVA [1240]|CHAMP VA [124000]|339.88||||339.88|254.91|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|CORESOURCE [1315]|CORESOURCE [131500]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|GEHA [1415]|GEHA [141500]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|339.88||||339.88|305.89|305.89|71.37 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|AETNA [1015]|AETNA ACO WILCO [101532]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MULTIPLAN [1680]|HMA [168003]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|339.88||||339.88||| 104564|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE 100 MCG-SALMETEROL 50 MCG/DOSE BLISTR POWDR FOR INHALATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|339.88||||339.88||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|GEHA [1415]|GEHA [141500]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|68.79||||68.79|51.59|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|||68.79||||68.79|20.64|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68.79||||68.79|44.71|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68.79||||68.79|32.98|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68.79||||68.79|14.45|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68.79||||68.79|29.58|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68.79||||68.79|41.27|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68.79||||68.79|24.15|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68.79||||68.79|29.3|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68.79||||68.79|29.58|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68.79||||68.79|34.46|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68.79||||68.79|61.91|61.91|14.45 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MULTIPLAN [1680]|HMA [168003]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68.79||||68.79||| 104604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAXIMIN 550 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68.79||||68.79||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.8|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.8|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.8|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.8 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|||10.00||||10.00|3|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|||10.00||||10.00|3|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10491|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|||10.00||||10.00|3|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 105|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|||13.41||||13.41|4.02|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.41||||13.41|6.43|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.41||||13.41|2.82|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.41||||13.41|5.77|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.41||||13.41|8.72|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.41||||13.41|10.06|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.41||||13.41|8.05|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.41||||13.41|4.71|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.41||||13.41|5.77|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.41||||13.41|6.72|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.41||||13.41|5.71|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.41||||13.41|12.07|12.07|2.82 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.41||||13.41||| 10531|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MERCAPTOPURINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.41||||13.41||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56.60||||56.60|24.34|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56.60||||56.60|19.87|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56.60||||56.60|28.36|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56.60||||56.60|33.96|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|TRUSTMARK [2030]|STARMARK [203000]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|HEALTHNET [1495]|HEALTHNET [149500]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MULTIPLAN [1680]|IHC HS [168011]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56.60||||56.60|24.34|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|UMR [2035]|UMR OPTIONS [203501]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56.60||||56.60|11.89|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56.60||||56.60|27.14|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56.60||||56.60|36.79|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56.60||||56.60|24.11|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|||56.60||||56.60|16.98|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|CHAMPVA [1240]|CHAMP VA [124000]|56.60||||56.60|42.45|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|CORESOURCE [1315]|CORESOURCE [131500]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|GEHA [1415]|GEHA [141500]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56.60||||56.60|50.94|50.94|11.89 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|AETNA [1015]|AETNA ACO WILCO [101532]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MULTIPLAN [1680]|HMA [168003]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56.60||||56.60||| 10535|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 4 GRAM/60 ML ENEMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56.60||||56.60||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHIMAZOLE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|167.56||||167.56|125.67|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|||167.56||||167.56|50.27|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167.56||||167.56|108.91|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167.56||||167.56|80.35|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167.56||||167.56|47.83|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167.56||||167.56|72.05|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167.56||||167.56|35.19|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|167.56||||167.56|58.65|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167.56||||167.56|100.54|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167.56||||167.56|72.05|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|167.56||||167.56|71.38|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167.56||||167.56|58.81|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|167.56||||167.56|83.95|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167.56||||167.56|150.8|150.8|35.19 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167.56||||167.56||| 10577|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 1,000 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167.56||||167.56||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.17||||61.17|26.3|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.17||||61.17|5.98|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.17||||61.17|12.85|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.17||||61.17|29.33|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.17||||61.17|39.76|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|||61.17||||61.17|18.35|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|61.17||||61.17|45.88|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.17||||61.17|26.3|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.17||||61.17|30.65|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.17||||61.17|26.06|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.17||||61.17|21.47|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.17||||61.17|36.7|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|61.17||||61.17|21.41|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.17||||61.17|55.05|55.05|5.98 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.17||||61.17||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.17||||61.17||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.59||||11.59|2.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.59||||11.59|5.56|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.59||||11.59|4.98|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.59||||11.59|6.95|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.59||||11.59|4.94|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.59||||11.59|4.07|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.59||||11.59|7.53|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|||11.59||||11.59|3.48|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.59||||11.59|4.98|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|||11.59||||11.59|3.48|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|11.59||||11.59|8.69|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.59||||11.59|4.98|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.59||||11.59|7.53|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.59||||11.59|5.81|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.59||||11.59|4.07|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.59||||11.59|5.56|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.59||||11.59|2.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.59||||11.59|4.98|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.59||||11.59|5.81|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.59||||11.59|6.95|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|11.59||||11.59|8.69|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.59||||11.59|4.94|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.59||||11.59|10.43|10.43|2.43 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.59||||11.59||| 10587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.59||||11.59||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.16||||13.16|6.59|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.16||||13.16|5.61|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.16||||13.16|5.61|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.16||||13.16|5.66|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.16||||13.16|7.9|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|||13.16||||13.16|3.95|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.16||||13.16|2.76|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|||13.16||||13.16|3.95|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.16||||13.16|4.62|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.16||||13.16|9.87|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.16||||13.16|9.87|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.16||||13.16|7.9|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.16||||13.16|4.62|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.16||||13.16|6.31|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.16||||13.16|2.76|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.16||||13.16|5.66|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.16||||13.16|8.55|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.16||||13.16|6.59|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.16||||13.16|6.31|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.16||||13.16|5.66|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.16||||13.16|8.55|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.16||||13.16|5.66|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.16||||13.16|11.84|11.84|2.76 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.16||||13.16||| 10588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOLAZONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.16||||13.16||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|||31.35||||31.35|9.4|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.35||||31.35|20.38|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.35||||31.35|15.03|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.35||||31.35|20.38|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.35||||31.35|15.03|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.35||||31.35|2.19|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.35||||31.35|6.58|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.35||||31.35|2.19|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.35||||31.35|6.58|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.35||||31.35|6.58|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.35||||31.35|2.19|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.35||||31.35|20.38|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|||31.35||||31.35|9.4|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|||31.35||||31.35|9.4|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|31.35||||31.35|10.97|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.35||||31.35|13.36|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.35||||31.35|15.71|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.35||||31.35|18.81|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.35||||31.35|13.36|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.35||||31.35|11|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.35||||31.35|18.81|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.35||||31.35|18.81|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.35||||31.35|18.81|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.35||||31.35|11|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|31.35||||31.35|23.51|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|31.35||||31.35|23.51|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.35||||31.35|11|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|31.35||||31.35|23.51|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|31.35||||31.35|23.51|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.35||||31.35|13.36|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.35||||31.35|15.71|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.35||||31.35|15.71|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.35||||31.35|15.03|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.35||||31.35|15.03|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.35||||31.35|11|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.35||||31.35|2.19|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.35||||31.35|6.58|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.35||||31.35|13.36|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|31.35||||31.35|10.97|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|31.35||||31.35|10.97|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|31.35||||31.35|10.97|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|||31.35||||31.35|9.4|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.35||||31.35|20.38|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.35||||31.35|15.71|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.35||||31.35|13.48|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.35||||31.35|28.22|28.22|2.19 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.35||||31.35||| 105899|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.35||||31.35||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.69||||41.69|20.89|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.69||||41.69|20.89|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.69||||41.69|17.76|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.69||||41.69|14.63|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.69||||41.69|14.63|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.69||||41.69|25.01|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.69||||41.69|25.01|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.69||||41.69|25.01|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.69||||41.69|14.63|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.69||||41.69|17.76|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.69||||41.69|17.76|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|41.69||||41.69|14.59|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.69||||41.69|8.75|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.69||||41.69|2.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|41.69||||41.69|14.59|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|41.69||||41.69|14.59|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|41.69||||41.69|14.59|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.69||||41.69|2.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.69||||41.69|2.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.69||||41.69|8.75|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.69||||41.69|8.75|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.69||||41.69|8.75|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.69||||41.69|8.75|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.69||||41.69|2.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|41.69||||41.69|14.59|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.69||||41.69|2.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.69||||41.69|19.99|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.69||||41.69|19.99|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.69||||41.69|19.99|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.69||||41.69|27.1|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.69||||41.69|17.93|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.69||||41.69|20.89|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.69||||41.69|27.1|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.69||||41.69|27.1|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|||41.69||||41.69|12.51|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.69||||41.69|14.63|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.69||||41.69|17.76|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.69||||41.69|20.89|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.69||||41.69|25.01|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.69||||41.69|25.01|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|||41.69||||41.69|12.51|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|||41.69||||41.69|12.51|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|41.69||||41.69|31.27|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|41.69||||41.69|31.27|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|41.69||||41.69|31.27|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|41.69||||41.69|31.27|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|||41.69||||41.69|12.51|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|||41.69||||41.69|12.51|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.69||||41.69|17.76|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|41.69||||41.69|31.27|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.69||||41.69|27.1|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.69||||41.69|20.89|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.69||||41.69|19.99|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.69||||41.69|14.63|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.69||||41.69|19.99|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.69||||41.69|37.52|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.69||||41.69|27.1|37.52|2.93 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.69||||41.69||| 105900|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.69||||41.69||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.64||||62.64|31.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.64||||62.64|31.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.64||||62.64|31.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.64||||62.64|26.68|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.64||||62.64|26.68|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.64||||62.64|37.58|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.64||||62.64|31.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.64||||62.64|37.58|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.64||||62.64|37.58|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.64||||62.64|26.68|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.64||||62.64|21.99|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.64||||62.64|37.58|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.64||||62.64|26.68|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.64||||62.64|37.58|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.64||||62.64|26.68|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.64||||62.64|21.99|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.64||||62.64|21.99|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.64||||62.64|31.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.64||||62.64|21.99|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.64||||62.64|31.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.64||||62.64|37.58|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.64||||62.64|21.99|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.64||||62.64|21.99|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.64||||62.64|26.68|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|62.64||||62.64|46.98|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|62.64||||62.64|46.98|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|62.64||||62.64|46.98|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|||62.64||||62.64|18.79|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|||62.64||||62.64|18.79|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|||62.64||||62.64|18.79|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|||62.64||||62.64|18.79|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.64||||62.64|40.72|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.64||||62.64|40.72|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.64||||62.64|40.72|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.64||||62.64|30.04|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.64||||62.64|30.04|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.64||||62.64|30.04|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.64||||62.64|30.04|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.64||||62.64|30.04|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.64||||62.64|13.15|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.64||||62.64|13.15|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.64||||62.64|13.15|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.64||||62.64|13.15|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.64||||62.64|13.15|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.64||||62.64|4.39|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.64||||62.64|4.39|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.64||||62.64|4.39|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.64||||62.64|4.39|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.64||||62.64|40.72|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.64||||62.64|4.39|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.64||||62.64|4.39|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.64||||62.64|13.15|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|||62.64||||62.64|18.79|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|62.64||||62.64|46.98|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.64||||62.64|40.72|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.64||||62.64|40.72|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|62.64||||62.64|46.98|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.64||||62.64|30.04|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|||62.64||||62.64|18.79|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.64||||62.64|26.94|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|62.64||||62.64|21.92|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|62.64||||62.64|21.92|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|62.64||||62.64|21.92|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|62.64||||62.64|21.92|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|62.64||||62.64|21.92|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|62.64||||62.64|21.92|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|62.64||||62.64|46.98|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|62.64||||62.64|56.38|56.38|4.39 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.64||||62.64||| 105901|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|62.64||||62.64||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.85|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.85|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.85|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.85|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|||63.60||||63.60|19.08|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|||63.60||||63.60|19.08|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|||63.60||||63.60|19.08|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|||63.60||||63.60|19.08|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.85 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|79.52||||79.52|59.64|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|79.52||||79.52|59.64|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|||79.52||||79.52|23.86|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|||79.52||||79.52|23.86|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79.52||||79.52|51.69|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79.52||||79.52|38.13|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79.52||||79.52|16.7|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79.52||||79.52|16.7|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79.52||||79.52|7.31|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79.52||||79.52|34.19|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79.52||||79.52|34.19|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|79.52||||79.52|27.83|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|79.52||||79.52|27.83|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|79.52||||79.52|27.83|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79.52||||79.52|34.19|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79.52||||79.52|38.13|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79.52||||79.52|7.31|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79.52||||79.52|7.31|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79.52||||79.52|16.7|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|||79.52||||79.52|23.86|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79.52||||79.52|47.71|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79.52||||79.52|47.71|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79.52||||79.52|47.71|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79.52||||79.52|33.88|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79.52||||79.52|38.13|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79.52||||79.52|33.88|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79.52||||79.52|34.19|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79.52||||79.52|51.69|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79.52||||79.52|33.88|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|79.52||||79.52|59.64|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79.52||||79.52|27.91|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79.52||||79.52|51.69|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79.52||||79.52|34.19|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79.52||||79.52|39.84|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79.52||||79.52|39.84|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79.52||||79.52|27.91|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79.52||||79.52|71.57|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79.52||||79.52|27.91|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79.52||||79.52|34.19|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79.52||||79.52|39.84|71.57|7.31 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79.52||||79.52||| 105903|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 100 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79.52||||79.52||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.41||||95.41|47.8|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.41||||95.41|33.49|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.41||||95.41|40.64|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.41||||95.41|40.64|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.41||||95.41|40.64|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.41||||95.41|33.49|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.41||||95.41|57.25|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.41||||95.41|57.25|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.41||||95.41|57.25|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.41||||95.41|40.64|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|95.41||||95.41|33.39|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|95.41||||95.41|33.39|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|95.41||||95.41|33.39|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|95.41||||95.41|33.39|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.41||||95.41|8.78|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.41||||95.41|8.78|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.41||||95.41|8.78|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.41||||95.41|8.78|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.41||||95.41|20.04|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.41||||95.41|20.04|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.41||||95.41|20.04|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.41||||95.41|20.04|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.41||||95.41|45.75|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.41||||95.41|45.75|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.41||||95.41|45.75|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.41||||95.41|62.02|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.41||||95.41|62.02|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.41||||95.41|62.02|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.41||||95.41|62.02|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.41||||95.41|33.49|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.41||||95.41|45.75|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|||95.41||||95.41|28.62|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|||95.41||||95.41|28.62|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|||95.41||||95.41|28.62|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|||95.41||||95.41|28.62|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.41||||95.41|47.8|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.41||||95.41|47.8|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.41||||95.41|33.49|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.41||||95.41|57.25|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.41||||95.41|47.8|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.41||||95.41|41.03|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|95.41||||95.41|71.56|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|95.41||||95.41|71.56|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|95.41||||95.41|71.56|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|95.41||||95.41|85.87|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|95.41||||95.41|71.56|85.87|8.78 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.41||||95.41||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.41||||95.41||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|||10.00||||10.00|3|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEXILETINE 200 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10609|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.15||||58.15|25|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.15||||58.15|24.77|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.15||||58.15|29.13|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.15||||58.15|25|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.15||||58.15|24.77|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.15||||58.15|20.41|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.15||||58.15|34.89|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.15||||58.15|34.89|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|TRUSTMARK [2030]|STARMARK [203000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|TRUSTMARK [2030]|STARMARK [203000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHNET [1495]|HEALTHNET [149500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHNET [1495]|HEALTHNET [149500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MULTIPLAN [1680]|IHC HS [168011]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.15||||58.15|25|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.15||||58.15|25|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MULTIPLAN [1680]|IHC HS [168011]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UMR [2035]|UMR OPTIONS [203501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UMR [2035]|UMR OPTIONS [203501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.15||||58.15|12.21|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.15||||58.15|12.21|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.15||||58.15|27.88|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.15||||58.15|27.88|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.15||||58.15|37.8|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.15||||58.15|37.8|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|||58.15||||58.15|17.44|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|||58.15||||58.15|17.44|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.15||||58.15|20.41|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.15||||58.15|29.13|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CHAMPVA [1240]|CHAMP VA [124000]|58.15||||58.15|43.61|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CHAMPVA [1240]|CHAMP VA [124000]|58.15||||58.15|43.61|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA [1015]|AETNA ACO WILCO [101532]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MULTIPLAN [1680]|HMA [168003]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MULTIPLAN [1680]|HMA [168003]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|AETNA [1015]|AETNA ACO WILCO [101532]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CORESOURCE [1315]|CORESOURCE [131500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|CORESOURCE [1315]|CORESOURCE [131500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|GEHA [1415]|GEHA [141500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|GEHA [1415]|GEHA [141500]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.15||||58.15|52.34|52.34|12.21 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.15||||58.15||| 106249|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 3.5 MG/G-POLYMYXIN B 10,000 UNIT/G-DEXAMETH 0.1 % EYE OINT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.15||||58.15||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|GEHA [1415]|GEHA [141500]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|||109.40||||109.40|32.82|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109.40||||109.40|71.11|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109.40||||109.40|22.97|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109.40||||109.40|12.83|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|UMR [2035]|UMR OPTIONS [203501]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109.40||||109.40|47.04|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MULTIPLAN [1680]|HMA [168003]|109.40||||109.40|38.29|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109.40||||109.40|52.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|109.40||||109.40|82.05|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109.40||||109.40|65.64|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109.40||||109.40|47.04|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|109.40||||109.40|46.6|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|109.40||||109.40|54.81|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109.40||||109.40|38.4|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109.40||||109.40|98.46|98.46|12.83 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109.40||||109.40||| 106278|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIAZEPAM 5 MG/ML INJECTION SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109.40||||109.40||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.38|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.38|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.38|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.38|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|||29.00||||29.00|8.7|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|||29.00||||29.00|8.7|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|||29.00||||29.00|8.7|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|||29.00||||29.00|8.7|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.38 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|GEHA [1415]|GEHA [141500]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|28.24||||28.24|21.18|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|||28.24||||28.24|8.47|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.24||||28.24|13.54|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.24||||28.24|5.93|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.24||||28.24|12.14|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.24||||28.24|18.36|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.24||||28.24|16.94|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.24||||28.24|12.14|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28.24||||28.24|12.03|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28.24||||28.24|14.15|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.24||||28.24|9.91|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.24||||28.24|25.42|25.42|5.93 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.24||||28.24||| 106490|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DABIGATRAN ETEXILATE 75 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.24||||28.24||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.07||||38.07|19.07|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.07||||38.07|16.22|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.07||||38.07|16.22|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.07||||38.07|16.22|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.07||||38.07|13.36|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.07||||38.07|19.07|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.07||||38.07|19.07|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.07||||38.07|13.36|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.07||||38.07|13.36|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.07||||38.07|13.36|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.07||||38.07|22.84|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.07||||38.07|22.84|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.07||||38.07|22.84|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.07||||38.07|7.99|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.07||||38.07|7.99|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.07||||38.07|7.99|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.07||||38.07|7.99|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.07||||38.07|18.25|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.07||||38.07|18.25|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.07||||38.07|18.25|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.07||||38.07|18.25|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.07||||38.07|24.75|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.07||||38.07|24.75|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.07||||38.07|24.75|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.07||||38.07|24.75|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|||38.07||||38.07|11.42|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|||38.07||||38.07|11.42|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|||38.07||||38.07|11.42|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|||38.07||||38.07|11.42|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.07||||38.07|22.84|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.07||||38.07|19.07|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.07||||38.07|16.22|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.07||||38.07|16.37|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|38.07||||38.07|28.55|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|38.07||||38.07|28.55|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|38.07||||38.07|28.55|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|38.07||||38.07|28.55|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.07||||38.07|34.26|34.26|7.99 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.07||||38.07||| 10674|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MUPIROCIN 2 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.07||||38.07||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NALTREXONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.14||||58.14|25|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.14||||58.14|29.13|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.14||||58.14|20.41|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.14||||58.14|34.88|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.14||||58.14|25|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.14||||58.14|12.21|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.14||||58.14|24.77|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.14||||58.14|27.88|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.14||||58.14|37.79|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|||58.14||||58.14|17.44|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|58.14||||58.14|43.61|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|GEHA [1415]|GEHA [141500]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.14||||58.14|52.33|52.33|12.21 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MULTIPLAN [1680]|HMA [168003]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.14||||58.14||| 10708|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.14||||58.14||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|GEHA [1415]|GEHA [141500]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|38.92||||38.92|29.19|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|||38.92||||38.92|11.68|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.92||||38.92|25.3|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.92||||38.92|18.66|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.92||||38.92|8.17|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.92||||38.92|16.74|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.92||||38.92|23.35|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.92||||38.92|16.74|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.92||||38.92|16.58|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.92||||38.92|19.5|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.92||||38.92|13.66|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.92||||38.92|35.03|35.03|8.17 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.92||||38.92||| 10722|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIMODIPINE 30 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.92||||38.92||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.32||||16.32|7.02|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.32||||16.32|8.18|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.32||||16.32|7.02|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.32||||16.32|6.95|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.32||||16.32|6.95|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.32||||16.32|8.18|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.32||||16.32|5.73|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.32||||16.32|5.73|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.32||||16.32|8.18|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.32||||16.32|5.73|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.32||||16.32|9.79|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.32||||16.32|9.79|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.32||||16.32|7.02|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.32||||16.32|7.02|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.32||||16.32|7.02|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.32||||16.32|3.43|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.32||||16.32|3.43|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.32||||16.32|3.43|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.32||||16.32|7.83|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.32||||16.32|7.83|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.32||||16.32|7.83|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.32||||16.32|10.61|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.32||||16.32|10.61|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.32||||16.32|10.61|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|||16.32||||16.32|4.9|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|||16.32||||16.32|4.9|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|||16.32||||16.32|4.9|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.32||||16.32|9.79|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.32||||16.32|7.02|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.32||||16.32|6.95|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|16.32||||16.32|12.24|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|16.32||||16.32|12.24|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|16.32||||16.32|12.24|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.32||||16.32|14.69|14.69|3.43 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.32||||16.32||| 10724|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.32||||16.32||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|||10.00||||10.00|3|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10765|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAMINE 7 GRAM-CALCIUM HMB 1.5 GRAM ORAL POWDER PACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.02|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|||10.00||||10.00|3|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.02 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON HCL 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1079|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 5 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|||10.00||||10.00|3|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|||10.00||||10.00|3|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISACODYL 10 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368.30||||368.30|129.27|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368.30||||368.30|158.37|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|368.30||||368.30|184.52|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368.30||||368.30|220.98|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR OPTIONS [203501]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|368.30||||368.30|156.9|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368.30||||368.30|158.37|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|368.30||||368.30|276.23|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GEHA [1415]|GEHA [141500]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|||368.30||||368.30|110.49|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368.30||||368.30|239.4|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|368.30||||368.30|331.47|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368.30||||368.30|176.6|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368.30||||368.30|77.34|331.47|77.34 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|HMA [168003]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|368.30||||368.30||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368.30||||368.30||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|368.29||||368.29|156.89|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR OPTIONS [203501]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368.29||||368.29|158.36|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368.29||||368.29|77.34|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368.29||||368.29|220.97|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368.29||||368.29|239.39|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368.29||||368.29|176.6|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|||368.29||||368.29|110.49|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368.29||||368.29|129.27|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|368.29||||368.29|276.22|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GEHA [1415]|GEHA [141500]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368.29||||368.29|331.46|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|368.29||||368.29|184.51|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368.29||||368.29|158.36|331.46|77.34 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|HMA [168003]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|368.29||||368.29||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368.29||||368.29||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|||122.65||||122.65|36.79|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122.65||||122.65|0.85|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122.65||||122.65|52.74|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|122.65||||122.65|42.93|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|122.65||||122.65|61.45|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122.65||||122.65|52.74|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|122.65||||122.65|91.99|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122.65||||122.65|25.76|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122.65||||122.65|58.81|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122.65||||122.65|73.59|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122.65||||122.65|79.72|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122.65||||122.65|43.05|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|122.65||||122.65|52.25|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|122.65||||122.65|110.39|110.39|0.85 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122.65||||122.65||| 108119|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 500 MG/100 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|122.65||||122.65||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|1.27|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|||90.00||||90.00|27|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|1.27 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 108120|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LEVOFLOXACIN 750 MG/150 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.96||||24.96|8.76|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.96||||24.96|12.5|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.96||||24.96|10.63|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.96||||24.96|12.5|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.96||||24.96|8.76|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.96||||24.96|16.22|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|24.96||||24.96|18.72|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|24.96||||24.96|18.72|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|24.96||||24.96|18.72|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.96||||24.96|11.97|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.96||||24.96|16.22|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|24.96||||24.96|18.72|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|||24.96||||24.96|7.49|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|||24.96||||24.96|7.49|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.96||||24.96|16.22|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|||24.96||||24.96|7.49|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.96||||24.96|11.97|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.96||||24.96|16.22|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.96||||24.96|5.24|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.96||||24.96|5.24|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.96||||24.96|5.24|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.96||||24.96|5.24|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.96||||24.96|11.97|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|||24.96||||24.96|7.49|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.96||||24.96|11.97|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.96||||24.96|14.98|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.96||||24.96|14.98|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.96||||24.96|14.98|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.96||||24.96|10.63|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.96||||24.96|8.76|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.96||||24.96|12.5|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.96||||24.96|14.98|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.96||||24.96|10.63|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.96||||24.96|10.63|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.96||||24.96|10.73|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.96||||24.96|22.46|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.96||||24.96|12.5|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.96||||24.96|8.76|22.46|5.24 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|24.96||||24.96||| 10813|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.96||||24.96||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.12|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|||90.00||||90.00|27|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.12|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|||90.00||||90.00|27|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.12 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 108132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10814|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 10855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|||10.00||||10.00|3|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|||10.00||||10.00|3|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 108850|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN E (DL, ACETATE) 400 UNIT CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177.00||||177.00|88.5|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|177.00||||177.00|88.68|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|177.00||||177.00|75.4|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177.00||||177.00|62.13|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|TRUSTMARK [2030]|STARMARK [203000]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MULTIPLAN [1680]|IHC HS [168011]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|HEALTHNET [1495]|HEALTHNET [149500]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177.00||||177.00|76.11|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177.00||||177.00|106.2|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177.00||||177.00|76.11|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|UMR [2035]|UMR OPTIONS [203501]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177.00||||177.00|37.17|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177.00||||177.00|84.87|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177.00||||177.00|115.05|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|||177.00||||177.00|53.1|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|CHAMPVA [1240]|CHAMP VA [124000]|177.00||||177.00|132.75|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|CORESOURCE [1315]|CORESOURCE [131500]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|GEHA [1415]|GEHA [141500]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177.00||||177.00|159.3|159.3|37.17 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|AETNA [1015]|AETNA ACO WILCO [101532]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MULTIPLAN [1680]|HMA [168003]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|177.00||||177.00||| 109481|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PENTETATE (DTPA) PER DOSE UP TO 25MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|177.00||||177.00||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|GEHA [1415]|GEHA [141500]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|CORESOURCE [1315]|CORESOURCE [131500]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|CHAMPVA [1240]|CHAMP VA [124000]|567.12||||567.12|425.34|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|567.12||||567.12|271.93|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|567.12||||567.12|368.63|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|567.12||||567.12|243.86|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|FMH BENEFIT SERVICES [1390]|FMH [139000]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|FIRST HEALTH [1375]|QUALCHOICE [137513]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|UMR [2035]|UMR OPTIONS [203501]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MULTIPLAN [1680]|IHC HS [168011]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|HEALTHNET [1495]|HEALTHNET [149500]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|567.12||||567.12|119.1|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|567.12||||567.12|340.27|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|567.12||||567.12|199.06|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|567.12||||567.12|241.59|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|567.12||||567.12|284.13|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|567.12||||567.12|243.86|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|TRUSTMARK [2030]|STARMARK [203000]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|567.12||||567.12|510.41|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|||567.12||||567.12|170.14|510.41|119.1 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|MULTIPLAN [1680]|HMA [168003]|567.12||||567.12||| 109784|ERX|0250 - PHARMACY-GENERAL|SODIUM NITRITE-SODIUM THIOSULFATE 300 MG/10 ML-12.5 GRAM/50 ML IV SOLN|AETNA [1015]|AETNA ACO WILCO [101532]|567.12||||567.12||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11018|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 50 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|50.66||||50.66|38|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.66||||50.66|32.93|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.66||||50.66|24.29|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.66||||50.66|10.64|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.66||||50.66|8.08|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.66||||50.66|21.78|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.66||||50.66|30.4|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|||50.66||||50.66|15.2|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.66||||50.66|21.78|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.66||||50.66|25.38|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.66||||50.66|21.58|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.66||||50.66|17.78|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.66||||50.66|45.59|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|50.66||||50.66|17.73|45.59|8.08 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.66||||50.66||| 11023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.66||||50.66||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.60||||50.60|25.35|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.60||||50.60|21.56|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.60||||50.60|25.35|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.60||||50.60|17.76|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.60||||50.60|21.76|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.60||||50.60|30.36|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.60||||50.60|21.56|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.60||||50.60|30.36|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.60||||50.60|21.76|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.60||||50.60|10.63|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.60||||50.60|10.63|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.60||||50.60|32.89|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|||50.60||||50.60|15.18|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|50.60||||50.60|37.95|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|GEHA [1415]|GEHA [141500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|GEHA [1415]|GEHA [141500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.60||||50.60|17.76|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|50.60||||50.60|37.95|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|||50.60||||50.60|15.18|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.60||||50.60|24.26|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.60||||50.60|32.89|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.60||||50.60|24.26|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.60||||50.60|21.76|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.60||||50.60|21.76|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.60||||50.60|45.54|45.54|10.63 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.60||||50.60||| 110250|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.60||||50.60||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|27.71||||27.71|20.78|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|GEHA [1415]|GEHA [141500]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|||27.71||||27.71|8.31|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.71||||27.71|18.01|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.71||||27.71|13.29|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.71||||27.71|5.82|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.71||||27.71|11.92|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.71||||27.71|16.63|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.71||||27.71|11.92|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.71||||27.71|13.88|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.71||||27.71|11.8|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.71||||27.71|9.73|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.71||||27.71|24.94|24.94|5.82 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MULTIPLAN [1680]|HMA [168003]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.71||||27.71||| 110427|ERX|0250 - PHARMACY-GENERAL|TICAGRELOR 90 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.71||||27.71||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.8|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|||90.00||||90.00|27|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.8 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 11074|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|POTASSIUM CHLORIDE 10 MEQ/100ML IN STERILE WATER INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|||90.00||||90.00|27|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|1.59|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|1.59 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 11081|ERX|0258 - PHARMACY-IV SOLUTIONS|POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM CHLORIDE INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85.28||||85.28|36.67|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85.28||||85.28|42.73|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85.28||||85.28|29.93|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85.28||||85.28|51.17|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|TRUSTMARK [2030]|STARMARK [203000]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|HEALTHNET [1495]|HEALTHNET [149500]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|HMA [168003]|85.28||||85.28|29.85|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|IHC HS [168011]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85.28||||85.28|36.67|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|UMR [2035]|UMR OPTIONS [203501]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85.28||||85.28|18.32|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85.28||||85.28|17.91|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85.28||||85.28|40.89|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85.28||||85.28|55.43|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85.28||||85.28|36.33|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|||85.28||||85.28|25.58|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|CHAMPVA [1240]|CHAMP VA [124000]|85.28||||85.28|63.96|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|CORESOURCE [1315]|CORESOURCE [131500]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|GEHA [1415]|GEHA [141500]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85.28||||85.28|76.75|76.75|17.91 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85.28||||85.28||| 11117|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISOLONE 15 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85.28||||85.28||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|||10.00||||10.00|3|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 111196|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS GLUCONATE 324 MG (37.5 MG IRON) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11129|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|41.24||||41.24|30.93|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|||41.24||||41.24|12.37|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.24||||41.24|26.81|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.24||||41.24|19.77|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.24||||41.24|8.66|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.24||||41.24|17.73|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.24||||41.24|24.74|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.24||||41.24|17.73|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.24||||41.24|20.66|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.24||||41.24|17.57|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.24||||41.24|14.48|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.24||||41.24|37.12|37.12|8.66 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.24||||41.24||| 11143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.24||||41.24||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSYLLIUM HUSK (ASPARTAME) 3.4 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|||10.00||||10.00|3|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11239|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOSTIGMINE BROMIDE 60 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|GEHA [1415]|GEHA [141500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|GEHA [1415]|GEHA [141500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|71.16||||71.16|53.37|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|||71.16||||71.16|21.35|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|||71.16||||71.16|21.35|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71.16||||71.16|46.25|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71.16||||71.16|46.25|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71.16||||71.16|34.12|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71.16||||71.16|14.94|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71.16||||71.16|14.94|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71.16||||71.16|30.6|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71.16||||71.16|30.6|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71.16||||71.16|34.12|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71.16||||71.16|42.7|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71.16||||71.16|42.7|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71.16||||71.16|30.6|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71.16||||71.16|35.65|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71.16||||71.16|30.31|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71.16||||71.16|30.6|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71.16||||71.16|35.65|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71.16||||71.16|30.31|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|71.16||||71.16|53.37|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71.16||||71.16|24.98|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71.16||||71.16|24.98|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71.16||||71.16|64.04|64.04|14.94 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71.16||||71.16||| 112703|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOBAZAM 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71.16||||71.16||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.60||||50.60|21.76|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.60||||50.60|25.35|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.60||||50.60|17.76|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.60||||50.60|21.56|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.60||||50.60|30.36|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.60||||50.60|21.76|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.60||||50.60|10.63|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.60||||50.60|24.26|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.60||||50.60|32.89|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|||50.60||||50.60|15.18|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|50.60||||50.60|37.95|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|GEHA [1415]|GEHA [141500]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.60||||50.60|45.54|45.54|10.63 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.60||||50.60||| 112834|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVAROXABAN 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.60||||50.60||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|||10.00||||10.00|3|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|||10.00||||10.00|3|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 150 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIFAMPIN 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|||10.00||||10.00|3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|||10.00||||10.00|3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|||10.00||||10.00|3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|||10.00||||10.00|3|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 113082|ERX|0250 - PHARMACY-GENERAL|RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|GEHA [1415]|GEHA [141500]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|CHAMPVA [1240]|CHAMP VA [124000]|2091.00||||2091.00|1568.25|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|||2091.00||||2091.00|627.3|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2091.00||||2091.00|1359.15|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2091.00||||2091.00|1002.63|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2091.00||||2091.00|439.11|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|UMR [2035]|UMR OPTIONS [203501]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2091.00||||2091.00|899.13|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MULTIPLAN [1680]|HMA [168003]|2091.00||||2091.00|731.85|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MULTIPLAN [1680]|IHC HS [168011]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|HEALTHNET [1495]|HEALTHNET [149500]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|TRUSTMARK [2030]|STARMARK [203000]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|CORESOURCE [1315]|CORESOURCE [131500]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2091.00||||2091.00|1254.6|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2091.00||||2091.00|899.13|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2091.00||||2091.00|1047.59|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2091.00||||2091.00|890.77|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2091.00||||2091.00|733.94|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2091.00||||2091.00|1045.5|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2091.00||||2091.00|1881.9|1881.9|439.11 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|AETNA [1015]|AETNA ACO WILCO [101532]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2091.00||||2091.00||| 113146|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN111 PENTETATE (DTPA) PER 0.5MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2091.00||||2091.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|||10.00||||10.00|3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|||10.00||||10.00|3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|||10.00||||10.00|3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|||10.00||||10.00|3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|||10.00||||10.00|3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|||10.00||||10.00|3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11349|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|||10.00||||10.00|3|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|||10.00||||10.00|3|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11351|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|||138.18||||138.18|41.45|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138.18||||138.18|69.23|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138.18||||138.18|89.82|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138.18||||138.18|82.91|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138.18||||138.18|29.02|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138.18||||138.18|48.5|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138.18||||138.18|58.86|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138.18||||138.18|59.42|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|GEHA [1415]|GEHA [141500]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138.18||||138.18|59.42|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138.18||||138.18|66.26|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|138.18||||138.18|103.64|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138.18||||138.18|124.36|124.36|29.02 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138.18||||138.18||| 113587|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LURASIDONE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138.18||||138.18||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|||10.00||||10.00|3|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11359|ERX|0250 - PHARMACY-GENERAL|SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|||10.00||||10.00|3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|||10.00||||10.00|3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|||10.00||||10.00|3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMVASTATIN 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|282.81||||282.81|121.61|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|282.81||||282.81|141.69|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|282.81||||282.81|99.27|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|282.81||||282.81|169.69|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|282.81||||282.81|98.98|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|282.81||||282.81|122.61|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|282.81||||282.81|59.39|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|||282.81||||282.81|84.84|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|282.81||||282.81|212.11|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|282.81||||282.81|183.83|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|282.81||||282.81|120.48|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|282.81||||282.81|121.61|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|282.81||||282.81|254.53|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|282.81||||282.81|135.61|254.53|59.39 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|282.81||||282.81||| 11368|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SINCALIDE 5 MCG SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|282.81||||282.81||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|||13.45||||13.45|4.03|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.45||||13.45|8.74|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.45||||13.45|6.45|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.45||||13.45|2.82|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.45||||13.45|2.82|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.45||||13.45|5.78|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.45||||13.45|5.78|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.45||||13.45|8.07|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.45||||13.45|8.07|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.45||||13.45|5.78|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.45||||13.45|5.78|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.45||||13.45|6.74|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.45||||13.45|5.73|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.45||||13.45|5.73|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.45||||13.45|6.74|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.45||||13.45|4.72|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.45||||13.45|4.72|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.45||||13.45|6.45|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|||13.45||||13.45|4.03|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.45||||13.45|8.74|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|13.45||||13.45|10.09|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|13.45||||13.45|10.09|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|GEHA [1415]|GEHA [141500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|GEHA [1415]|GEHA [141500]|13.45||||13.45|12.11|12.11|2.82 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.45||||13.45||| 11384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAMPHOR-MENTHOL-PHENOL TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.45||||13.45||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|142.38||||142.38|71.33|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|142.38||||142.38|60.65|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142.38||||142.38|85.43|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|142.38||||142.38|49.83|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142.38||||142.38|61.22|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142.38||||142.38|4.11|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142.38||||142.38|29.9|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142.38||||142.38|49.98|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142.38||||142.38|68.27|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142.38||||142.38|92.55|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142.38||||142.38|61.22|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|||142.38||||142.38|42.71|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|142.38||||142.38|106.79|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|142.38||||142.38|128.14|128.14|4.11 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|142.38||||142.38||| 113850|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/50 ML IN DEXTROSE (ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|142.38||||142.38||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|||10.00||||10.00|3|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11395|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|10.75|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|10.75|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|||25.00||||25.00|7.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|22.5|5.25 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 11403|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|||10.00||||10.00|3|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 114073|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT IN PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|||10.00||||10.00|3|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SOTALOL 80 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.93||||19.93|9.98|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.93||||19.93|7|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.93||||19.93|8.49|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.93||||19.93|11.96|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.93||||19.93|8.57|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.93||||19.93|4.19|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.93||||19.93|9.56|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.93||||19.93|8.57|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.93||||19.93|12.95|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|||19.93||||19.93|5.98|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|19.93||||19.93|14.95|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|19.93||||19.93|17.94|17.94|4.19 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.93||||19.93||| 11441|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 100 MG/ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.93||||19.93||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|||10.00||||10.00|3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|||10.00||||10.00|3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|||10.00||||10.00|3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11442|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUCRALFATE 1 GRAM TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.82||||14.82|6.37|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.82||||14.82|7.42|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.82||||14.82|5.2|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.82||||14.82|8.89|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.82||||14.82|6.37|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.82||||14.82|3.11|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.82||||14.82|6.31|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.82||||14.82|7.11|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.82||||14.82|9.63|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|||14.82||||14.82|4.45|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|14.82||||14.82|11.12|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.82||||14.82|13.34|13.34|3.11 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.82||||14.82||| 11500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 7.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.82||||14.82||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|GEHA [1415]|GEHA [141500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|GEHA [1415]|GEHA [141500]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|GEHA [1415]|GEHA [141500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|50.10||||50.10|37.58|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|21.87||||21.87|16.4|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|21.87||||21.87|16.4|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|||21.87||||21.87|6.56|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|||21.87||||21.87|6.56|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.87||||21.87|14.22|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.10||||50.10|32.57|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.87||||21.87|14.22|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.87||||21.87|10.49|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.87||||21.87|10.49|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.87||||21.87|4.59|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.10||||50.10|10.52|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.10||||50.10|21.54|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.87||||21.87|9.4|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.87||||21.87|9.4|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.87||||21.87|4.59|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.10||||50.10|24.02|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|||50.10||||50.10|15.03|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.10||||50.10|30.06|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.87||||21.87|13.12|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.87||||21.87|13.12|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.10||||50.10|21.54|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.10||||50.10|25.1|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.10||||50.10|21.34|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.87||||21.87|9.32|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.87||||21.87|9.32|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.87||||21.87|10.96|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.87||||21.87|9.4|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.87||||21.87|7.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.87||||21.87|10.96|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.87||||21.87|9.4|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.87||||21.87|7.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.10||||50.10|17.59|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.10||||50.10|45.09|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.87||||21.87|19.68|45.09|4.59 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.10||||50.10||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.87||||21.87||| 11561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.25 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.10||||50.10||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.58||||52.58|18.46|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.58||||52.58|18.46|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.58||||52.58|26.34|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.58||||52.58|22.4|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.58||||52.58|22.4|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.58||||52.58|22.4|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.58||||52.58|22.4|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.58||||52.58|26.34|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.58||||52.58|26.34|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.58||||52.58|26.34|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.58||||52.58|18.46|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.58||||52.58|26.34|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.58||||52.58|18.46|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.58||||52.58|31.55|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.58||||52.58|31.55|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.58||||52.58|31.55|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.58||||52.58|31.55|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.58||||52.58|11.04|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.58||||52.58|11.04|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.58||||52.58|11.04|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.58||||52.58|11.04|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.58||||52.58|11.04|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.58||||52.58|25.21|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.58||||52.58|25.21|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.58||||52.58|25.21|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.58||||52.58|25.21|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.58||||52.58|25.21|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.58||||52.58|34.18|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.58||||52.58|34.18|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.58||||52.58|34.18|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.58||||52.58|34.18|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.58||||52.58|34.18|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|||52.58||||52.58|15.77|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|||52.58||||52.58|15.77|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|||52.58||||52.58|15.77|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|||52.58||||52.58|15.77|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|||52.58||||52.58|15.77|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.58||||52.58|31.55|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.58||||52.58|18.46|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.58||||52.58|22.4|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.58||||52.58|22.61|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|52.58||||52.58|39.44|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|52.58||||52.58|39.44|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|52.58||||52.58|39.44|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|52.58||||52.58|39.44|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|52.58||||52.58|39.44|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.58||||52.58|47.32|47.32|11.04 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.58||||52.58||| 11562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIMOLOL MALEATE 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.58||||52.58||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|||10.00||||10.00|3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|||10.00||||10.00|3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|||10.00||||10.00|3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11599|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.19||||25.19|8.84|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.19||||25.19|10.83|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.19||||25.19|12.62|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.19||||25.19|10.73|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.19||||25.19|15.11|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.19||||25.19|10.83|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.19||||25.19|5.29|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.19||||25.19|12.08|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.19||||25.19|16.37|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|||25.19||||25.19|7.56|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|25.19||||25.19|18.89|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.19||||25.19|22.67|22.67|5.29 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.19||||25.19||| 11624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|URSODIOL 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.19||||25.19||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|594.92||||594.92|446.19|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|594.92||||594.92|446.19|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|||594.92||||594.92|178.48|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|594.92||||594.92|386.7|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|594.92||||594.92|386.7|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|594.92||||594.92|285.26|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|594.92||||594.92|285.26|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|594.92||||594.92|124.93|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|594.92||||594.92|58.72|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|594.92||||594.92|58.72|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|594.92||||594.92|255.82|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|594.92||||594.92|255.82|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|594.92||||594.92|208.22|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|594.92||||594.92|208.22|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|594.92||||594.92|124.93|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|||594.92||||594.92|178.48|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|594.92||||594.92|356.95|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|594.92||||594.92|356.95|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|594.92||||594.92|255.82|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|594.92||||594.92|298.05|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|594.92||||594.92|253.44|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|594.92||||594.92|255.82|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|594.92||||594.92|298.05|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|594.92||||594.92|253.44|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|594.92||||594.92|208.82|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|594.92||||594.92|208.82|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|594.92||||594.92|535.43|535.43|58.72 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|594.92||||594.92||| 11627|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 10 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|594.92||||594.92||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|||10.00||||10.00|3|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|||29.00||||29.00|8.7|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|||29.00||||29.00|8.7|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|||29.00||||29.00|8.7|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|||29.00||||29.00|8.7|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|||29.00||||29.00|8.7|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|||29.00||||29.00|8.7|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 11671|ERX|0250 - PHARMACY-GENERAL|WATER FOR INJECTION, STERILE INJECTION SOLUTION *VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|955.26||||955.26|406.94|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|955.26||||955.26|335.3|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|955.26||||955.26|410.76|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|955.26||||955.26|478.59|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|TRUSTMARK [2030]|STARMARK [203000]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MULTIPLAN [1680]|IHC HS [168011]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|HEALTHNET [1495]|HEALTHNET [149500]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|955.26||||955.26|410.76|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|UMR [2035]|UMR OPTIONS [203501]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|955.26||||955.26|200.6|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|955.26||||955.26|573.16|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|955.26||||955.26|458.05|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|955.26||||955.26|620.92|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|||955.26||||955.26|286.58|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|CHAMPVA [1240]|CHAMP VA [124000]|955.26||||955.26|716.45|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|CORESOURCE [1315]|CORESOURCE [131500]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|GEHA [1415]|GEHA [141500]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|955.26||||955.26|859.73|859.73|200.6 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|AETNA [1015]|AETNA ACO WILCO [101532]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MULTIPLAN [1680]|HMA [168003]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|955.26||||955.26||| 116728|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IPRATROPIUM 20 MCG-ALBUTEROL 100 MCG/ACTUATION MIST FOR INHALATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|955.26||||955.26||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|||10.00||||10.00|3|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|||10.00||||10.00|3|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZOLPIDEM 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|||3637.00||||3637.00|1091.1|1091.1|1091.1 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|AETNA [1015]|AETNA ACO WILCO [101532]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|HEALTHNET [1495]|HEALTHNET [149500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MULTIPLAN [1680]|IHC HS [168011]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|FMH BENEFIT SERVICES [1390]|FMH [139000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|FIRST HEALTH [1375]|QUALCHOICE [137513]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MULTIPLAN [1680]|HMA [168003]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|TRUSTMARK [2030]|STARMARK [203000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|UMR [2035]|UMR OPTIONS [203501]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|CHAMPVA [1240]|CHAMP VA [124000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|CORESOURCE [1315]|CORESOURCE [131500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|GEHA [1415]|GEHA [141500]|3637.00||||3637.00||| 11800000|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE ROOM REHAB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3637.00||||3637.00||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|||4000.70||||4000.70|1200.21|1200.21|1200.21 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|GEHA [1415]|GEHA [141500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|CORESOURCE [1315]|CORESOURCE [131500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|CHAMPVA [1240]|CHAMP VA [124000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|UMR [2035]|UMR OPTIONS [203501]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|FIRST HEALTH [1375]|QUALCHOICE [137513]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|FMH BENEFIT SERVICES [1390]|FMH [139000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MULTIPLAN [1680]|IHC HS [168011]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MULTIPLAN [1680]|HMA [168003]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|HEALTHNET [1495]|HEALTHNET [149500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|AETNA [1015]|AETNA ACO WILCO [101532]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|TRUSTMARK [2030]|STARMARK [203000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4000.70||||4000.70||| 11800001|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/ATTEND REHAB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4000.70||||4000.70||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|||4400.77||||4400.77|1320.23|1320.23|1320.23 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|TRUSTMARK [2030]|STARMARK [203000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|AETNA [1015]|AETNA ACO WILCO [101532]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MULTIPLAN [1680]|IHC HS [168011]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MULTIPLAN [1680]|HMA [168003]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|FMH BENEFIT SERVICES [1390]|FMH [139000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|FIRST HEALTH [1375]|QUALCHOICE [137513]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|HEALTHNET [1495]|HEALTHNET [149500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|UMR [2035]|UMR OPTIONS [203501]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|CHAMPVA [1240]|CHAMP VA [124000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|CORESOURCE [1315]|CORESOURCE [131500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|GEHA [1415]|GEHA [141500]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4400.77||||4400.77||| 11800002|EAP|0118 - ROOM & BOARD-PRIVATE (ONE BED)-REHABILITATI|HC PRIVATE W/SPEC BED REHAB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4400.77||||4400.77||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 119007|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 30 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33.20||||33.20|21.58|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33.20||||33.20|6.97|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33.20||||33.20|11.65|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33.20||||33.20|16.63|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.20||||33.20|15.92|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.20||||33.20|14.28|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33.20||||33.20|19.92|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|||33.20||||33.20|9.96|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33.20||||33.20|14.14|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.20||||33.20|24.9|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33.20||||33.20|29.88|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33.20||||33.20|14.28|29.88|6.97 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33.20||||33.20||| 119040|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33.20||||33.20||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68.25||||68.25|44.36|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|176.00||||176.00|88.18|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|176.00||||176.00|74.98|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68.25||||68.25|40.95|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176.00||||176.00|84.39|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|||68.25||||68.25|20.47|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176.00||||176.00|105.6|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68.25||||68.25|29.07|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176.00||||176.00|36.96|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68.25||||68.25|14.33|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68.25||||68.25|29.35|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176.00||||176.00|75.68|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68.25||||68.25|34.19|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176.00||||176.00|114.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68.25||||68.25|32.73|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|176.00||||176.00|132|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|||176.00||||176.00|52.8|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176.00||||176.00|75.68|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68.25||||68.25|23.96|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68.25||||68.25|29.35|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|68.25||||68.25|61.43|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|68.25||||68.25|51.19|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176.00||||176.00||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176.00||||176.00|61.78|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|176.00||||176.00|158.4|158.4|14.33 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68.25||||68.25||| 119135|ERX|0250 - PHARMACY-GENERAL|GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176.00||||176.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 119246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 15 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.46||||19.46|6.83|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.46||||19.46|9.33|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|19.46||||19.46|14.6|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.46||||19.46|11.68|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.46||||19.46|8.29|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.46||||19.46|8.37|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.46||||19.46|9.75|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.46||||19.46|4.09|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.46||||19.46|12.65|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|||19.46||||19.46|5.84|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.46||||19.46|17.51|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.46||||19.46|8.37|17.51|4.09 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.46||||19.46||| 119248|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE ER 100 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.46||||19.46||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.20||||33.20|14.28|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33.20||||33.20|6.97|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.20||||33.20|15.92|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.20||||33.20|15.92|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|||33.20||||33.20|9.96|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.20||||33.20|24.9|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|GEHA [1415]|GEHA [141500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.20||||33.20|14.28|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|||33.20||||33.20|9.96|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33.20||||33.20|21.58|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33.20||||33.20|21.58|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.20||||33.20|24.9|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33.20||||33.20|6.97|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33.20||||33.20|19.92|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|GEHA [1415]|GEHA [141500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33.20||||33.20|11.65|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33.20||||33.20|14.14|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33.20||||33.20|14.28|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33.20||||33.20|19.92|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33.20||||33.20|14.14|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33.20||||33.20|16.63|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33.20||||33.20|11.65|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33.20||||33.20|16.63|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33.20||||33.20|14.28|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33.20||||33.20|29.88|29.88|6.97 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33.20||||33.20||| 119614|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|APIXABAN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33.20||||33.20||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|185.40||||185.40|139.05|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|449.01||||449.01|336.76|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|307.82||||307.82|230.87|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|185.40||||185.40|120.51|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|||449.01||||449.01|134.7|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|||307.82||||307.82|92.35|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|449.01||||449.01|291.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|185.40||||185.40|38.93|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|449.01||||449.01|215.3|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|185.40||||185.40|88.9|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|185.40||||185.40|79.72|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|185.40||||185.40|5.3|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|307.82||||307.82|10.6|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|307.82||||307.82|147.6|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|||185.40||||185.40|55.62|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|307.82||||307.82|64.64|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|449.01||||449.01|193.07|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|307.82||||307.82|132.36|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|307.82||||307.82|200.08|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|449.01||||449.01|15.9|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|449.01||||449.01|94.29|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|307.82||||307.82|131.13|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|449.01||||449.01|191.28|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|185.40||||185.40|92.89|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|307.82||||307.82|108.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|185.40||||185.40|78.98|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|185.40||||185.40|92.7|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|449.01||||449.01|224.51|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|185.40||||185.40|111.24|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|449.01||||449.01|224.95|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|307.82||||307.82|184.69|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|449.01||||449.01|193.07|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|449.01||||449.01|269.41|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|307.82||||307.82|153.91|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|185.40||||185.40|65.08|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|307.82||||307.82|132.36|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|185.40||||185.40|79.72|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|449.01||||449.01|157.6|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|449.01||||449.01|404.11|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|307.82||||307.82|154.22|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|307.82||||307.82|277.04|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|185.40||||185.40|166.86|404.11|5.3 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|307.82||||307.82||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|449.01||||449.01||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|185.40||||185.40||| 119842|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|185.40||||185.40||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156.80||||156.80|94.08|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156.80||||156.80|67.42|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156.80||||156.80|55.04|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|156.80||||156.80|66.8|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|||156.80||||156.80|47.04|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156.80||||156.80|67.42|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156.80||||156.80|18.02|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156.80||||156.80|32.93|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156.80||||156.80|75.19|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156.80||||156.80|101.92|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|156.80||||156.80|78.56|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156.80||||156.80|78.4|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|156.80||||156.80|117.6|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|156.80||||156.80|141.12|141.12|18.02 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|156.80||||156.80||| 119843|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156.80||||156.80||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12025|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MECLIZINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|||10.00||||10.00|3|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12098|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|60.60||||60.60|45.45|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|||60.60||||60.60|18.18|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.60||||60.60|39.39|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.60||||60.60|12.73|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.60||||60.60|26.06|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.60||||60.60|29.06|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.60||||60.60|26.06|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.60||||60.60|54.54|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.60||||60.60|36.36|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60.60||||60.60|25.82|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.60||||60.60|21.27|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60.60||||60.60|30.36|54.54|12.73 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.60||||60.60||| 121739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.60||||60.60||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 121938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|GEHA [1415]|GEHA [141500]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CHAMPVA [1240]|CHAMP VA [124000]|381.92||||381.92|286.44|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|||381.92||||381.92|114.58|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|381.92||||381.92|248.25|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|381.92||||381.92|183.13|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|381.92||||381.92|164.23|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|381.92||||381.92|191.34|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|381.92||||381.92|162.7|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|381.92||||381.92|134.05|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|381.92||||381.92|229.15|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|TRUSTMARK [2030]|STARMARK [203000]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CORESOURCE [1315]|CORESOURCE [131500]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MULTIPLAN [1680]|IHC HS [168011]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|381.92||||381.92|164.23|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UMR [2035]|UMR OPTIONS [203501]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|381.92||||381.92|80.2|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHNET [1495]|HEALTHNET [149500]|381.92||||381.92|343.73|343.73|80.2 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA [1015]|AETNA ACO WILCO [101532]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MULTIPLAN [1680]|HMA [168003]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|381.92||||381.92||| 122009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|381.92||||381.92||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|||10.00||||10.00|3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|||10.00||||10.00|3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|||10.00||||10.00|3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12207|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE 37.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|777.00||||777.00|388.5|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|777.00||||777.00|389.28|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|TRUSTMARK [2030]|STARMARK [203000]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|777.00||||777.00|202.65|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|777.00||||777.00|334.11|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|777.00||||777.00|181.98|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|777.00||||777.00|163.17|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|777.00||||777.00|505.05|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|||777.00||||777.00|233.1|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|777.00||||777.00|146.41|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|777.00||||777.00|159.17|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|777.00||||777.00|202.65|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|CORESOURCE [1315]|CORESOURCE [131500]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|777.00||||777.00|372.57|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|CHAMPVA [1240]|CHAMP VA [124000]|777.00||||777.00|582.75|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|GEHA [1415]|GEHA [141500]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|777.00||||777.00|165.44|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|777.00||||777.00|205.8|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|UMR [2035]|UMR OPTIONS [203501]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|777.00||||777.00|143.78|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MULTIPLAN [1680]|HMA [168003]|777.00||||777.00|271.95|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MULTIPLAN [1680]|IHC HS [168011]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|HEALTHNET [1495]|HEALTHNET [149500]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|777.00||||777.00|153.73|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|777.00||||777.00|155.06|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|777.00||||777.00|159.17|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|777.00||||777.00|272.73|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|777.00||||777.00|331|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|777.00||||777.00|334.11|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|777.00||||777.00|148.01|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|777.00||||777.00|466.2|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|777.00||||777.00|155.06|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|777.00||||777.00|140.96|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|777.00||||777.00|699.3|699.3|140.96 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|777.00||||777.00||| 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|AETNA [1015]|AETNA ACO WILCO [101532]|777.00||||777.00||| 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|777.00||||777.00||| 122091|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO RA223 RADIUM DICHLORIDE (XOFIGO) PER UCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|777.00||||777.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|GEHA [1415]|GEHA [141500]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|46.53||||46.53|34.9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.53||||46.53|30.24|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.53||||46.53|22.31|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|||10.00||||10.00|3|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.53||||46.53|9.77|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.53||||46.53|20.01|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|||46.53||||46.53|13.96|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.53||||46.53|20.01|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.53||||46.53|16.33|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.53||||46.53|19.82|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.53||||46.53|23.31|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.53||||46.53|27.92|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.53||||46.53|41.88|41.88|2.1 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.53||||46.53||| 122165|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % VISCOUS MUCOSAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|||29.00||||29.00|8.7|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 122284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CHAMPVA [1240]|CHAMP VA [124000]|18.36||||18.36|13.77|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CORESOURCE [1315]|CORESOURCE [131500]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|||18.36||||18.36|5.51|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.36||||18.36|11.93|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.36||||18.36|8.8|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.36||||18.36|3.86|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UMR [2035]|UMR OPTIONS [203501]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|IHC HS [168011]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHNET [1495]|HEALTHNET [149500]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|TRUSTMARK [2030]|STARMARK [203000]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.36||||18.36|6.44|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|GEHA [1415]|GEHA [141500]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.36||||18.36|11.02|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.36||||18.36|7.89|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.36||||18.36|7.82|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.36||||18.36|9.2|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.36||||18.36|7.89|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.36||||18.36|16.52|16.52|3.86 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|HMA [168003]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.36||||18.36||| 122363|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.36||||18.36||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.20||||34.20|20.52|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.20||||34.20|14.71|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.20||||34.20|12|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.20||||34.20|17.13|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHNET [1495]|HEALTHNET [149500]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|IHC HS [168011]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.20||||34.20|14.71|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|TRUSTMARK [2030]|STARMARK [203000]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UMR [2035]|UMR OPTIONS [203501]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.20||||34.20|7.18|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.20||||34.20|14.57|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.20||||34.20|16.4|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.20||||34.20|22.23|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|||34.20||||34.20|10.26|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CORESOURCE [1315]|CORESOURCE [131500]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CHAMPVA [1240]|CHAMP VA [124000]|34.20||||34.20|25.65|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|GEHA [1415]|GEHA [141500]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.20||||34.20|30.78|30.78|7.18 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|HMA [168003]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.20||||34.20||| 122366|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.20||||34.20||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|GEHA [1415]|GEHA [141500]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|142.64||||142.64|106.98|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|||142.64||||142.64|42.79|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142.64||||142.64|92.72|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142.64||||142.64|29.95|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142.64||||142.64|61.34|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|UMR [2035]|UMR OPTIONS [203501]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142.64||||142.64|68.4|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|142.64||||142.64|60.76|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142.64||||142.64|61.34|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142.64||||142.64|50.07|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|142.64||||142.64|71.46|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142.64||||142.64|85.58|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142.64||||142.64|128.38|128.38|29.95 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MULTIPLAN [1680]|HMA [168003]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142.64||||142.64||| 123|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACETYLCYSTEINE 200 MG/ML (20 %) PO/NEB SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142.64||||142.64||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.11|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.53|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|||29.00||||29.00|8.7|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|||29.00||||29.00|8.7|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.11 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 123657|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN LOCK FLUSH (PORCINE) 100 UNIT/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|||10.00||||10.00|3|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|||10.00||||10.00|3|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 123751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE-ASPARTAME 4 GRAM ORAL POWDER FOR SUSP IN A PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|||10.00||||10.00|3|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 124729|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|18.52||||18.52|13.89|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.52||||18.52|12.04|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.52||||18.52|8.88|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.52||||18.52|3.89|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|UMR [2035]|UMR OPTIONS [203501]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.52||||18.52|7.96|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|||18.52||||18.52|5.56|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.52||||18.52|7.96|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.52||||18.52|9.28|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.52||||18.52|6.5|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|GEHA [1415]|GEHA [141500]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.52||||18.52|7.89|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.52||||18.52|11.11|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.52||||18.52|16.67|16.67|3.89 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MULTIPLAN [1680]|HMA [168003]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.52||||18.52||| 124751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE-ALOE VERA NASAL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.52||||18.52||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.37||||10.37|6.22|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.37||||10.37|6.22|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.37||||10.37|5.2|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.37||||10.37|4.42|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.37||||10.37|3.64|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.37||||10.37|4.46|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.37||||10.37|4.42|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.37||||10.37|5.2|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.37||||10.37|4.46|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.37||||10.37|4.46|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.37||||10.37|2.18|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.37||||10.37|2.18|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.37||||10.37|4.97|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.37||||10.37|4.97|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.37||||10.37|6.74|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.37||||10.37|6.74|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|||10.37||||10.37|3.11|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|||10.37||||10.37|3.11|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.37||||10.37|3.64|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.37||||10.37|4.46|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|10.37||||10.37|7.78|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|10.37||||10.37|7.78|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|GEHA [1415]|GEHA [141500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|GEHA [1415]|GEHA [141500]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.37||||10.37|9.33|9.33|2.18 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.37||||10.37||| 124764|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.37||||10.37||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|18.47||||18.47|13.85|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|48.02||||48.02|36.02|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|||48.02||||48.02|14.41|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|||10.00||||10.00|3|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|||18.47||||18.47|5.54|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.47||||18.47|12.01|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.02||||48.02|31.21|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.47||||18.47|8.86|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.47||||18.47|3.88|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.02||||48.02|10.08|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.47||||18.47|7.94|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.02||||48.02|20.65|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.02||||48.02|23.03|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.47||||18.47|9.25|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.47||||18.47|7.87|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48.02||||48.02|24.06|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48.02||||48.02|20.46|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.47||||18.47|6.48|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.47||||18.47|7.94|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.02||||48.02|16.86|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.02||||48.02|20.65|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.47||||18.47|11.08|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.02||||48.02|28.81|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.02||||48.02|24.01|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.47||||18.47|9.24|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.02||||48.02|43.22|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.47||||18.47|16.62|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|43.22|2.1 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.02||||48.02||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.47||||18.47||| 12556|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.02||||48.02||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|||90.00||||90.00|27|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 125739|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS PIGGYBACK *MINI-BAG*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|||10.00||||10.00|3|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12580|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.57||||18.57|7.99|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.57||||18.57|9.3|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.57||||18.57|7.91|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.57||||18.57|7.99|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.57||||18.57|3.9|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.57||||18.57|6.52|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.57||||18.57|11.14|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.57||||18.57|8.9|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.57||||18.57|12.07|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|||18.57||||18.57|5.57|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|18.57||||18.57|13.93|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.57||||18.57|16.71|16.71|3.9 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.57||||18.57||| 125841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE-ALOE VERA 10 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.57||||18.57||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|||10.00||||10.00|3|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|||10.00||||10.00|3|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 125976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|||29.00||||29.00|8.7|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 126165|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DOXERCALCIFEROL 2 MCG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 126194|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|||29.00||||29.00|8.7|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 126225|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 100 MG/ML INTRAMUSCULAR OIL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|GEHA [1415]|GEHA [141500]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|CHAMPVA [1240]|CHAMP VA [124000]|80.00||||80.00|60|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|CORESOURCE [1315]|CORESOURCE [131500]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|||80.00||||80.00|24|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80.00||||80.00|52|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80.00||||80.00|38.36|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|UMR [2035]|UMR OPTIONS [203501]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80.00||||80.00|34.4|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|FIRST HEALTH [1375]|QUALCHOICE [137513]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|FMH BENEFIT SERVICES [1390]|FMH [139000]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MULTIPLAN [1680]|IHC HS [168011]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80.00||||80.00|16.8|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|HEALTHNET [1495]|HEALTHNET [149500]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|TRUSTMARK [2030]|STARMARK [203000]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80.00||||80.00|34.4|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|80.00||||80.00|40.08|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|80.00||||80.00|34.08|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80.00||||80.00|28.08|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80.00||||80.00|48|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80.00||||80.00|72|72|16.8 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MULTIPLAN [1680]|HMA [168003]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|AETNA [1015]|AETNA ACO WILCO [101532]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80.00||||80.00||| 126226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80.00||||80.00||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.75||||57.75|34.65|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.75||||57.75|28.93|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.75||||57.75|24.6|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.75||||57.75|20.27|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|57.75||||57.75|20.21|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.75||||57.75|24.83|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.75||||57.75|9.33|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.75||||57.75|12.13|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.75||||57.75|24.83|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.75||||57.75|27.69|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.75||||57.75|37.54|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|||57.75||||57.75|17.32|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|57.75||||57.75|43.31|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.75||||57.75|51.98|51.98|9.33 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.75||||57.75||| 126504|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.75||||57.75||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|GEHA [1415]|GEHA [141500]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|CORESOURCE [1315]|CORESOURCE [131500]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|||10.61||||10.61|3.18|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.61||||10.61|6.9|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.61||||10.61|5.09|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.61||||10.61|2.23|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|UMR [2035]|UMR OPTIONS [203501]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.61||||10.61|4.56|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MULTIPLAN [1680]|IHC HS [168011]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|HEALTHNET [1495]|HEALTHNET [149500]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|TRUSTMARK [2030]|STARMARK [203000]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|CHAMPVA [1240]|CHAMP VA [124000]|10.61||||10.61|7.96|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.61||||10.61|4.56|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.61||||10.61|5.32|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.61||||10.61|3.72|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.61||||10.61|4.52|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.61||||10.61|6.37|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.61||||10.61|9.55|9.55|2.23 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MULTIPLAN [1680]|HMA [168003]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|AETNA [1015]|AETNA ACO WILCO [101532]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.61||||10.61||| 126845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM PHOSPHATES 9.5 GRAM-3.5 GRAM/59 ML ENEMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.61||||10.61||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|228.59||||228.59|98.29|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|228.59||||228.59|114.52|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|228.59||||228.59|97.38|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|TRUSTMARK [2030]|STARMARK [203000]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MULTIPLAN [1680]|IHC HS [168011]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHNET [1495]|HEALTHNET [149500]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|228.59||||228.59|98.29|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UMR [2035]|UMR OPTIONS [203501]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|228.59||||228.59|48|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|228.59||||228.59|80.24|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|228.59||||228.59|109.61|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|228.59||||228.59|148.58|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|||228.59||||228.59|68.58|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|228.59||||228.59|137.15|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CORESOURCE [1315]|CORESOURCE [131500]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CHAMPVA [1240]|CHAMP VA [124000]|228.59||||228.59|171.44|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|GEHA [1415]|GEHA [141500]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|228.59||||228.59|205.73|205.73|48 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA [1015]|AETNA ACO WILCO [101532]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MULTIPLAN [1680]|HMA [168003]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|228.59||||228.59||| 127374|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 100 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|228.59||||228.59||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|GEHA [1415]|GEHA [141500]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CHAMPVA [1240]|CHAMP VA [124000]|306.04||||306.04|229.53|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CORESOURCE [1315]|CORESOURCE [131500]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|||306.04||||306.04|91.81|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|306.04||||306.04|198.93|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|306.04||||306.04|146.75|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|306.04||||306.04|64.27|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UMR [2035]|UMR OPTIONS [203501]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|306.04||||306.04|131.6|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MULTIPLAN [1680]|IHC HS [168011]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HEALTHNET [1495]|HEALTHNET [149500]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|TRUSTMARK [2030]|STARMARK [203000]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|306.04||||306.04|131.6|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|306.04||||306.04|153.33|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|306.04||||306.04|107.42|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|306.04||||306.04|130.37|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|306.04||||306.04|183.62|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|306.04||||306.04|275.44|275.44|64.27 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MULTIPLAN [1680]|HMA [168003]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA [1015]|AETNA ACO WILCO [101532]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|306.04||||306.04||| 127375|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE FUROATE 200 MCG/ACTUATION BLISTER POWDER FOR INHALATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|306.04||||306.04||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.77||||28.77|12.37|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.77||||28.77|6.04|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.77||||28.77|13.8|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.77||||28.77|18.7|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|||28.77||||28.77|8.63|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|28.77||||28.77|21.58|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|GEHA [1415]|GEHA [141500]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.77||||28.77|17.26|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.77||||28.77|12.37|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28.77||||28.77|12.26|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.77||||28.77|10.1|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28.77||||28.77|14.41|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.77||||28.77|25.89|25.89|6.04 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28.77||||28.77||| 127429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.77||||28.77||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|||3267.00||||3267.00|980.1|980.1|980.1 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MULTIPLAN [1680]|HMA [168003]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|HEALTHNET [1495]|HEALTHNET [149500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|FIRST HEALTH [1375]|QUALCHOICE [137513]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|GEHA [1415]|GEHA [141500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|UMR [2035]|UMR OPTIONS [203501]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|CHAMPVA [1240]|CHAMP VA [124000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|FMH BENEFIT SERVICES [1390]|FMH [139000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|CORESOURCE [1315]|CORESOURCE [131500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MULTIPLAN [1680]|IHC HS [168011]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|TRUSTMARK [2030]|STARMARK [203000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|AETNA [1015]|AETNA ACO WILCO [101532]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3267.00||||3267.00||| 12800000|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM REHAB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3267.00||||3267.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|||3630.00||||3630.00|1089|1089|1089 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|FIRST HEALTH [1375]|QUALCHOICE [137513]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|UMR [2035]|UMR OPTIONS [203501]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|HEALTHNET [1495]|HEALTHNET [149500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MULTIPLAN [1680]|HMA [168003]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|GEHA [1415]|GEHA [141500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|CHAMPVA [1240]|CHAMP VA [124000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|AETNA [1015]|AETNA ACO WILCO [101532]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|CORESOURCE [1315]|CORESOURCE [131500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|FMH BENEFIT SERVICES [1390]|FMH [139000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|TRUSTMARK [2030]|STARMARK [203000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|MULTIPLAN [1680]|IHC HS [168011]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3630.00||||3630.00||| 12800001|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/ATTENDANT REHAB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3630.00||||3630.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|||3993.00||||3993.00|1197.9|1197.9|1197.9 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|UMR [2035]|UMR OPTIONS [203501]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|CHAMPVA [1240]|CHAMP VA [124000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|GEHA [1415]|GEHA [141500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|CORESOURCE [1315]|CORESOURCE [131500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|FIRST HEALTH [1375]|QUALCHOICE [137513]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MULTIPLAN [1680]|HMA [168003]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MULTIPLAN [1680]|IHC HS [168011]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|FMH BENEFIT SERVICES [1390]|FMH [139000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|TRUSTMARK [2030]|STARMARK [203000]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|AETNA [1015]|AETNA ACO WILCO [101532]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|HEALTHNET [1495]|HEALTHNET [149500]|3993.00||||3993.00||| 12800002|EAP|0128 - ROOM & BOARD-SEMIPRIVATE (TWO-BEDS)-REHABIL|HC SEMI-PRIVATE ROOM W/SPEC BED REHAB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3993.00||||3993.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 12803|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PILOCARPINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68.79||||68.79|44.71|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68.79||||68.79|32.98|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68.79||||68.79|32.98|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68.79||||68.79|14.45|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68.79||||68.79|14.45|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68.79||||68.79|14.45|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68.79||||68.79|29.58|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68.79||||68.79|29.58|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68.79||||68.79|29.58|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68.79||||68.79|41.27|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68.79||||68.79|32.98|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68.79||||68.79|34.46|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68.79||||68.79|41.27|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68.79||||68.79|29.3|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68.79||||68.79|24.15|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68.79||||68.79|24.15|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68.79||||68.79|29.58|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68.79||||68.79|24.15|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68.79||||68.79|29.3|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68.79||||68.79|44.71|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68.79||||68.79|34.46|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68.79||||68.79|29.3|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68.79||||68.79|29.58|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68.79||||68.79|34.46|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68.79||||68.79|41.27|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68.79||||68.79|29.58|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68.79||||68.79|44.71|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|68.79||||68.79|51.59|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|68.79||||68.79|51.59|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|68.79||||68.79|51.59|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|||68.79||||68.79|20.64|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|||68.79||||68.79|20.64|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|||68.79||||68.79|20.64|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68.79||||68.79|61.91|61.91|14.45 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68.79||||68.79||| 128147|ERX|0250 - PHARMACY-GENERAL|SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68.79||||68.79||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.08||||27.08|16.25|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.08||||27.08|9.51|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.08||||27.08|11.54|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.08||||27.08|11.64|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.08||||27.08|13.57|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.08||||27.08|5.69|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.08||||27.08|11.64|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|27.08||||27.08|20.31|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.08||||27.08|12.98|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.08||||27.08|17.6|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.08||||27.08|24.37|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|||27.08||||27.08|8.12|24.37|5.69 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.08||||27.08||| 128497|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN 100 MG/4 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.08||||27.08||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|18.93||||18.93|14.2|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.93||||18.93|9.08|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.93||||18.93|12.3|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|UMR [2035]|UMR OPTIONS [203501]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.93||||18.93|3.98|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.93||||18.93|8.14|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.93||||18.93|9.48|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.93||||18.93|8.06|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.93||||18.93|8.14|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|GEHA [1415]|GEHA [141500]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.93||||18.93|6.64|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|||18.93||||18.93|5.68|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.93||||18.93|11.36|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.93||||18.93|17.04|17.04|3.98 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.93||||18.93||| 128751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY|MULTIPLAN [1680]|HMA [168003]|18.93||||18.93||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.12||||27.12|11.66|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.12||||27.12|16.27|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.12||||27.12|11.55|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.12||||27.12|13.59|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.12||||27.12|9.52|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|CHAMPVA [1240]|CHAMP VA [124000]|27.12||||27.12|20.34|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.12||||27.12|11.66|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|UMR [2035]|UMR OPTIONS [203501]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.12||||27.12|5.7|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|||27.12||||27.12|8.14|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.12||||27.12|13|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|HEALTHNET [1495]|HEALTHNET [149500]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.12||||27.12|17.63|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|TRUSTMARK [2030]|STARMARK [203000]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MULTIPLAN [1680]|IHC HS [168011]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|CORESOURCE [1315]|CORESOURCE [131500]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|GEHA [1415]|GEHA [141500]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.12||||27.12|24.41|24.41|5.7 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MULTIPLAN [1680]|HMA [168003]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|AETNA [1015]|AETNA ACO WILCO [101532]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.12||||27.12||| 128756|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.12||||27.12||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|||234.82||||234.82|70.45|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|234.82||||234.82|176.12|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234.82||||234.82|49.31|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234.82||||234.82|112.6|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|234.82||||234.82|100.03|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234.82||||234.82|100.97|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234.82||||234.82|140.89|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|234.82||||234.82|117.64|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234.82||||234.82|82.42|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234.82||||234.82|100.97|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234.82||||234.82|152.63|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234.82||||234.82|211.34|211.34|49.31 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234.82||||234.82||| 12886|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|234.82||||234.82||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.88||||27.88|5.85|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.88||||27.88|5.85|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.88||||27.88|5.85|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.88||||27.88|5.85|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.88||||27.88|13.37|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.88||||27.88|18.12|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.88||||27.88|13.37|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.88||||27.88|18.12|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.88||||27.88|18.12|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.88||||27.88|18.12|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.88||||27.88|18.12|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.88||||27.88|13.37|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|||27.88||||27.88|8.36|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|||27.88||||27.88|8.36|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.88||||27.88|5.85|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|||27.88||||27.88|8.36|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.88||||27.88|13.37|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|||27.88||||27.88|8.36|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.88||||27.88|13.37|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|27.88||||27.88|20.91|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|||27.88||||27.88|8.36|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|27.88||||27.88|20.91|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|27.88||||27.88|20.91|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|27.88||||27.88|20.91|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|27.88||||27.88|20.91|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.88||||27.88|13.97|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.88||||27.88|11.88|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.88||||27.88|11.88|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.88||||27.88|13.97|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.88||||27.88|11.88|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.88||||27.88|11.88|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.88||||27.88|9.79|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.88||||27.88|9.79|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.88||||27.88|9.79|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.88||||27.88|9.79|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.88||||27.88|16.73|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.88||||27.88|16.73|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.88||||27.88|16.73|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.88||||27.88|16.73|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.88||||27.88|16.73|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.88||||27.88|9.79|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.88||||27.88|13.97|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.88||||27.88|13.97|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.88||||27.88|13.97|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.88||||27.88|11.88|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.88||||27.88|11.99|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|27.88||||27.88|25.09|25.09|5.85 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.88||||27.88||| 128924|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.88||||27.88||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.06|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|||29.00||||29.00|8.7|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.06 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 128935|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM/10 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|||10.00||||10.00|3|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|||10.00||||10.00|3|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THYROID (PORK) 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|||10.00||||10.00|3|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|||10.00||||10.00|3|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTOBACILLUS ACIDOPH-L.BULGARICUS 1 MILLION CELL TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|||10.00||||10.00|3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|||10.00||||10.00|3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|||10.00||||10.00|3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|||10.00||||10.00|3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 129288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|||10.00||||10.00|3|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.8|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.8|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|||10.00||||10.00|3|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.8 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 12933|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.87||||50.87|25.49|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.87||||50.87|21.67|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.87||||50.87|25.49|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.87||||50.87|21.67|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.87||||50.87|17.86|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|50.87||||50.87|17.8|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.87||||50.87|21.87|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.87||||50.87|21.87|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|50.87||||50.87|17.8|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.87||||50.87|5.98|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.87||||50.87|5.98|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.87||||50.87|10.68|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.87||||50.87|10.68|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.87||||50.87|30.52|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.87||||50.87|24.39|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.87||||50.87|24.39|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.87||||50.87|30.52|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.87||||50.87|17.86|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.87||||50.87|33.07|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.87||||50.87|33.07|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.87||||50.87|21.87|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.87||||50.87|21.87|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|||50.87||||50.87|15.26|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|||50.87||||50.87|15.26|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|50.87||||50.87|38.15|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|50.87||||50.87|38.15|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.87||||50.87||| 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.87||||50.87|45.78|45.78|5.98 129397|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SOD SUCC (PF) 125 MG/2 ML SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.87||||50.87||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|381.92||||381.92|229.15|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|381.92||||381.92|164.23|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|381.92||||381.92|191.34|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|381.92||||381.92|162.7|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|381.92||||381.92|134.05|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|GEHA [1415]|GEHA [141500]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CORESOURCE [1315]|CORESOURCE [131500]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CHAMPVA [1240]|CHAMP VA [124000]|381.92||||381.92|286.44|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|||381.92||||381.92|114.58|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|381.92||||381.92|248.25|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|381.92||||381.92|183.13|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|381.92||||381.92|80.2|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UMR [2035]|UMR OPTIONS [203501]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|381.92||||381.92|164.23|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HEALTHNET [1495]|HEALTHNET [149500]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MULTIPLAN [1680]|IHC HS [168011]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|TRUSTMARK [2030]|STARMARK [203000]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|381.92||||381.92|343.73|343.73|80.2 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|MULTIPLAN [1680]|HMA [168003]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA [1015]|AETNA ACO WILCO [101532]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|381.92||||381.92||| 129483|ERX|0250 - PHARMACY-GENERAL|FLUTICASONE FUROATE 200 MCG-VILANTEROL 25 MCG/DOSE INHALATION POWDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|381.92||||381.92||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|334.00||||334.00|167|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|334.00||||334.00|143.62|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|334.00||||334.00|167.33|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|334.00||||334.00|117.23|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|334.00||||334.00|200.4|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MULTIPLAN [1680]|IHC HS [168011]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MULTIPLAN [1680]|HMA [168003]|334.00||||334.00|116.9|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|HEALTHNET [1495]|HEALTHNET [149500]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|334.00||||334.00|143.62|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|TRUSTMARK [2030]|STARMARK [203000]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|UMR [2035]|UMR OPTIONS [203501]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|334.00||||334.00|70.14|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|334.00||||334.00|160.15|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|334.00||||334.00|217.1|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|334.00||||334.00|142.28|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|||334.00||||334.00|100.2|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|CHAMPVA [1240]|CHAMP VA [124000]|334.00||||334.00|250.5|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|CORESOURCE [1315]|CORESOURCE [131500]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|GEHA [1415]|GEHA [141500]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|334.00||||334.00|300.6|300.6|70.14 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|AETNA [1015]|AETNA ACO WILCO [101532]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|334.00||||334.00||| 129630|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEDRONATE (MDP) PER DOSE UP TO 30MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|334.00||||334.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|GEHA [1415]|GEHA [141500]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|CORESOURCE [1315]|CORESOURCE [131500]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|CHAMPVA [1240]|CHAMP VA [124000]|377.00||||377.00|282.75|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|||377.00||||377.00|113.1|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|377.00||||377.00|245.05|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|377.00||||377.00|79.17|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|UMR [2035]|UMR OPTIONS [203501]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|377.00||||377.00|162.11|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|HEALTHNET [1495]|HEALTHNET [149500]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MULTIPLAN [1680]|IHC HS [168011]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MULTIPLAN [1680]|HMA [168003]|377.00||||377.00|131.95|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|377.00||||377.00|180.77|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|TRUSTMARK [2030]|STARMARK [203000]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|377.00||||377.00|226.2|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|377.00||||377.00|162.11|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|377.00||||377.00|188.88|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|377.00||||377.00|160.6|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|377.00||||377.00|132.33|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|377.00||||377.00|188.5|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|377.00||||377.00|339.3|339.3|79.17 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|AETNA [1015]|AETNA ACO WILCO [101532]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|377.00||||377.00||| 129636|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MEBROFENIN (CHOLETEC) PER DOSE UP TO 15 MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|377.00||||377.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|624.00||||624.00|312|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|624.00||||624.00|268.32|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|624.00||||624.00|312.62|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|624.00||||624.00|219.02|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|624.00||||624.00|265.82|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|624.00||||624.00|374.4|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|TRUSTMARK [2030]|STARMARK [203000]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MULTIPLAN [1680]|IHC HS [168011]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|HEALTHNET [1495]|HEALTHNET [149500]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MULTIPLAN [1680]|HMA [168003]|624.00||||624.00|218.4|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|624.00||||624.00|268.32|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|UMR [2035]|UMR OPTIONS [203501]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|624.00||||624.00|131.04|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|624.00||||624.00|299.21|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|624.00||||624.00|405.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|||624.00||||624.00|187.2|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|CHAMPVA [1240]|CHAMP VA [124000]|624.00||||624.00|468|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|CORESOURCE [1315]|CORESOURCE [131500]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|GEHA [1415]|GEHA [141500]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|624.00||||624.00|561.6|561.6|131.04 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|AETNA [1015]|AETNA ACO WILCO [101532]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|624.00||||624.00||| 129660|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PYROPHOSPHATE PER DOSE UP TO 25 MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|624.00||||624.00||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|GEHA [1415]|GEHA [141500]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|38.41||||38.41|28.81|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|||38.41||||38.41|11.52|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.41||||38.41|24.97|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.41||||38.41|18.42|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.41||||38.41|8.07|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.41||||38.41|16.52|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.41||||38.41|23.05|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.41||||38.41|16.52|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.41||||38.41|19.24|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.41||||38.41|13.48|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.41||||38.41|16.36|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.41||||38.41|34.57|34.57|8.07 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MULTIPLAN [1680]|HMA [168003]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.41||||38.41||| 129911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.41||||38.41||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469.00||||469.00|234.5|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469.00||||469.00|201.67|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|469.00||||469.00|234.97|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469.00||||469.00|164.62|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469.00||||469.00|281.4|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MULTIPLAN [1680]|IHC HS [168011]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MULTIPLAN [1680]|HMA [168003]|469.00||||469.00|164.15|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|HEALTHNET [1495]|HEALTHNET [149500]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469.00||||469.00|201.67|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|TRUSTMARK [2030]|STARMARK [203000]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|UMR [2035]|UMR OPTIONS [203501]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469.00||||469.00|98.49|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|469.00||||469.00|199.79|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469.00||||469.00|224.89|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469.00||||469.00|304.85|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|||469.00||||469.00|140.7|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|CHAMPVA [1240]|CHAMP VA [124000]|469.00||||469.00|351.75|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|CORESOURCE [1315]|CORESOURCE [131500]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|GEHA [1415]|GEHA [141500]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469.00||||469.00|422.1|422.1|98.49 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|AETNA [1015]|AETNA ACO WILCO [101532]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|469.00||||469.00||| 130411|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SULFUR COLLOID PER DOSE UP TO 20MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|469.00||||469.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13089|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|344.00||||344.00|172|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|344.00||||344.00|147.92|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|344.00||||344.00|172.34|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|344.00||||344.00|120.74|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|344.00||||344.00|146.54|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|TRUSTMARK [2030]|STARMARK [203000]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MULTIPLAN [1680]|HMA [168003]|344.00||||344.00|120.4|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|HEALTHNET [1495]|HEALTHNET [149500]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MULTIPLAN [1680]|IHC HS [168011]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|344.00||||344.00|147.92|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|UMR [2035]|UMR OPTIONS [203501]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|344.00||||344.00|72.24|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|344.00||||344.00|206.4|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|344.00||||344.00|164.95|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|344.00||||344.00|223.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|||344.00||||344.00|103.2|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|CHAMPVA [1240]|CHAMP VA [124000]|344.00||||344.00|258|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|CORESOURCE [1315]|CORESOURCE [131500]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|GEHA [1415]|GEHA [141500]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|344.00||||344.00|309.6|309.6|72.24 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|AETNA [1015]|AETNA ACO WILCO [101532]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|344.00||||344.00||| 130892|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MAA PER DOSE UP TO 10MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|344.00||||344.00||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|38.83||||38.83|29.12|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.83||||38.83|25.24|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.83||||38.83|18.62|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.83||||38.83|16.7|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.83||||38.83|8.15|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|||38.83||||38.83|11.65|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|GEHA [1415]|GEHA [141500]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.83||||38.83|23.3|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.83||||38.83|16.7|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.83||||38.83|19.45|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.83||||38.83|16.54|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.83||||38.83|13.63|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.83||||38.83|34.95|34.95|8.15 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.83||||38.83||| 131064|ERX|0250 - PHARMACY-GENERAL|LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.83||||38.83||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|||10.00||||10.00|3|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 131099|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML (5 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|GEHA [1415]|GEHA [141500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|GEHA [1415]|GEHA [141500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|GEHA [1415]|GEHA [141500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.92||||12.92|9.69|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.92||||12.92|9.69|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|||12.92||||12.92|3.88|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|||12.92||||12.92|3.88|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.92||||12.92|8.4|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.92||||12.92|8.4|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.92||||12.92|6.2|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.92||||12.92|6.2|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.92||||12.92|2.71|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.92||||12.92|2.71|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.92||||12.92|5.56|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.92||||12.92|5.56|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.92||||12.92|5.56|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.92||||12.92|2.71|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.92||||12.92|6.2|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.92||||12.92|8.4|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|||12.92||||12.92|3.88|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.92||||12.92|7.75|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.92||||12.92|7.75|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.92||||12.92|7.75|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.92||||12.92|5.56|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.92||||12.92|6.47|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.92||||12.92|5.5|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.92||||12.92|6.47|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.92||||12.92|5.5|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.92||||12.92|5.56|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.92||||12.92|6.47|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.92||||12.92|5.5|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.92||||12.92|9.69|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.92||||12.92|4.53|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.92||||12.92|5.56|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.92||||12.92|4.53|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.92||||12.92|4.53|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.92||||12.92|11.63|11.63|2.71 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.92||||12.92||| 13133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALACYCLOVIR 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.92||||12.92||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|||10.00||||10.00|3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|||10.00||||10.00|3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|||10.00||||10.00|3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|||10.00||||10.00|3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 131702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG/6 ML (6 ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|||10.00||||10.00|3|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 131776|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VIT C,E-ZN-COPPER-LUTEIN-ZEAXAN 60 MG-13.5 MG-15 MG-2 MG-6 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|CORESOURCE [1315]|CORESOURCE [131500]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|CHAMPVA [1240]|CHAMP VA [124000]|1337.00||||1337.00|1002.75|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|||1337.00||||1337.00|401.1|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1337.00||||1337.00|583|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1337.00||||1337.00|869.05|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1337.00||||1337.00|641.09|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1337.00||||1337.00|574.91|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|UMR [2035]|UMR OPTIONS [203501]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|HEALTHNET [1495]|HEALTHNET [149500]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MULTIPLAN [1680]|HMA [168003]|1337.00||||1337.00|467.95|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MULTIPLAN [1680]|IHC HS [168011]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1337.00||||1337.00|280.77|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|TRUSTMARK [2030]|STARMARK [203000]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1337.00||||1337.00|802.2|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|GEHA [1415]|GEHA [141500]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1337.00||||1337.00|469.29|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1337.00||||1337.00|574.91|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1337.00||||1337.00|669.84|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1337.00||||1337.00|569.56|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1337.00||||1337.00|668.5|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1337.00||||1337.00|1203.3|1203.3|280.77 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|AETNA [1015]|AETNA ACO WILCO [101532]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1337.00||||1337.00||| 132483|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO F18 FDG (FLUORDEOXYGLUCOSE) PER DOSE UP TO 45 MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1337.00||||1337.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|||10.00||||10.00|3|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13369|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|GEHA [1415]|GEHA [141500]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|254.40||||254.40|24.1|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|CORESOURCE [1315]|CORESOURCE [131500]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|CHAMPVA [1240]|CHAMP VA [124000]|254.40||||254.40|190.8|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|254.40||||254.40|29.74|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254.40||||254.40|21.33|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254.40||||254.40|23.19|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|||254.40||||254.40|76.32|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254.40||||254.40|121.98|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254.40||||254.40|53.42|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254.40||||254.40|30.21|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|UMR [2035]|UMR OPTIONS [203501]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254.40||||254.40|21.1|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|254.40||||254.40|26.51|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254.40||||254.40|109.39|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|HEALTHNET [1495]|HEALTHNET [149500]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MULTIPLAN [1680]|IHC HS [168011]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|254.40||||254.40|29.74|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MULTIPLAN [1680]|HMA [168003]|254.40||||254.40|89.04|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254.40||||254.40|165.36|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|TRUSTMARK [2030]|STARMARK [203000]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254.40||||254.40|22.4|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254.40||||254.40|22.76|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254.40||||254.40|23.19|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254.40||||254.40|21.72|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254.40||||254.40|152.64|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254.40||||254.40|89.29|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254.40||||254.40|109.39|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|254.40||||254.40|127.45|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|254.40||||254.40|108.37|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254.40||||254.40|127.2|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254.40||||254.40|22.76|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254.40||||254.40|228.96|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254.40||||254.40|20.69|228.96|20.69 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|254.40||||254.40||| 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254.40||||254.40||| 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|AETNA [1015]|AETNA ACO WILCO [101532]|254.40||||254.40||| 133818|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO I-131 SODIUM IODIDE CAPSULE TX PER MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|254.40||||254.40||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103.70||||103.70|44.18|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103.70||||103.70|44.59|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103.70||||103.70|51.95|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103.70||||103.70|36.4|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|103.70||||103.70|36.3|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103.70||||103.70|44.59|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103.70||||103.70|4.11|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103.70||||103.70|21.78|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103.70||||103.70|62.22|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103.70||||103.70|49.72|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103.70||||103.70|67.41|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|||103.70||||103.70|31.11|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|103.70||||103.70|77.78|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103.70||||103.70|93.33|93.33|4.11 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103.70||||103.70||| 133930|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/100 ML IN DEXTROSE(ISO-OSMOTIC) INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103.70||||103.70||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|29.45||||29.45|22.09|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.45||||29.45|19.14|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.45||||29.45|14.12|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.45||||29.45|12.66|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.45||||29.45|6.18|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|||29.45||||29.45|8.83|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.45||||29.45|17.67|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.45||||29.45|12.55|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.45||||29.45|10.34|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.45||||29.45|12.66|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.45||||29.45|14.75|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.45||||29.45|26.51|26.51|6.18 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.45||||29.45||| 1350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CAPSAICIN 0.025 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.45||||29.45||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7002.00||||7002.00|2457.7|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7002.00||||7002.00|3010.86|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7002.00||||7002.00|2982.85|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7002.00||||7002.00|4201.2|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|TRUSTMARK [2030]|STARMARK [203000]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MULTIPLAN [1680]|IHC HS [168011]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MULTIPLAN [1680]|HMA [168003]|7002.00||||7002.00|2450.7|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|HEALTHNET [1495]|HEALTHNET [149500]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7002.00||||7002.00|3010.86|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|UMR [2035]|UMR OPTIONS [203501]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7002.00||||7002.00|1470.42|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7002.00||||7002.00|3508|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7002.00||||7002.00|3357.46|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7002.00||||7002.00|4551.3|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7002.00||||7002.00|3501|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|||7002.00||||7002.00|2100.6|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|CHAMPVA [1240]|CHAMP VA [124000]|7002.00||||7002.00|5251.5|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|CORESOURCE [1315]|CORESOURCE [131500]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|GEHA [1415]|GEHA [141500]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7002.00||||7002.00|6301.8|6301.8|1470.42 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|AETNA [1015]|AETNA ACO WILCO [101532]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7002.00||||7002.00||| 13545|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|INDIUM 111-PENTETREOTIDE 3 MCI/ML-10 MCG INTRAVENOUS KIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7002.00||||7002.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1355|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 100 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|||10.00||||10.00|3|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|||10.00||||10.00|3|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1357|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|||10.00||||10.00|3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|||10.00||||10.00|3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|||10.00||||10.00|3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1359|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMIDE PEROXIDE 6.5 % EAR DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13981|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 13982|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LAMOTRIGINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|||10.00||||10.00|3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|||10.00||||10.00|3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|||10.00||||10.00|3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 300 MG-CODEINE 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.48||||16.48|5.78|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.48||||16.48|7.02|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.48||||16.48|8.26|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.48||||16.48|9.89|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.48||||16.48|7.09|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|GEHA [1415]|GEHA [141500]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|CORESOURCE [1315]|CORESOURCE [131500]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|CHAMPVA [1240]|CHAMP VA [124000]|16.48||||16.48|12.36|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|||16.48||||16.48|4.94|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.48||||16.48|10.71|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.48||||16.48|7.9|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.48||||16.48|3.46|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|UMR [2035]|UMR OPTIONS [203501]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.48||||16.48|7.09|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|IHC HS [168011]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|HEALTHNET [1495]|HEALTHNET [149500]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|TRUSTMARK [2030]|STARMARK [203000]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.48||||16.48|14.83|14.83|3.46 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.48||||16.48||| 14101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM ER 90 MG CAPSULE,EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|HMA [168003]|16.48||||16.48||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.06|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.06|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.06|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.06 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 1445|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|113.05||||113.05|84.79|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|||113.05||||113.05|33.91|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113.05||||113.05|73.48|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113.05||||113.05|54.21|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113.05||||113.05|73.48|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113.05||||113.05|23.74|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113.05||||113.05|23.74|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113.05||||113.05|48.61|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|GEHA [1415]|GEHA [141500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|GEHA [1415]|GEHA [141500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113.05||||113.05|48.61|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|113.05||||113.05|84.79|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113.05||||113.05|67.83|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113.05||||113.05|48.61|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113.05||||113.05|56.64|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|||113.05||||113.05|33.91|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113.05||||113.05|54.21|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113.05||||113.05|48.16|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113.05||||113.05|48.61|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113.05||||113.05|48.16|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113.05||||113.05|67.83|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113.05||||113.05|39.68|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113.05||||113.05|39.68|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113.05||||113.05|101.75|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113.05||||113.05|56.64|101.75|23.74 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113.05||||113.05||| 14471|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DORZOLAMIDE 2 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113.05||||113.05||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14550|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TERAZOSIN 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14626|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|||10.00||||10.00|3|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|||10.00||||10.00|3|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAMADOL 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 1465|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|||10.00||||10.00|3|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN 850 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|||10.00||||10.00|3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|||10.00||||10.00|3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|||10.00||||10.00|3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|||10.00||||10.00|3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|||10.00||||10.00|3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14792|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|||10.00||||10.00|3|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|||10.00||||10.00|3|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14793|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TIZANIDINE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|||10.00||||10.00|3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|||10.00||||10.00|3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|||10.00||||10.00|3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 14824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOSARTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.43|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.43|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.43|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|||10.00||||10.00|3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|||10.00||||10.00|3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|||10.00||||10.00|3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.43 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15113|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|||10.00||||10.00|3|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15327|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|||10.00||||10.00|3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SUMATRIPTAN 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15340|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 50 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15341|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICLOFENAC SODIUM 75 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.03||||58.03|34.82|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.03||||58.03|20.37|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.03||||58.03|24.72|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.03||||58.03|24.95|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.03||||58.03|29.07|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.03||||58.03|12.19|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|CHAMPVA [1240]|CHAMP VA [124000]|58.03||||58.03|43.52|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MULTIPLAN [1680]|IHC HS [168011]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|UMR [2035]|UMR OPTIONS [203501]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.03||||58.03|24.95|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.03||||58.03|37.72|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.03||||58.03|27.83|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|CORESOURCE [1315]|CORESOURCE [131500]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|TRUSTMARK [2030]|STARMARK [203000]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|GEHA [1415]|GEHA [141500]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|||58.03||||58.03|17.41|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|HEALTHNET [1495]|HEALTHNET [149500]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.03||||58.03|52.23|52.23|12.19 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|AETNA [1015]|AETNA ACO WILCO [101532]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|MULTIPLAN [1680]|HMA [168003]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.03||||58.03||| 1562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHERRY FLAVOR (BULK) ORAL SYRUP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.03||||58.03||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|241.83||||241.83|115.96|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|GEHA [1415]|GEHA [141500]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|241.83||||241.83|84.88|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|||241.83||||241.83|72.55|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|241.83||||241.83|103.99|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|UMR [2035]|UMR OPTIONS [203501]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|241.83||||241.83|181.37|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|241.83||||241.83|157.19|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|241.83||||241.83|145.1|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|241.83||||241.83|50.78|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|241.83||||241.83|121.16|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|241.83||||241.83|103.99|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|241.83||||241.83|103.02|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|241.83||||241.83|217.65|217.65|50.78 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MULTIPLAN [1680]|HMA [168003]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|241.83||||241.83||| 15738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|241.83||||241.83||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|||10.00||||10.00|3|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|||10.00||||10.00|3|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BICALUTAMIDE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|||10.00||||10.00|3|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|||10.00||||10.00|3|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15747|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 6.25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|||10.00||||10.00|3|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|||10.00||||10.00|3|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|||10.00||||10.00|3|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|||10.00||||10.00|3|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 15749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 12.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CHAMPVA [1240]|CHAMP VA [124000]|84.50||||84.50|63.38|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|GEHA [1415]|GEHA [141500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CORESOURCE [1315]|CORESOURCE [131500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CORESOURCE [1315]|CORESOURCE [131500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UMR [2035]|UMR OPTIONS [203501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|GEHA [1415]|GEHA [141500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84.50||||84.50|17.75|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84.50||||84.50|54.93|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84.50||||84.50|17.75|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84.50||||84.50|54.93|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84.50||||84.50|40.52|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UMR [2035]|UMR OPTIONS [203501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84.50||||84.50|36.34|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|TRUSTMARK [2030]|STARMARK [203000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHNET [1495]|HEALTHNET [149500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|TRUSTMARK [2030]|STARMARK [203000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84.50||||84.50|50.7|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84.50||||84.50|36|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84.50||||84.50|36|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84.50||||84.50|36.34|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84.50||||84.50|29.66|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84.50||||84.50|29.66|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|||84.50||||84.50|25.35|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|||84.50||||84.50|25.35|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84.50||||84.50|50.7|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84.50||||84.50|42.33|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84.50||||84.50|40.52|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84.50||||84.50|42.33|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MULTIPLAN [1680]|IHC HS [168011]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84.50||||84.50|36.34|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84.50||||84.50|36.34|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MULTIPLAN [1680]|HMA [168003]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MULTIPLAN [1680]|HMA [168003]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|HEALTHNET [1495]|HEALTHNET [149500]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MULTIPLAN [1680]|IHC HS [168011]|84.50||||84.50|76.05|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CHAMPVA [1240]|CHAMP VA [124000]|84.50||||84.50|63.38|76.05|17.75 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84.50||||84.50||| 15796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84.50||||84.50||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|||10.00||||10.00|3|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16052|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESMOPRESSIN 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|||10.00||||10.00|3|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16205|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ANASTROZOLE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|||10.00||||10.00|3|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16218|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 1 MCG/ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1623|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1624|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORDIAZEPOXIDE 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|||10.00||||10.00|3|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|||10.00||||10.00|3|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16299|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE-ZINC ACETATE 2 %-0.1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|||10.00||||10.00|3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|||10.00||||10.00|3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|||10.00||||10.00|3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16356|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIMEPIRIDE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.93||||29.93|12.87|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.93||||29.93|10.51|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.93||||29.93|12.87|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.93||||29.93|12.75|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.93||||29.93|12.75|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.93||||29.93|17.96|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.93||||29.93|10.48|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.93||||29.93|10.48|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.93||||29.93|12.87|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.93||||29.93|12.87|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.93||||29.93|3.58|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.93||||29.93|3.58|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.93||||29.93|6.29|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.93||||29.93|6.29|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.93||||29.93|17.96|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.93||||29.93|14.99|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.93||||29.93|14.35|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.93||||29.93|14.99|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.93||||29.93|14.35|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.93||||29.93|10.51|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.93||||29.93|19.45|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.93||||29.93|19.45|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|||29.93||||29.93|8.98|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|||29.93||||29.93|8.98|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.93||||29.93|22.45|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.93||||29.93|22.45|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.93||||29.93|26.94|26.94|3.58 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.93||||29.93||| 16369|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.93||||29.93||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|52.50||||52.50|39.38|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|52.50||||52.50|39.38|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|||52.50||||52.50|15.75|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.50||||52.50|25.17|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.50||||52.50|25.17|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.50||||52.50|11.03|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.50||||52.50|7.17|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.50||||52.50|22.58|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.50||||52.50|22.58|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|52.50||||52.50|18.38|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|52.50||||52.50|18.38|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.50||||52.50|7.17|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.50||||52.50|34.13|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.50||||52.50|11.03|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.50||||52.50|31.5|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.50||||52.50|31.5|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.50||||52.50|18.43|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.50||||52.50|18.43|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.50||||52.50|22.58|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.50||||52.50|34.13|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.50||||52.50|22.58|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.50||||52.50|26.3|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|||52.50||||52.50|15.75|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.50||||52.50|22.37|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.50||||52.50|26.3|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.50||||52.50|22.37|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.50||||52.50|47.25|47.25|7.17 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.50||||52.50||| 16371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFEPIME 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.50||||52.50||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|||10.00||||10.00|3|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 165150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|||23.19||||23.19|6.96|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.19||||23.19|15.07|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.19||||23.19|4.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.19||||23.19|9.97|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.19||||23.19|11.12|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.19||||23.19|13.91|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.19||||23.19|8.14|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.19||||23.19|9.97|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23.19||||23.19|11.62|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.19||||23.19|11.6|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23.19||||23.19|9.88|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|23.19||||23.19|17.39|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.19||||23.19|20.87|20.87|4.87 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.19||||23.19||| 1656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23.19||||23.19||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.79||||22.79|11.4|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.79||||22.79|8|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22.79||||22.79|11.42|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22.79||||22.79|9.71|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.79||||22.79|13.67|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.79||||22.79|9.8|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.79||||22.79|4.79|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.79||||22.79|10.93|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.79||||22.79|9.8|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.79||||22.79|14.81|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|||22.79||||22.79|6.84|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|22.79||||22.79|17.09|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.79||||22.79|20.51|20.51|4.79 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22.79||||22.79||| 1657|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORPROMAZINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.79||||22.79||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|||10.00||||10.00|3|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|||10.00||||10.00|3|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1661|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORTHALIDONE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16632|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PAROXETINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|||10.00||||10.00|3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|||10.00||||10.00|3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|||10.00||||10.00|3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|||10.00||||10.00|3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|||10.00||||10.00|3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 16830|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELATONIN 3 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|145.51||||145.51|61.99|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145.51||||145.51|62.57|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|145.51||||145.51|72.9|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145.51||||145.51|87.31|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145.51||||145.51|62.57|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145.51||||145.51|30.56|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145.51||||145.51|69.77|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145.51||||145.51|51.07|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145.51||||145.51|94.58|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|||145.51||||145.51|43.65|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|145.51||||145.51|109.13|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145.51||||145.51|130.96|130.96|30.56 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|145.51||||145.51||| 168991|ERX|0250 - PHARMACY-GENERAL|CLINDAMYCIN 900 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|145.51||||145.51||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|||10.00||||10.00|3|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|||10.00||||10.00|3|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 171181|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.62||||57.62|20.22|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.62||||57.62|24.55|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.62||||57.62|24.78|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.62||||57.62|28.87|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.62||||57.62|34.57|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|TRUSTMARK [2030]|STARMARK [203000]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MULTIPLAN [1680]|IHC HS [168011]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|HEALTHNET [1495]|HEALTHNET [149500]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.62||||57.62|24.78|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|UMR [2035]|UMR OPTIONS [203501]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.62||||57.62|12.1|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.62||||57.62|27.63|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.62||||57.62|37.45|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|||57.62||||57.62|17.29|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|CHAMPVA [1240]|CHAMP VA [124000]|57.62||||57.62|43.22|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|CORESOURCE [1315]|CORESOURCE [131500]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|GEHA [1415]|GEHA [141500]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.62||||57.62|51.86|51.86|12.1 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|AETNA [1015]|AETNA ACO WILCO [101532]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MULTIPLAN [1680]|HMA [168003]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.62||||57.62||| 171372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 40,000-126,000-168,000 UNIT CAPSULE, DELAY REL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.62||||57.62||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|GEHA [1415]|GEHA [141500]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|CHAMPVA [1240]|CHAMP VA [124000]|15.06||||15.06|11.3|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|||15.06||||15.06|4.52|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.06||||15.06|7.22|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.06||||15.06|3.16|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|UMR [2035]|UMR OPTIONS [203501]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.06||||15.06|6.48|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|HEALTHNET [1495]|HEALTHNET [149500]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MULTIPLAN [1680]|IHC HS [168011]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.06||||15.06|9.79|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|TRUSTMARK [2030]|STARMARK [203000]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|CORESOURCE [1315]|CORESOURCE [131500]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.06||||15.06|9.04|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.06||||15.06|5.29|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.06||||15.06|6.48|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15.06||||15.06|7.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15.06||||15.06|6.42|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.06||||15.06|13.55|13.55|3.16 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MULTIPLAN [1680]|HMA [168003]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|AETNA [1015]|AETNA ACO WILCO [101532]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.06||||15.06||| 171617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIPASE-PROTEASE-AMYLASE 5,000-17,000-24,000 UNIT CAPSULE, DELAYED REL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.06||||15.06||| 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176.48||||176.48|75.89|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|176.48||||176.48|88.42|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|176.48||||176.48|75.18|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176.48||||176.48|60|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176.48||||176.48|36.16|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176.48||||176.48|37.88|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176.48||||176.48|58.06|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|176.48||||176.48|61.77|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|176.48||||176.48|49.51|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176.48||||176.48|75.89|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|176.48||||176.48|68.6|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176.48||||176.48|35.13|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176.48||||176.48|36.46|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176.48||||176.48|37.06|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176.48||||176.48|105.89|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176.48||||176.48|61.94|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176.48||||176.48|84.62|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176.48||||176.48|114.71|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|||176.48||||176.48|52.94|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176.48||||176.48|37.88|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176.48||||176.48|60|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|176.48||||176.48|34.44|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|176.48||||176.48|49.51|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|176.48||||176.48|132.36|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|176.48||||176.48|62.36|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176.48||||176.48|158.83|158.83|34.44 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176.48||||176.48||| 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|176.48||||176.48||| 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|176.48||||176.48||| 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176.48||||176.48||| 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|176.48||||176.48||| 173069|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176.48||||176.48||| 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|373.92||||373.92|155.91|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|373.92||||373.92|280.44|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|373.92||||373.92|150|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|373.92||||373.92|243.05|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|373.92||||373.92|179.29|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|373.92||||373.92|91.16|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|373.92||||373.92|87.82|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|373.92||||373.92|160.79|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|373.92||||373.92|171.5|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|373.92||||373.92|78.52|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|373.92||||373.92|130.87|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|373.92||||373.92|123.78|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|||373.92||||373.92|112.18|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|373.92||||373.92|145.16|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|373.92||||373.92|94.71|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|373.92||||373.92|123.78|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|373.92||||373.92|90.41|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|373.92||||373.92|150|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|373.92||||373.92|224.35|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|373.92||||373.92|131.25|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|373.92||||373.92|159.29|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|373.92||||373.92|160.79|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|373.92||||373.92|187.33|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|373.92||||373.92|94.71|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|373.92||||373.92|336.53|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|373.92||||373.92|86.1|336.53|78.52 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|373.92||||373.92||| 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|373.92||||373.92||| 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|373.92||||373.92||| 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|373.92||||373.92||| 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|373.92||||373.92||| 173070|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA-EPBX 10,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|373.92||||373.92||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.45||||30.45|10.69|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.45||||30.45|10.69|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30.45||||30.45|12.97|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.45||||30.45|10.69|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30.45||||30.45|15.26|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30.45||||30.45|12.97|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30.45||||30.45|12.97|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30.45||||30.45|15.26|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30.45||||30.45|15.26|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.45||||30.45|10.69|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.45||||30.45|18.27|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.45||||30.45|18.27|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.45||||30.45|18.27|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|30.45||||30.45|10.66|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|30.45||||30.45|10.66|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|30.45||||30.45|10.66|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|30.45||||30.45|10.66|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.45||||30.45|4.56|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.45||||30.45|4.56|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.45||||30.45|4.56|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.45||||30.45|4.56|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.45||||30.45|6.39|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.45||||30.45|6.39|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.45||||30.45|6.39|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.45||||30.45|6.39|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.45||||30.45|14.6|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.45||||30.45|14.6|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.45||||30.45|14.6|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.45||||30.45|14.6|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.45||||30.45|19.79|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.45||||30.45|19.79|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.45||||30.45|19.79|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.45||||30.45|19.79|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|||30.45||||30.45|9.13|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|||30.45||||30.45|9.13|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|||30.45||||30.45|9.13|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|||30.45||||30.45|9.13|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.45||||30.45|18.27|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30.45||||30.45|12.97|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30.45||||30.45|15.26|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.45||||30.45|13.09|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|30.45||||30.45|22.84|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|30.45||||30.45|22.84|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|30.45||||30.45|22.84|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|30.45||||30.45|22.84|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.45||||30.45|27.41|27.41|4.56 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30.45||||30.45||| 17379|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30.45||||30.45||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|61.22||||61.22|45.92|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|61.22||||61.22|45.92|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|||61.22||||61.22|18.37|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|||61.22||||61.22|18.37|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|||61.22||||61.22|18.37|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.22||||61.22|39.79|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.22||||61.22|39.79|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.22||||61.22|29.35|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.22||||61.22|29.35|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.22||||61.22|12.86|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.22||||61.22|12.86|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.22||||61.22|12.86|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.22||||61.22|9.12|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.22||||61.22|9.12|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.22||||61.22|26.32|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.22||||61.22|26.32|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.22||||61.22|26.32|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|61.22||||61.22|21.43|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|61.22||||61.22|21.43|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|61.22||||61.22|21.43|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.22||||61.22|9.12|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.22||||61.22|29.35|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.22||||61.22|39.79|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.22||||61.22|36.73|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.22||||61.22|36.73|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.22||||61.22|36.73|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.22||||61.22|21.49|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.22||||61.22|21.49|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.22||||61.22|26.32|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.22||||61.22|30.67|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.22||||61.22|26.08|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.22||||61.22|26.32|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.22||||61.22|30.67|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|61.22||||61.22|45.92|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.22||||61.22|26.08|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.22||||61.22|30.67|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.22||||61.22|21.49|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.22||||61.22|26.32|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.22||||61.22|26.08|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.22||||61.22|55.1|55.1|9.12 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.22||||61.22||| 17380|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MEROPENEM 1 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.22||||61.22||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.48||||19.48|6.84|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.48||||19.48|8.38|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.48||||19.48|9.76|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.48||||19.48|8.3|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.48||||19.48|11.69|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.48||||19.48|8.38|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.48||||19.48|4.09|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.48||||19.48|9.34|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.48||||19.48|12.66|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|||19.48||||19.48|5.84|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|19.48||||19.48|14.61|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|GEHA [1415]|GEHA [141500]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.48||||19.48|17.53|17.53|4.09 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.48||||19.48||| 17387|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.48||||19.48||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|||10.00||||10.00|3|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|||10.00||||10.00|3|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1740|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 150 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.81||||86.81|37.33|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86.81||||86.81|55.33|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86.81||||86.81|18.23|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.81||||86.81|41.63|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86.81||||86.81|56.43|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|||86.81||||86.81|26.04|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|86.81||||86.81|65.11|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|GEHA [1415]|GEHA [141500]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86.81||||86.81|52.09|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86.81||||86.81|36.98|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86.81||||86.81|37.33|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|86.81||||86.81|30.38|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86.81||||86.81|30.47|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86.81||||86.81|43.49|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86.81||||86.81|78.13|78.13|18.23 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.81||||86.81||| 17405|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN LISPRO (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86.81||||86.81||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|96.13||||96.13|72.1|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.13||||96.13|20.19|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|||96.13||||96.13|28.84|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.13||||96.13|41.34|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.13||||96.13|62.48|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.13||||96.13|40.95|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.13||||96.13|57.68|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.13||||96.13|46.09|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.13||||96.13|33.74|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.13||||96.13|48.16|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.13||||96.13|86.52|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.13||||96.13|41.34|86.52|20.19 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.13||||96.13||| 174389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BALSAM PERU-CASTOR OIL TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.13||||96.13||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|||10.00||||10.00|3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|||10.00||||10.00|3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|||10.00||||10.00|3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 17466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIRTAZAPINE 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80.40||||80.40|52.26|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80.40||||80.40|38.55|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|||80.40||||80.40|24.12|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|80.40||||80.40|60.3|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80.40||||80.40|34.57|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80.40||||80.40|8.81|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|80.40||||80.40|28.14|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|80.40||||80.40|34.25|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80.40||||80.40|28.22|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80.40||||80.40|48.24|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80.40||||80.40|16.88|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80.40||||80.40|34.57|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|80.40||||80.40|40.28|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80.40||||80.40|72.36|72.36|8.81 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80.40||||80.40||| 175161|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80.40||||80.40||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|||10.00||||10.00|3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|||10.00||||10.00|3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|||10.00||||10.00|3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|||10.00||||10.00|3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1755|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE HCL 0.1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|334.50||||334.50|217.43|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|334.50||||334.50|143.84|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|334.50||||334.50|250.88|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|334.50||||334.50|70.25|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|334.50||||334.50|160.39|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|334.50||||334.50|5.87|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|334.50||||334.50|117.08|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|||334.50||||334.50|100.35|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|334.50||||334.50|167.58|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|334.50||||334.50|200.7|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|334.50||||334.50|142.5|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|334.50||||334.50|117.41|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|GEHA [1415]|GEHA [141500]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|334.50||||334.50|143.84|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|334.50||||334.50|301.05|301.05|5.87 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|334.50||||334.50||| 175565|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|334.50||||334.50||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211.80||||211.80|127.08|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211.80||||211.80|127.08|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211.80||||211.80|91.07|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211.80||||211.80|91.07|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211.80||||211.80|105.9|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211.80||||211.80|105.9|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211.80||||211.80|74.34|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|211.80||||211.80|90.23|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|211.80||||211.80|90.23|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211.80||||211.80|101.56|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211.80||||211.80|101.56|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211.80||||211.80|44.48|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211.80||||211.80|74.34|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.80||||211.80|91.07|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|||211.80||||211.80|63.54|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|||211.80||||211.80|63.54|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211.80||||211.80|137.67|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211.80||||211.80|44.48|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211.80||||211.80|5.3|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.80||||211.80|91.07|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|211.80||||211.80|106.11|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211.80||||211.80|5.3|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211.80||||211.80|137.67|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|211.80||||211.80|158.85|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|211.80||||211.80|158.85|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211.80||||211.80|190.62|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|211.80||||211.80|106.11|190.62|5.3 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211.80||||211.80||| 17595|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211.80||||211.80||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.82||||10.82|8.12|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.82||||10.82|8.12|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.82||||10.82|5.19|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|||10.82||||10.82|3.25|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.82||||10.82|7.03|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.82||||10.82|7.03|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.82||||10.82|2.27|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|||10.82||||10.82|3.25|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.82||||10.82|4.65|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.82||||10.82|4.65|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.82||||10.82|5.19|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.82||||10.82|5.19|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.82||||10.82|7.03|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.82||||10.82|4.65|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.82||||10.82|6.49|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.82||||10.82|6.49|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.82||||10.82|6.49|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.82||||10.82|3.8|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.82||||10.82|3.8|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.82||||10.82|4.65|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.82||||10.82|3.8|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.82||||10.82|4.65|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.82||||10.82|4.65|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.82||||10.82|5.42|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.82||||10.82|5.42|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.82||||10.82|4.61|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.82||||10.82|5.42|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|||10.82||||10.82|3.25|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.82||||10.82|2.27|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.82||||10.82|2.27|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.82||||10.82|4.61|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.82||||10.82|8.12|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.82||||10.82|4.61|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.82||||10.82|9.74|9.74|2.27 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.82||||10.82||| 1767|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.82||||10.82||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.95||||16.95|7.29|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.95||||16.95|5.95|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.95||||16.95|7.29|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.95||||16.95|10.17|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.95||||16.95|7.22|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.95||||16.95|8.49|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|UMR [2035]|UMR OPTIONS [203501]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.95||||16.95|3.56|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.95||||16.95|8.13|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|16.95||||16.95|12.71|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|GEHA [1415]|GEHA [141500]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.95||||16.95|11.02|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|||16.95||||16.95|5.08|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.95||||16.95|15.26|15.26|3.56 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MULTIPLAN [1680]|HMA [168003]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.95||||16.95||| 1769|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 1 % VAGINAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.95||||16.95||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|GEHA [1415]|GEHA [141500]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|167.25||||167.25|125.44|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|||167.25||||167.25|50.17|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167.25||||167.25|108.71|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167.25||||167.25|80.2|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167.25||||167.25|35.12|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167.25||||167.25|2.94|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167.25||||167.25|71.92|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|167.25||||167.25|58.54|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|167.25||||167.25|71.25|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167.25||||167.25|150.53|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167.25||||167.25|71.92|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|167.25||||167.25|83.79|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167.25||||167.25|58.7|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167.25||||167.25|100.35|150.53|2.94 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167.25||||167.25||| 177089|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG/100 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167.25||||167.25||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|585.00||||585.00|292.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|585.00||||585.00|249.21|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|585.00||||585.00|251.55|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|TRUSTMARK [2030]|STARMARK [203000]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MULTIPLAN [1680]|IHC HS [168011]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|585.00||||585.00|251.55|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|HEALTHNET [1495]|HEALTHNET [149500]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|UMR [2035]|UMR OPTIONS [203501]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MULTIPLAN [1680]|HMA [168003]|585.00||||585.00|204.75|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|585.00||||585.00|122.85|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|585.00||||585.00|280.51|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|585.00||||585.00|380.25|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|||585.00||||585.00|175.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|585.00||||585.00|351|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|585.00||||585.00|205.34|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|585.00||||585.00|293.09|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|CHAMPVA [1240]|CHAMP VA [124000]|585.00||||585.00|438.75|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|CORESOURCE [1315]|CORESOURCE [131500]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|GEHA [1415]|GEHA [141500]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|585.00||||585.00|526.5|526.5|122.85 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|AETNA [1015]|AETNA ACO WILCO [101532]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|585.00||||585.00||| 177537|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO XE133 XENON GAS PER VIAL 10 MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|585.00||||585.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|||10.00||||10.00|3|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 177830|ERX|0250 - PHARMACY-GENERAL|CALCIUM ACETATE 667 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|213.81||||213.81|107.12|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213.81||||213.81|91.94|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213.81||||213.81|75.05|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213.81||||213.81|75.05|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71.27||||71.27|25.02|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71.27||||71.27|30.65|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142.54||||142.54|61.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71.27||||71.27|25.02|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71.27||||71.27|30.65|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142.54||||142.54|50.03|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213.81||||213.81|91.94|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|213.81||||213.81|91.08|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|213.81||||213.81|107.12|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71.27||||71.27|35.71|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71.27||||71.27|30.36|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71.27||||71.27|35.71|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|142.54||||142.54|71.41|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213.81||||213.81|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142.54||||142.54|85.52|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71.27||||71.27|42.76|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71.27||||71.27|42.76|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUSTMARK [2030]|STARMARK [203000]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUSTMARK [2030]|STARMARK [203000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|IHC HS [168011]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUSTMARK [2030]|STARMARK [203000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|IHC HS [168011]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHNET [1495]|HEALTHNET [149500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHNET [1495]|HEALTHNET [149500]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHNET [1495]|HEALTHNET [149500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHNET [1495]|HEALTHNET [149500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA ACO WILCO [101532]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA ACO WILCO [101532]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|HMA [168003]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA ACO WILCO [101532]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|HMA [168003]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|HMA [168003]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|HMA [168003]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FMH BENEFIT SERVICES [1390]|FMH [139000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FMH BENEFIT SERVICES [1390]|FMH [139000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FMH BENEFIT SERVICES [1390]|FMH [139000]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213.81||||213.81|91.94|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71.27||||71.27|30.65|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71.27||||71.27|30.65|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142.54||||142.54|61.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FIRST HEALTH [1375]|QUALCHOICE [137513]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FIRST HEALTH [1375]|QUALCHOICE [137513]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FIRST HEALTH [1375]|QUALCHOICE [137513]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FIRST HEALTH [1375]|QUALCHOICE [137513]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|142.54||||142.54|60.72|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213.81||||213.81|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213.81||||213.81|91.94|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FMH BENEFIT SERVICES [1390]|FMH [139000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FMH BENEFIT SERVICES [1390]|FMH [139000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHNET [1495]|HEALTHNET [149500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|IHC HS [168011]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR [2035]|UMR OPTIONS [203501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR [2035]|UMR OPTIONS [203501]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|IHC HS [168011]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|IHC HS [168011]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR [2035]|UMR OPTIONS [203501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUSTMARK [2030]|STARMARK [203000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUSTMARK [2030]|STARMARK [203000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR [2035]|UMR OPTIONS [203501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR [2035]|UMR OPTIONS [203501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|FIRST HEALTH [1375]|QUALCHOICE [137513]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71.27||||71.27|14.97|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213.81||||213.81|44.9|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213.81||||213.81|44.9|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142.54||||142.54|68.35|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71.27||||71.27|34.17|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71.27||||71.27|46.33|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213.81||||213.81|102.52|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213.81||||213.81|138.98|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213.81||||213.81|138.98|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|||71.27||||71.27|21.38|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|||213.81||||213.81|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|||142.54||||142.54|42.76|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|||71.27||||71.27|21.38|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|||213.81||||213.81|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MULTIPLAN [1680]|HMA [168003]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA ACO WILCO [101532]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AETNA [1015]|AETNA ACO WILCO [101532]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142.54||||142.54|92.65|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71.27||||71.27|46.33|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71.27||||71.27|34.17|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213.81||||213.81|102.52|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71.27||||71.27|30.36|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|213.81||||213.81|91.08|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142.54||||142.54|29.93|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71.27||||71.27|14.97|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHAMPVA [1240]|CHAMP VA [124000]|213.81||||213.81|160.36|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHAMPVA [1240]|CHAMP VA [124000]|213.81||||213.81|160.36|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHAMPVA [1240]|CHAMP VA [124000]|71.27||||71.27|53.45|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHAMPVA [1240]|CHAMP VA [124000]|71.27||||71.27|53.45|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CHAMPVA [1240]|CHAMP VA [124000]|142.54||||142.54|106.91|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CORESOURCE [1315]|CORESOURCE [131500]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CORESOURCE [1315]|CORESOURCE [131500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CORESOURCE [1315]|CORESOURCE [131500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|GEHA [1415]|GEHA [141500]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|GEHA [1415]|GEHA [141500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142.54||||142.54|128.29|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|GEHA [1415]|GEHA [141500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|GEHA [1415]|GEHA [141500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|GEHA [1415]|GEHA [141500]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CORESOURCE [1315]|CORESOURCE [131500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|CORESOURCE [1315]|CORESOURCE [131500]|71.27||||71.27|64.14|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213.81||||213.81|192.43|192.43|14.97 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71.27||||71.27||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|213.81||||213.81||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|142.54||||142.54||| 17837|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71.27||||71.27||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|GEHA [1415]|GEHA [141500]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|||63.45||||63.45|19.03|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.45||||63.45|13.32|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.45||||63.45|27.28|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.45||||63.45|30.42|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.45||||63.45|38.07|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.45||||63.45|22.27|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.45||||63.45|27.03|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.45||||63.45|27.28|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.45||||63.45|31.79|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|63.45||||63.45|47.59|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.45||||63.45|57.11|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.45||||63.45|41.24|57.11|13.32 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.45||||63.45||| 17881|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.2 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.45||||63.45||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66.21||||66.21|24.25|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.21||||66.21|13.24|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66.21||||66.21|33.17|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66.21||||66.21|21.85|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66.21||||66.21|33.11|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66.21||||66.21|23.24|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66.21||||66.21|28.47|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66.21||||66.21|23.24|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66.21||||66.21|28.47|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66.21||||66.21|28.21|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66.21||||66.21|33.17|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66.21||||66.21|28.21|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66.21||||66.21|39.73|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66.21||||66.21|25.1|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66.21||||66.21|25.1|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.21||||66.21|13.24|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66.21||||66.21|21.85|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66.21||||66.21|21.85|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66.21||||66.21|24.25|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MULTIPLAN [1680]|HMA [168003]|66.21||||66.21|23.17|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66.21||||66.21|25.7|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66.21||||66.21|25.7|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.21||||66.21|28.47|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.21||||66.21|28.47|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MULTIPLAN [1680]|HMA [168003]|66.21||||66.21|23.17|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66.21||||66.21|28.7|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66.21||||66.21|28.7|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.21||||66.21|13.24|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.21||||66.21|13.24|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66.21||||66.21|19.86|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66.21||||66.21|19.86|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UMR [2035]|UMR OPTIONS [203501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66.21||||66.21|13.9|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66.21||||66.21|43.04|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|||66.21||||66.21|19.86|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66.21||||66.21|25.7|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|GEHA [1415]|GEHA [141500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66.21||||66.21|26.09|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|66.21||||66.21|49.66|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|66.21||||66.21|49.66|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66.21||||66.21|25.7|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66.21||||66.21|23.1|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66.21||||66.21|23.1|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66.21||||66.21|39.73|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66.21||||66.21|26.09|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66.21||||66.21|25.1|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|||66.21||||66.21|19.86|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66.21||||66.21|33.11|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66.21||||66.21|25.1|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66.21||||66.21|43.04|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.21||||66.21|31.75|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.21||||66.21|31.75|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66.21||||66.21|21.85|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|GEHA [1415]|GEHA [141500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66.21||||66.21||| 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.21||||66.21|17.88|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66.21||||66.21|20.75|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66.21||||66.21|20.75|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|UMR [2035]|UMR OPTIONS [203501]|66.21||||66.21|59.59|59.59|13.24 179292|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLU VACCINE QS 2020-21(6MOS UP)(PF) 60 MCG(15 MCGX4)/0.5 ML IM SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66.21||||66.21|13.9|59.59|13.24 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 17936|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|250.88||||250.88|106.87|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250.88||||250.88|107.88|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|250.88||||250.88|125.69|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250.88||||250.88|107.88|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250.88||||250.88|52.68|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250.88||||250.88|163.07|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|||250.88||||250.88|75.26|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|GEHA [1415]|GEHA [141500]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250.88||||250.88|150.53|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250.88||||250.88|88.06|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|250.88||||250.88|188.16|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250.88||||250.88|225.79|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250.88||||250.88|120.3|225.79|52.68 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|250.88||||250.88||| 180031|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG/150 ML IN WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|250.88||||250.88||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|418.13||||418.13|313.6|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|418.13||||418.13|271.78|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|418.13||||418.13|200.49|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|418.13||||418.13|250.88|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|418.13||||418.13|209.48|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|418.13||||418.13|178.12|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|418.13||||418.13|146.76|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|418.13||||418.13|179.8|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|||418.13||||418.13|125.44|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|418.13||||418.13|179.8|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|GEHA [1415]|GEHA [141500]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|418.13||||418.13|87.81|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|418.13||||418.13|376.32|376.32|87.81 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|418.13||||418.13||| 180032|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1.25 GRAM/250 ML-WATER FOR INJECTION(PEG,NADA) IV PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|418.13||||418.13||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|||10.00||||10.00|3|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 1802|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE SULFATE 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|GEHA [1415]|GEHA [141500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|23.75||||23.75|17.81|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|23.75||||23.75|17.81|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|||23.75||||23.75|7.12|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.75||||23.75|15.44|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.75||||23.75|15.44|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.75||||23.75|11.39|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.75||||23.75|11.39|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.75||||23.75|4.99|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.75||||23.75|10.21|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.75||||23.75|10.21|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.75||||23.75|4.99|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|||23.75||||23.75|7.12|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.75||||23.75|14.25|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.75||||23.75|14.25|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.75||||23.75|8.34|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.75||||23.75|8.34|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23.75||||23.75|10.12|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.75||||23.75|10.21|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23.75||||23.75|11.9|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23.75||||23.75|10.12|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.75||||23.75|10.21|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23.75||||23.75|11.9|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|GEHA [1415]|GEHA [141500]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MULTIPLAN [1680]|HMA [168003]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.75||||23.75|21.38|21.38|4.99 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.75||||23.75||| 1821|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLCHICINE 0.6 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.75||||23.75||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|||10.00||||10.00|3|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|||10.00||||10.00|3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|||10.00||||10.00|3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|||10.00||||10.00|3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18293|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TORSEMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.36||||64.36|22.59|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.36||||64.36|27.67|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.36||||64.36|22.59|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.36||||64.36|27.67|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64.36||||64.36|32.24|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64.36||||64.36|27.42|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64.36||||64.36|32.24|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.36||||64.36|38.62|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|64.36||||64.36|22.53|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|64.36||||64.36|22.53|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.36||||64.36|27.67|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.36||||64.36|27.67|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.36||||64.36|7|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.36||||64.36|7|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.36||||64.36|13.52|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.36||||64.36|13.52|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.36||||64.36|30.86|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.36||||64.36|30.86|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.36||||64.36|41.83|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.36||||64.36|41.83|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|||64.36||||64.36|19.31|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|||64.36||||64.36|19.31|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.36||||64.36|38.62|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64.36||||64.36|27.42|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|64.36||||64.36|48.27|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|64.36||||64.36|48.27|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.36||||64.36|57.92|57.92|7 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64.36||||64.36||| 18302|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64.36||||64.36||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|54.09||||54.09|40.57|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|54.09||||54.09|40.57|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|||54.09||||54.09|16.23|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|||54.09||||54.09|16.23|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|||54.09||||54.09|16.23|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.09||||54.09|35.16|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.09||||54.09|35.16|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.09||||54.09|25.94|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.09||||54.09|25.94|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.09||||54.09|11.36|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.09||||54.09|11.36|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.09||||54.09|5.25|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.09||||54.09|5.25|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.09||||54.09|5.25|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.09||||54.09|23.26|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.09||||54.09|23.26|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.09||||54.09|23.26|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|54.09||||54.09|18.93|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|54.09||||54.09|18.93|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|54.09||||54.09|18.93|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.09||||54.09|11.36|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.09||||54.09|25.94|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.09||||54.09|35.16|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.09||||54.09|32.45|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.09||||54.09|32.45|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.09||||54.09|32.45|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.09||||54.09|18.99|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.09||||54.09|18.99|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.09||||54.09|23.26|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.09||||54.09|18.99|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.09||||54.09|23.26|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54.09||||54.09|27.1|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54.09||||54.09|23.04|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.09||||54.09|23.26|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54.09||||54.09|27.1|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54.09||||54.09|23.04|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|54.09||||54.09|40.57|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54.09||||54.09|27.1|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54.09||||54.09|23.04|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.09||||54.09|48.68|48.68|5.25 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.09||||54.09||| 18303|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.09||||54.09||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.23||||34.23|12.01|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.23||||34.23|14.58|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.23||||34.23|17.15|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.23||||34.23|20.54|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|34.23||||34.23|11.98|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.23||||34.23|14.72|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.23||||34.23|3.5|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.23||||34.23|7.19|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.23||||34.23|14.72|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.23||||34.23|16.41|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.23||||34.23|22.25|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|||34.23||||34.23|10.27|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|34.23||||34.23|25.67|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.23||||34.23|30.81|30.81|3.5 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.23||||34.23||| 18304|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.23||||34.23||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|||10.00||||10.00|3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|||10.00||||10.00|3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|||10.00||||10.00|3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|||10.00||||10.00|3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18307|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 400 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18308|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18309|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|||10.00||||10.00|3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|||10.00||||10.00|3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|||10.00||||10.00|3|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|||10.00||||10.00|3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|||10.00||||10.00|3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|||10.00||||10.00|3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|||10.00||||10.00|3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|||10.00||||10.00|3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|||10.00||||10.00|3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|||10.00||||10.00|3|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18386|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|||10.00||||10.00|3|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|||10.00||||10.00|3|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARVEDILOL 3.125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45.27||||45.27|27.16|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45.27||||45.27|22.68|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45.27||||45.27|19.29|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45.27||||45.27|15.89|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45.27||||45.27|19.29|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45.27||||45.27|15.89|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45.27||||45.27|15.89|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45.27||||45.27|15.89|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45.27||||45.27|22.68|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45.27||||45.27|27.16|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45.27||||45.27|27.16|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45.27||||45.27|22.68|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45.27||||45.27|27.16|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45.27||||45.27|19.29|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45.27||||45.27|19.29|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45.27||||45.27|29.43|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45.27||||45.27|21.71|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|45.27||||45.27|33.95|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45.27||||45.27|9.51|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45.27||||45.27|9.51|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45.27||||45.27|9.51|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45.27||||45.27|19.47|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45.27||||45.27|9.51|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45.27||||45.27|21.71|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|45.27||||45.27|33.95|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45.27||||45.27|21.71|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45.27||||45.27|21.71|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45.27||||45.27|29.43|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45.27||||45.27|29.43|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45.27||||45.27|29.43|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|||45.27||||45.27|13.58|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|||45.27||||45.27|13.58|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45.27||||45.27|22.68|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|45.27||||45.27|33.95|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|GEHA [1415]|GEHA [141500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|||45.27||||45.27|13.58|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|GEHA [1415]|GEHA [141500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|GEHA [1415]|GEHA [141500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|||45.27||||45.27|13.58|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|GEHA [1415]|GEHA [141500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|45.27||||45.27|33.95|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|45.27||||45.27|40.74|40.74|9.51 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45.27||||45.27||| 18621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LATANOPROST 0.005 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45.27||||45.27||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|||10.00||||10.00|3|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18786|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DONEPEZIL 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|||10.00||||10.00|3|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18918|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18919|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOFLOXACIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|||10.00||||10.00|3|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|||10.00||||10.00|3|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 18920|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|||10.00||||10.00|3|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 18922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TOPIRAMATE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|||10.00||||10.00|3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|||10.00||||10.00|3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|||10.00||||10.00|3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|||10.00||||10.00|3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|||10.00||||10.00|3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19177|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATORVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|||10.00||||10.00|3|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19433|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 3 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|127.72||||127.72|95.79|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|127.72||||127.72|95.79|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|GEHA [1415]|GEHA [141500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|GEHA [1415]|GEHA [141500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.72||||127.72|44.83|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.72||||127.72|44.83|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.72||||127.72|54.92|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127.72||||127.72|63.99|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127.72||||127.72|54.41|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127.72||||127.72|63.99|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.72||||127.72|76.63|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.72||||127.72|54.92|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.72||||127.72|54.92|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.72||||127.72|76.63|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.72||||127.72|54.92|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127.72||||127.72|54.41|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.72||||127.72|26.82|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.72||||127.72|26.82|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.72||||127.72|114.95|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.72||||127.72|61.24|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.72||||127.72|61.24|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.72||||127.72|83.02|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.72||||127.72|83.02|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|||127.72||||127.72|38.32|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|||127.72||||127.72|38.32|114.95|26.82 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127.72||||127.72||| 19452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLOPATADINE 0.1 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127.72||||127.72||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|GEHA [1415]|GEHA [141500]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|206.63||||206.63|154.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|||206.63||||206.63|61.99|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206.63||||206.63|99.08|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206.63||||206.63|43.39|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206.63||||206.63|88.85|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206.63||||206.63|134.31|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206.63||||206.63|123.98|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206.63||||206.63|72.53|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|206.63||||206.63|88.02|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206.63||||206.63|88.85|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|206.63||||206.63|103.52|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206.63||||206.63|185.97|185.97|43.39 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MULTIPLAN [1680]|HMA [168003]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206.63||||206.63||| 19596|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206.63||||206.63||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|207.11||||207.11|72.7|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103.56||||103.56|36.35|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103.56||||103.56|44.12|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|207.11||||207.11|89.06|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|207.11||||207.11|103.76|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|207.11||||207.11|88.23|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103.56||||103.56|51.88|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103.56||||103.56|62.14|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|207.11||||207.11|89.06|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103.56||||103.56|44.53|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|207.11||||207.11|43.49|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103.56||||103.56|21.75|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|207.11||||207.11|99.31|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103.56||||103.56|49.66|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|207.11||||207.11|134.62|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103.56||||103.56|67.31|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|207.11||||207.11|124.27|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|||103.56||||103.56|31.07|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|||207.11||||207.11|62.13|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103.56||||103.56|44.53|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|207.11||||207.11|155.33|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|103.56||||103.56|77.67|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|207.11||||207.11||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103.56||||103.56|93.2|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|207.11||||207.11|186.4|186.4|21.75 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103.56||||103.56||| 19733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|KETOROLAC 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|207.11||||207.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|54.11||||54.11|40.58|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|54.11||||54.11|40.58|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|||54.11||||54.11|16.23|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.11||||54.11|35.17|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.11||||54.11|25.95|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.11||||54.11|25.95|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.11||||54.11|11.36|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.11||||54.11|23.27|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.11||||54.11|23.27|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.11||||54.11|11.36|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.11||||54.11|35.17|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|||54.11||||54.11|16.23|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.11||||54.11|32.47|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.11||||54.11|32.47|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.11||||54.11|23.27|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54.11||||54.11|23.05|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.11||||54.11|18.99|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.11||||54.11|18.99|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.11||||54.11|23.27|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54.11||||54.11|27.11|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54.11||||54.11|23.05|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54.11||||54.11|27.11|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.11||||54.11|48.7|48.7|11.36 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.11||||54.11||| 19746|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OFLOXACIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.11||||54.11||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 19882|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SERTRALINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.95|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.95|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.95 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 2007|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|||10.00||||10.00|3|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2008|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|||10.00||||10.00|3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|||10.00||||10.00|3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|||10.00||||10.00|3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYANOCOBALAMIN (VIT B-12) 500 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|||10.00||||10.00|3|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|||10.00||||10.00|3|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2033|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYPROHEPTADINE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|||10.00||||10.00|3|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|||10.00||||10.00|3|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 20566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MELOXICAM 7.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|||10.00||||10.00|3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|||10.00||||10.00|3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|||10.00||||10.00|3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 20943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AZITHROMYCIN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21057|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OLANZAPINE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|||10.00||||10.00|3|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21061|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 300 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|||10.00||||10.00|3|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|||10.00||||10.00|3|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21062|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.01||||39.01|13.69|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.01||||39.01|4.27|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.01||||39.01|13.69|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.01||||39.01|19.54|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.01||||39.01|8.19|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.01||||39.01|16.62|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.01||||39.01|4.27|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.01||||39.01|23.41|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.01||||39.01|8.19|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|||39.01||||39.01|11.7|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.01||||39.01|19.54|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.01||||39.01|4.27|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.01||||39.01|23.41|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.01||||39.01|4.27|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|39.01||||39.01|13.65|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.01||||39.01|18.71|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|39.01||||39.01|29.26|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|39.01||||39.01|13.65|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|||39.01||||39.01|11.7|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.01||||39.01|8.19|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|||39.01||||39.01|11.7|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|39.01||||39.01|13.65|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.01||||39.01|18.71|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.01||||39.01|25.36|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.01||||39.01|16.62|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.01||||39.01|16.62|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.01||||39.01|23.41|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|39.01||||39.01|29.26|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|39.01||||39.01|29.26|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.01||||39.01|18.71|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.01||||39.01|25.36|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.01||||39.01|25.36|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.01||||39.01|25.36|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.01||||39.01|16.62|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.01||||39.01|13.69|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|||39.01||||39.01|11.7|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.01||||39.01|8.19|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|39.01||||39.01|29.26|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.01||||39.01|18.71|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.01||||39.01|13.69|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.01||||39.01|19.54|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.01||||39.01|16.77|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.01||||39.01|23.41|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.01||||39.01|19.54|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|39.01||||39.01|13.65|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.01||||39.01|35.11|35.11|4.27 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.01||||39.01||| 21063|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZITHROMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.01||||39.01||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|||10.00||||10.00|3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|||10.00||||10.00|3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|||10.00||||10.00|3|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21288|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|||10.00||||10.00|3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|||10.00||||10.00|3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|||10.00||||10.00|3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21290|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21300|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|||10.00||||10.00|3|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2131|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|||10.00||||10.00|3|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DAPSONE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|||10.00||||10.00|3|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21372|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.87|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.87|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|||10.00||||10.00|3|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|||10.00||||10.00|3|9|0.87 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21374|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE MOFETIL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LETROZOLE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|||10.00||||10.00|3|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21688|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 0.25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|||10.00||||10.00|3|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21689|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROPINIROLE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21823|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 21824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUETIAPINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|||10.00||||10.00|3|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|||10.00||||10.00|3|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 22142|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOPIDOGREL 75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|||10.00||||10.00|3|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 22143|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RALOXIFENE 60 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 22289|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFDINIR 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.71|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.71|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.71|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.71 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 22473|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|KETOROLAC 30 MG/ML (1 ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|||10.00||||10.00|3|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 22509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MONTELUKAST 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 22719|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2286|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DESIPRAMINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|84.00||||84.00|63|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|||84.00||||84.00|25.2|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|||59.07||||59.07|17.72|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59.07||||59.07|38.4|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84.00||||84.00|54.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84.00||||84.00|40.28|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84.00||||84.00|17.64|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59.07||||59.07|12.4|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84.00||||84.00|10.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59.07||||59.07|25.4|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84.00||||84.00|36.12|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|84.00||||84.00|29.4|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|59.07||||59.07|20.67|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59.07||||59.07|5.3|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59.07||||59.07|28.32|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84.00||||84.00|50.4|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59.07||||59.07|35.44|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59.07||||59.07|29.59|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84.00||||84.00|42.08|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|59.07||||59.07|44.3|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59.07||||59.07|25.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59.07||||59.07|25.4|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84.00||||84.00|36.12|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84.00||||84.00|35.78|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59.07||||59.07|20.73|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84.00||||84.00|29.48|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84.00||||84.00|75.6|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59.07||||59.07|53.16|75.6|5.3 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84.00||||84.00||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59.07||||59.07||| 23128|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84.00||||84.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 23150|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 180 MG 24 HR CAPSULE,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|||10.00||||10.00|3|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|||10.00||||10.00|3|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|||10.00||||10.00|3|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|||10.00||||10.00|3|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2326|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXAMETHASONE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|||10.00||||10.00|3|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|||10.00||||10.00|3|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|1.7|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|1.7|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|1.7 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2327|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.55|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.55 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 2332|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 2357|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|4.26|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|||90.00||||90.00|27|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|4.26 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 2364|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|GEHA [1415]|GEHA [141500]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|11.29||||11.29|8.47|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|||11.29||||11.29|3.39|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.29||||11.29|7.34|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.29||||11.29|2.37|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.29||||11.29|4.85|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.29||||11.29|5.41|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.29||||11.29|6.77|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.29||||11.29|3.96|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.29||||11.29|5.66|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.29||||11.29|4.85|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.29||||11.29|4.81|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.29||||11.29|10.16|10.16|2.37 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.29||||11.29||| 23872|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.29||||11.29||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.52||||139.52|59.99|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.52||||139.52|48.97|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139.52||||139.52|69.9|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139.52||||139.52|59.44|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139.52||||139.52|59.44|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139.52||||139.52|69.9|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.52||||139.52|83.71|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.52||||139.52|83.71|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.52||||139.52|59.99|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.52||||139.52|59.99|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.52||||139.52|29.3|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.52||||139.52|29.3|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.52||||139.52|66.9|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.52||||139.52|66.9|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.52||||139.52|90.69|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.52||||139.52|90.69|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|||139.52||||139.52|41.86|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|||139.52||||139.52|41.86|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.52||||139.52|48.97|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.52||||139.52|59.99|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|139.52||||139.52|104.64|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|139.52||||139.52|104.64|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.52||||139.52|125.57|125.57|29.3 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139.52||||139.52||| 23873|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEFLUNOMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139.52||||139.52||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|||0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 24000001|EAP|0024 - INPATIENT REHAB FACILITY PROSPECTIVE PAYMEN|HC INPATIENT REHABILITATION FACILITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|||10.00||||10.00|3|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|||10.00||||10.00|3|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2404|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|||10.00||||10.00|3|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|||10.00||||10.00|3|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2405|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIAZEPAM 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|||10.00||||10.00|3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DICYCLOMINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|||10.00||||10.00|3|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|||10.00||||10.00|3|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24216|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24268|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|||10.00||||10.00|3|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|||10.00||||10.00|3|9|2.1 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2444|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIGOXIN 125 MCG (0.125 MG) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|||11.55||||11.55|3.46|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.55||||11.55|7.51|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.55||||11.55|5.54|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.55||||11.55|7.51|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.55||||11.55|2.43|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.55||||11.55|4.97|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.55||||11.55|2.43|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|||11.55||||11.55|3.46|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.55||||11.55|4.97|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.55||||11.55|4.97|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|||11.55||||11.55|3.46|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.55||||11.55|5.79|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.55||||11.55|5.54|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.55||||11.55|7.51|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.55||||11.55|5.54|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.55||||11.55|6.93|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.55||||11.55|2.43|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.55||||11.55|6.93|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.55||||11.55|5.79|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.55||||11.55|6.93|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.55||||11.55|4.92|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.55||||11.55|4.97|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.55||||11.55|4.97|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.55||||11.55|4.05|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.55||||11.55|4.92|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.55||||11.55|4.92|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.55||||11.55|4.05|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.55||||11.55|5.79|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.55||||11.55|4.97|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.55||||11.55|4.05|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|11.55||||11.55|8.66|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|11.55||||11.55|8.66|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|11.55||||11.55|8.66|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.55||||11.55|10.4|10.4|2.43 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.55||||11.55||| 24470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.55||||11.55||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|||10.00||||10.00|3|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24473|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CILOSTAZOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|GEHA [1415]|GEHA [141500]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|||21.28||||21.28|6.38|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.28||||21.28|4.47|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.28||||21.28|9.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.28||||21.28|13.83|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.28||||21.28|10.2|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|21.28||||21.28|15.96|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.28||||21.28|12.77|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.28||||21.28|10.66|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.28||||21.28|7.47|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.28||||21.28|9.07|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.28||||21.28|9.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|21.28||||21.28|19.15|19.15|4.47 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.28||||21.28||| 24501|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CELECOXIB 200 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.28||||21.28||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24521|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|||63.04||||63.04|18.91|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|GEHA [1415]|GEHA [141500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|63.04||||63.04|47.28|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|63.04||||63.04|47.28|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|GEHA [1415]|GEHA [141500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|||63.04||||63.04|18.91|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.04||||63.04|40.98|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.04||||63.04|30.23|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.04||||63.04|30.23|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.04||||63.04|13.24|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.04||||63.04|27.11|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.04||||63.04|27.11|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.04||||63.04|13.24|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.04||||63.04|37.82|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.04||||63.04|40.98|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.04||||63.04|27.11|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.04||||63.04|22.13|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.04||||63.04|22.13|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.04||||63.04|27.11|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.04||||63.04|31.58|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.04||||63.04|26.86|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.04||||63.04|31.58|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.04||||63.04|26.86|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.04||||63.04|37.82|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|63.04||||63.04|56.74|56.74|13.24 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.04||||63.04||| 24702|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MODAFINIL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.04||||63.04||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|||10.00||||10.00|3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|||10.00||||10.00|3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|||10.00||||10.00|3|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2475|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|||10.00||||10.00|3|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2476|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 60 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|||10.00||||10.00|3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|||10.00||||10.00|3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|||10.00||||10.00|3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|||10.00||||10.00|3|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.8 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24914|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|TACROLIMUS 0.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|GEHA [1415]|GEHA [141500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|GEHA [1415]|GEHA [141500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|127.20||||127.20|95.4|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|||127.20||||127.20|38.16|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|||127.20||||127.20|38.16|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.20||||127.20|82.68|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.20||||127.20|82.68|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.20||||127.20|60.99|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.20||||127.20|26.71|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.20||||127.20|26.71|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.20||||127.20|11.08|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UMR [2035]|UMR OPTIONS [203501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UMR [2035]|UMR OPTIONS [203501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.20||||127.20|54.7|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.20||||127.20|54.7|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|127.20||||127.20|44.52|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|127.20||||127.20|44.52|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.20||||127.20|11.08|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.20||||127.20|60.99|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.20||||127.20|76.32|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.20||||127.20|76.32|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.20||||127.20|54.7|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127.20||||127.20|54.19|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.20||||127.20|44.65|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.20||||127.20|44.65|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127.20||||127.20|63.73|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.20||||127.20|54.7|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|127.20||||127.20|95.4|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127.20||||127.20|54.19|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127.20||||127.20|63.73|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.20||||127.20|114.48|114.48|11.08 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.20||||127.20||| 24932|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE 62.5 MG/5 ML INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.20||||127.20||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|||10.00||||10.00|3|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 250|ERX|0250 - PHARMACY-GENERAL|ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.69|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.69|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.69 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 2508|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2509|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|GEHA [1415]|GEHA [141500]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|CORESOURCE [1315]|CORESOURCE [131500]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|CHAMPVA [1240]|CHAMP VA [124000]|12.63||||12.63|9.47|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|||12.63||||12.63|3.79|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.63||||12.63|6.06|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.63||||12.63|2.65|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|UMR [2035]|UMR OPTIONS [203501]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.63||||12.63|5.43|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|HEALTHNET [1495]|HEALTHNET [149500]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MULTIPLAN [1680]|IHC HS [168011]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.63||||12.63|8.21|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|TRUSTMARK [2030]|STARMARK [203000]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.63||||12.63|7.58|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.63||||12.63|5.43|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.63||||12.63|5.38|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.63||||12.63|4.43|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.63||||12.63|6.33|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.63||||12.63|6.32|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.63||||12.63|11.37|11.37|2.65 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MULTIPLAN [1680]|HMA [168003]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|AETNA [1015]|AETNA ACO WILCO [101532]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.63||||12.63||| 2511|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.63||||12.63||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|||10.00||||10.00|3|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|||10.00||||10.00|3|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25118|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25119|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25238|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER 120 MG 24 HR CAPSULE,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|||10.00||||10.00|3|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIPYRIDAMOLE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26.35||||26.35|11.33|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26.35||||26.35|11.33|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26.35||||26.35|13.2|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26.35||||26.35|11.23|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26.35||||26.35|9.25|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26.35||||26.35|13.2|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26.35||||26.35|9.25|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26.35||||26.35|15.81|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26.35||||26.35|11.33|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26.35||||26.35|11.33|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26.35||||26.35|5.53|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26.35||||26.35|5.53|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26.35||||26.35|12.63|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26.35||||26.35|12.63|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26.35||||26.35|17.13|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26.35||||26.35|17.13|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26.35||||26.35|15.81|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|||26.35||||26.35|7.9|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|||26.35||||26.35|7.9|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26.35||||26.35|11.23|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|26.35||||26.35|19.76|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|26.35||||26.35|19.76|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|GEHA [1415]|GEHA [141500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|GEHA [1415]|GEHA [141500]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26.35||||26.35|23.72|23.72|5.53 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26.35||||26.35||| 253|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26.35||||26.35||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.58||||10.58|7.94|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|||10.58||||10.58|3.17|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.58||||10.58|6.88|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.58||||10.58|2.22|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.58||||10.58|4.55|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.58||||10.58|5.07|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.58||||10.58|6.35|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.58||||10.58|4.51|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.58||||10.58|4.55|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.58||||10.58|5.3|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.58||||10.58|3.71|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.58||||10.58|9.52|9.52|2.22 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.58||||10.58||| 254|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALBUTEROL SULFATE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.58||||10.58||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2551|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2552|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 250 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25520|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RISPERIDONE 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|||10.00||||10.00|3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|||10.00||||10.00|3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|||10.00||||10.00|3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|||10.00||||10.00|3|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIOGLITAZONE 15 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2553|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 500 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2566|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|||10.00||||10.00|3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|||10.00||||10.00|3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|||10.00||||10.00|3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 25855|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2608|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|GEHA [1415]|GEHA [141500]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|566.00||||566.00|35.19|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|CORESOURCE [1315]|CORESOURCE [131500]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|CHAMPVA [1240]|CHAMP VA [124000]|566.00||||566.00|424.5|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|566.00||||566.00|31.15|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|566.00||||566.00|52.96|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|UMR [2035]|UMR OPTIONS [203501]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|566.00||||566.00|38.72|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MULTIPLAN [1680]|IHC HS [168011]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|566.00||||566.00|32.71|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|566.00||||566.00|283.57|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|566.00||||566.00|198.67|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|566.00||||566.00|90.55|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|566.00||||566.00|38.83|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|566.00||||566.00|241.12|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|566.00||||566.00|243.38|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|566.00||||566.00|339.6|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|566.00||||566.00|38.09|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|TRUSTMARK [2030]|STARMARK [203000]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|566.00||||566.00|39.9|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MULTIPLAN [1680]|HMA [168003]|566.00||||566.00|54.41|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|566.00||||566.00|52.15|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|566.00||||566.00|33.86|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|HEALTHNET [1495]|HEALTHNET [149500]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|566.00||||566.00|243.38|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|566.00||||566.00|37|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|566.00||||566.00|52.15|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|566.00||||566.00|118.86|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|566.00||||566.00|566|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|566.00||||566.00|509.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|566.00||||566.00|271.4|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|566.00||||566.00|367.9|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|566.00||||566.00|33.86|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|566.00||||566.00|36.28|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|||566.00||||566.00|169.8|566|31.15 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|566.00||||566.00||| 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|566.00||||566.00||| 26096361|EAP|0260 - IV THERAPY-GENERAL|HC IV INF HYDRATION EACH ADDL HR|AETNA [1015]|AETNA ACO WILCO [101532]|566.00||||566.00||| 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|CORESOURCE [1315]|CORESOURCE [131500]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1084.00||||1084.00|447.39|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1084.00||||1084.00|380.48|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1084.00||||1084.00|650.4|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1084.00||||1084.00|466.12|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1084.00||||1084.00|183.64|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1084.00||||1084.00|192.39|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1084.00||||1084.00|170.19|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1084.00||||1084.00|251.43|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MULTIPLAN [1680]|HMA [168003]|1084.00||||1084.00|262.35|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MULTIPLAN [1680]|IHC HS [168011]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|HEALTHNET [1495]|HEALTHNET [149500]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1084.00||||1084.00|191.22|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1084.00||||1084.00|466.12|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|TRUSTMARK [2030]|STARMARK [203000]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1084.00||||1084.00|178.4|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|UMR [2035]|UMR OPTIONS [203501]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1084.00||||1084.00|161.54|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1084.00||||1084.00|167.25|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1084.00||||1084.00|255.35|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1084.00||||1084.00|227.64|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1084.00||||1084.00|1084|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1084.00||||1084.00|461.78|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1084.00||||1084.00|543.08|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1084.00||||1084.00|519.78|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1084.00||||1084.00|704.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|||1084.00||||1084.00|325.2|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1084.00||||1084.00|192.39|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1084.00||||1084.00|167.25|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1084.00||||1084.00|174.9|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1084.00||||1084.00|153.84|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|CHAMPVA [1240]|CHAMP VA [124000]|1084.00||||1084.00|813|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1084.00||||1084.00|251.43|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1084.00||||1084.00|173.84|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|GEHA [1415]|GEHA [141500]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1084.00||||1084.00|975.6|1084|153.84 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1084.00||||1084.00||| 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|AETNA [1015]|AETNA ACO WILCO [101532]|1084.00||||1084.00||| 26096365|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX INITIAL 1ST HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1084.00||||1084.00||| 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|566.00||||566.00|52.15|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|GEHA [1415]|GEHA [141500]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|CORESOURCE [1315]|CORESOURCE [131500]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|CHAMPVA [1240]|CHAMP VA [124000]|566.00||||566.00|424.5|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|566.00||||566.00|33.86|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|566.00||||566.00|367.9|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|566.00||||566.00|271.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|566.00||||566.00|118.86|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|566.00||||566.00|37|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|566.00||||566.00|38.72|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|566.00||||566.00|52.96|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|566.00||||566.00|566|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|566.00||||566.00|243.38|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|UMR [2035]|UMR OPTIONS [203501]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|HEALTHNET [1495]|HEALTHNET [149500]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MULTIPLAN [1680]|IHC HS [168011]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|566.00||||566.00|52.15|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MULTIPLAN [1680]|HMA [168003]|566.00||||566.00|54.41|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|566.00||||566.00|39.9|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|566.00||||566.00|339.6|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|566.00||||566.00|241.12|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|566.00||||566.00|39.9|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|||566.00||||566.00|169.8|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|566.00||||566.00|90.55|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|566.00||||566.00|31.15|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|566.00||||566.00|283.57|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|566.00||||566.00|243.38|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|566.00||||566.00|35.19|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|566.00||||566.00|38.09|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|566.00||||566.00|33.86|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|566.00||||566.00|32.71|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|566.00||||566.00|35.3|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|566.00||||566.00|36.28|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|TRUSTMARK [2030]|STARMARK [203000]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|566.00||||566.00|509.4|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|566.00||||566.00|198.67|566|31.15 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|566.00||||566.00||| 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|AETNA [1015]|AETNA ACO WILCO [101532]|566.00||||566.00||| 26096366|EAP|0260 - IV THERAPY-GENERAL|HC IV INF TX/DX EACH ADDL HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|566.00||||566.00||| 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|CHAMPVA [1240]|CHAMP VA [124000]|282.00||||282.00|211.5|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|282.00||||282.00|61.61|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|282.00||||282.00|142.82|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|282.00||||282.00|98.98|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|282.00||||282.00|141.28|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|282.00||||282.00|60.43|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|282.00||||282.00|33.86|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|282.00||||282.00|32.71|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|HEALTHNET [1495]|HEALTHNET [149500]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MULTIPLAN [1680]|HMA [168003]|282.00||||282.00|86.33|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|282.00||||282.00|38.72|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|282.00||||282.00|82.74|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|TRUSTMARK [2030]|STARMARK [203000]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|282.00||||282.00|121.26|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MULTIPLAN [1680]|IHC HS [168011]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|282.00||||282.00|58.71|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|UMR [2035]|UMR OPTIONS [203501]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|282.00||||282.00|63.31|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|282.00||||282.00|84.03|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|282.00||||282.00|59.22|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|282.00||||282.00|282|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|282.00||||282.00|169.2|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|282.00||||282.00|135.22|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|282.00||||282.00|121.26|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|282.00||||282.00|183.3|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|282.00||||282.00|120.13|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|||282.00||||282.00|84.6|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|282.00||||282.00|33.86|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|282.00||||282.00|57.56|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|282.00||||282.00|31.15|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|282.00||||282.00|80.52|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|282.00||||282.00|35.19|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|CORESOURCE [1315]|CORESOURCE [131500]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|GEHA [1415]|GEHA [141500]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|282.00||||282.00|253.8|282|31.15 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|282.00||||282.00||| 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|282.00||||282.00||| 26096372|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IM/SQ|AETNA [1015]|AETNA ACO WILCO [101532]|282.00||||282.00||| 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|FIRST HEALTH [1375]|QUALCHOICE [137513]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|GEHA [1415]|GEHA [141500]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|CORESOURCE [1315]|CORESOURCE [131500]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|426.00||||426.00|251.43|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|CHAMPVA [1240]|CHAMP VA [124000]|426.00||||426.00|319.5|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|426.00||||426.00|45.43|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|426.00||||426.00|49.39|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|||426.00||||426.00|127.8|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|426.00||||426.00|204.27|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|426.00||||426.00|426|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|426.00||||426.00|89.46|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|426.00||||426.00|255.35|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|UMR [2035]|UMR OPTIONS [203501]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|426.00||||426.00|178.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|426.00||||426.00|183.18|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|426.00||||426.00|56.47|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|FMH BENEFIT SERVICES [1390]|FMH [139000]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MULTIPLAN [1680]|IHC HS [168011]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|426.00||||426.00|251.43|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MULTIPLAN [1680]|HMA [168003]|426.00||||426.00|262.35|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|HEALTHNET [1495]|HEALTHNET [149500]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|426.00||||426.00|47.71|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|426.00||||426.00|149.53|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|426.00||||426.00|276.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|426.00||||426.00|187.21|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|426.00||||426.00|426|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|426.00||||426.00|181.48|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|426.00||||426.00|183.18|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|426.00||||426.00|255.6|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|426.00||||426.00|183.64|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|426.00||||426.00|51.33|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|426.00||||426.00|213.43|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|426.00||||426.00|49.39|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|426.00||||426.00|192.39|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|TRUSTMARK [2030]|STARMARK [203000]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|426.00||||426.00|383.4|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|426.00||||426.00|174.9|426|45.43 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|426.00||||426.00||| 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|AETNA [1015]|AETNA ACO WILCO [101532]|426.00||||426.00||| 26096374|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IV PUSH SGL OR INI DRUG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|426.00||||426.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|392.00||||392.00|196|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|392.00||||392.00|166.99|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|392.00||||392.00|196.39|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|392.00||||392.00|168.56|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|392.00||||392.00|137.59|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|392.00||||392.00|235.2|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|HEALTHNET [1495]|HEALTHNET [149500]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MULTIPLAN [1680]|IHC HS [168011]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|FIRST HEALTH [1375]|QUALCHOICE [137513]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|UMR [2035]|UMR OPTIONS [203501]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|392.00||||392.00|392|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|392.00||||392.00|254.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|CORESOURCE [1315]|CORESOURCE [131500]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|GEHA [1415]|GEHA [141500]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|CHAMPVA [1240]|CHAMP VA [124000]|392.00||||392.00|294|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|392.00||||392.00|187.96|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|392.00||||392.00|82.32|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|392.00||||392.00|168.56|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|||392.00||||392.00|117.6|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|TRUSTMARK [2030]|STARMARK [203000]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|FMH BENEFIT SERVICES [1390]|FMH [139000]|392.00||||392.00|352.8|392|82.32 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|AETNA [1015]|AETNA ACO WILCO [101532]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MULTIPLAN [1680]|HMA [168003]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|392.00||||392.00||| 26096376|EAP|0260 - IV THERAPY-GENERAL|HC INJ TX/DX IVP EA ADDL SAME DRUG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|392.00||||392.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2611|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 2612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXEPIN 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|GEHA [1415]|GEHA [141500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|GEHA [1415]|GEHA [141500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|GEHA [1415]|GEHA [141500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|105.32||||105.32|78.99|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|105.32||||105.32|78.99|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|||105.32||||105.32|31.6|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|||105.32||||105.32|31.6|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|||105.32||||105.32|31.6|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105.32||||105.32|68.46|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105.32||||105.32|50.5|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105.32||||105.32|50.5|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105.32||||105.32|22.12|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105.32||||105.32|68.46|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UMR [2035]|UMR OPTIONS [203501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UMR [2035]|UMR OPTIONS [203501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105.32||||105.32|68.46|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105.32||||105.32|45.29|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105.32||||105.32|45.29|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105.32||||105.32|45.29|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UMR [2035]|UMR OPTIONS [203501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105.32||||105.32|50.5|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|HMA [168003]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|HMA [168003]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|HMA [168003]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105.32||||105.32|22.12|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105.32||||105.32|22.12|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105.32||||105.32|45.29|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|105.32||||105.32|52.77|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105.32||||105.32|36.97|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105.32||||105.32|36.97|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|105.32||||105.32|44.87|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105.32||||105.32|45.29|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105.32||||105.32|63.19|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|105.32||||105.32|78.99|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105.32||||105.32|63.19|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105.32||||105.32|63.19|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|105.32||||105.32|52.77|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|105.32||||105.32|52.77|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105.32||||105.32|36.97|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|105.32||||105.32|44.87|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105.32||||105.32|45.29|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|105.32||||105.32|44.87|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105.32||||105.32|94.79|94.79|22.12 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105.32||||105.32||| 2622|ERX|0250 - PHARMACY-GENERAL|DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER FOR SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105.32||||105.32||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.22||||16.22|9.73|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.22||||16.22|9.73|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.22||||16.22|5.69|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.22||||16.22|6.97|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.22||||16.22|5.69|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.22||||16.22|8.13|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.22||||16.22|6.91|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.22||||16.22|6.97|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.22||||16.22|8.13|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.22||||16.22|6.97|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.22||||16.22|6.91|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.22||||16.22|6.91|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.22||||16.22|6.97|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.22||||16.22|6.97|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.22||||16.22|6.97|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.22||||16.22|3.41|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.22||||16.22|3.41|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.22||||16.22|3.41|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.22||||16.22|7.78|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.22||||16.22|7.78|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.22||||16.22|7.78|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.22||||16.22|10.54|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.22||||16.22|10.54|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.22||||16.22|10.54|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|||16.22||||16.22|4.87|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|||16.22||||16.22|4.87|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|||16.22||||16.22|4.87|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.22||||16.22|5.69|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.22||||16.22|8.13|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.22||||16.22|9.73|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|16.22||||16.22|12.17|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|16.22||||16.22|12.17|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|16.22||||16.22|12.17|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|GEHA [1415]|GEHA [141500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|GEHA [1415]|GEHA [141500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|GEHA [1415]|GEHA [141500]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.22||||16.22|14.6|14.6|3.41 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.22||||16.22||| 2625|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXYCYCLINE HYCLATE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.22||||16.22||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA ER 50 MG-LEVODOPA 200 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.06||||49.06|29.44|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.06||||49.06|29.44|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.06||||49.06|29.44|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.06||||49.06|24.58|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.06||||49.06|21.1|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.06||||49.06|17.22|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.06||||49.06|20.9|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.06||||49.06|20.9|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.06||||49.06|17.22|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.06||||49.06|21.1|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.06||||49.06|17.22|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.06||||49.06|24.58|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.06||||49.06|21.1|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.06||||49.06|21.1|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.06||||49.06|21.1|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.06||||49.06|10.3|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.06||||49.06|10.3|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.06||||49.06|10.3|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.06||||49.06|23.52|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.06||||49.06|23.52|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.06||||49.06|23.52|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.06||||49.06|31.89|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.06||||49.06|31.89|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.06||||49.06|31.89|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|||49.06||||49.06|14.72|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|||49.06||||49.06|14.72|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|||49.06||||49.06|14.72|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.06||||49.06|20.9|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.06||||49.06|21.1|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.06||||49.06|24.58|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|49.06||||49.06|36.8|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|49.06||||49.06|36.8|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|49.06||||49.06|36.8|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|GEHA [1415]|GEHA [141500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|GEHA [1415]|GEHA [141500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|GEHA [1415]|GEHA [141500]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.06||||49.06|44.15|44.15|10.3 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.06||||49.06||| 26546|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 75 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.06||||49.06||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|GEHA [1415]|GEHA [141500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|GEHA [1415]|GEHA [141500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|24.01||||24.01|18.01|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|24.01||||24.01|18.01|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|24.01||||24.01|18.01|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|||24.01||||24.01|7.2|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|||24.01||||24.01|7.2|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|||24.01||||24.01|7.2|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.01||||24.01|15.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.01||||24.01|15.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.01||||24.01|15.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.01||||24.01|11.51|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.01||||24.01|11.51|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.01||||24.01|5.04|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.01||||24.01|5.04|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.01||||24.01|10.32|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.01||||24.01|10.32|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.01||||24.01|10.32|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.01||||24.01|5.04|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.01||||24.01|11.51|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.01||||24.01|10.32|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.01||||24.01|8.43|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.01||||24.01|10.23|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.01||||24.01|12.03|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.01||||24.01|10.32|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.01||||24.01|12.03|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.01||||24.01|10.32|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.01||||24.01|8.43|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.01||||24.01|10.23|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.01||||24.01|12.03|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.01||||24.01|8.43|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.01||||24.01|10.23|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.01||||24.01|14.41|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.01||||24.01|14.41|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.01||||24.01|14.41|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|GEHA [1415]|GEHA [141500]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.01||||24.01|21.61|21.61|5.04 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.01||||24.01||| 26547|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ENTACAPONE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.01||||24.01||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|||10.00||||10.00|3|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|||10.00||||10.00|3|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26816|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|||10.00||||10.00|3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|||10.00||||10.00|3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|||10.00||||10.00|3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|||10.00||||10.00|3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|||10.00||||10.00|3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|||10.00||||10.00|3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26817|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVETIRACETAM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|||10.00||||10.00|3|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 26966|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOFETILIDE 250 MCG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|CORESOURCE [1315]|CORESOURCE [131500]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|CHAMPVA [1240]|CHAMP VA [124000]|12.00||||12.00|9|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|||12.00||||12.00|3.6|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.00||||12.00|7.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.00||||12.00|5.75|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.00||||12.00|2.52|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|UMR [2035]|UMR OPTIONS [203501]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.00||||12.00|5.16|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MULTIPLAN [1680]|IHC HS [168011]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|HEALTHNET [1495]|HEALTHNET [149500]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.00||||12.00|12|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|TRUSTMARK [2030]|STARMARK [203000]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|GEHA [1415]|GEHA [141500]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.00||||12.00|5.16|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.00||||12.00|6.01|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.00||||12.00|4.21|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.00||||12.00|5.11|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.00||||12.00|7.2|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.00||||12.00|10.8|12|2.52 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MULTIPLAN [1680]|HMA [168003]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|AETNA [1015]|AETNA ACO WILCO [101532]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.00||||12.00||| 27010019|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC ANTIFUNGAL POWDER EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.00||||12.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.00||||34.00|20.4|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.00||||34.00|14.62|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.00||||34.00|17.03|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.00||||34.00|14.48|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|TRUSTMARK [2030]|STARMARK [203000]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MULTIPLAN [1680]|IHC HS [168011]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.00||||34.00|14.62|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|HEALTHNET [1495]|HEALTHNET [149500]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|UMR [2035]|UMR OPTIONS [203501]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.00||||34.00|7.14|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.00||||34.00|34|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.00||||34.00|11.93|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.00||||34.00|16.3|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.00||||34.00|22.1|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|||34.00||||34.00|10.2|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|CHAMPVA [1240]|CHAMP VA [124000]|34.00||||34.00|25.5|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|CORESOURCE [1315]|CORESOURCE [131500]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|GEHA [1415]|GEHA [141500]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.00||||34.00|30.6|34|7.14 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|AETNA [1015]|AETNA ACO WILCO [101532]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MULTIPLAN [1680]|HMA [168003]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.00||||34.00||| 27010038|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BAG URINE METER DRAINAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.00||||34.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|GEHA [1415]|GEHA [141500]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|CORESOURCE [1315]|CORESOURCE [131500]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|CHAMPVA [1240]|CHAMP VA [124000]|12.00||||12.00|9|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|||12.00||||12.00|3.6|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.00||||12.00|7.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.00||||12.00|5.75|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.00||||12.00|12|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.00||||12.00|2.52|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|UMR [2035]|UMR OPTIONS [203501]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.00||||12.00|5.16|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MULTIPLAN [1680]|IHC HS [168011]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|HEALTHNET [1495]|HEALTHNET [149500]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|TRUSTMARK [2030]|STARMARK [203000]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.00||||12.00|5.16|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.00||||12.00|6.01|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.00||||12.00|4.21|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.00||||12.00|5.11|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.00||||12.00|7.2|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.00||||12.00|10.8|12|2.52 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MULTIPLAN [1680]|HMA [168003]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|AETNA [1015]|AETNA ACO WILCO [101532]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.00||||12.00||| 27010093|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CALAZIME PASTE 4 OZ EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.00||||12.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92.00||||92.00|55.2|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|92.00||||92.00|46.09|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92.00||||92.00|32.29|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|92.00||||92.00|39.19|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|TRUSTMARK [2030]|STARMARK [203000]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|HEALTHNET [1495]|HEALTHNET [149500]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MULTIPLAN [1680]|IHC HS [168011]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|FMH BENEFIT SERVICES [1390]|FMH [139000]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|FIRST HEALTH [1375]|QUALCHOICE [137513]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92.00||||92.00|39.56|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|UMR [2035]|UMR OPTIONS [203501]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92.00||||92.00|19.32|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92.00||||92.00|92|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92.00||||92.00|39.56|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92.00||||92.00|44.11|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92.00||||92.00|59.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|||92.00||||92.00|27.6|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|CHAMPVA [1240]|CHAMP VA [124000]|92.00||||92.00|69|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|CORESOURCE [1315]|CORESOURCE [131500]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|GEHA [1415]|GEHA [141500]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92.00||||92.00|82.8|92|19.32 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|AETNA [1015]|AETNA ACO WILCO [101532]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MULTIPLAN [1680]|HMA [168003]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|92.00||||92.00||| 27010161|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CUSHION SEAT PRESR ULCER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|92.00||||92.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|CORESOURCE [1315]|CORESOURCE [131500]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|CHAMPVA [1240]|CHAMP VA [124000]|77.00||||77.00|57.75|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|||77.00||||77.00|23.1|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77.00||||77.00|50.05|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77.00||||77.00|36.92|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77.00||||77.00|16.17|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|UMR [2035]|UMR OPTIONS [203501]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77.00||||77.00|33.11|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|FIRST HEALTH [1375]|QUALCHOICE [137513]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|FMH BENEFIT SERVICES [1390]|FMH [139000]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MULTIPLAN [1680]|IHC HS [168011]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|HEALTHNET [1495]|HEALTHNET [149500]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77.00||||77.00|77|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|TRUSTMARK [2030]|STARMARK [203000]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77.00||||77.00|33.11|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77.00||||77.00|38.58|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|GEHA [1415]|GEHA [141500]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77.00||||77.00|27.03|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77.00||||77.00|32.8|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77.00||||77.00|46.2|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77.00||||77.00|69.3|77|16.17 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MULTIPLAN [1680]|HMA [168003]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|AETNA [1015]|AETNA ACO WILCO [101532]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77.00||||77.00||| 27010189|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC FLUTTER VALVE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77.00||||77.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.00||||6.00|2.58|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MULTIPLAN [1680]|IHC HS [168011]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|||6.00||||6.00|1.8|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6.00||||6.00|3.6|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|GEHA [1415]|GEHA [141500]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6.00||||6.00|2.56|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|UMR [2035]|UMR OPTIONS [203501]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|CHAMPVA [1240]|CHAMP VA [124000]|6.00||||6.00|4.5|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6.00||||6.00|3.01|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6.00||||6.00|3.9|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|HEALTHNET [1495]|HEALTHNET [149500]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6.00||||6.00|6|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6.00||||6.00|1.26|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6.00||||6.00|2.58|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|CORESOURCE [1315]|CORESOURCE [131500]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|TRUSTMARK [2030]|STARMARK [203000]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6.00||||6.00|2.11|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.00||||6.00|2.88|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6.00||||6.00|5.4|6|1.26 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|AETNA [1015]|AETNA ACO WILCO [101532]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MULTIPLAN [1680]|HMA [168003]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.00||||6.00||| 27010202|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC BELT OSTOMY LARGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.00||||6.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|UMR [2035]|UMR OPTIONS [203501]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|||13.00||||13.00|3.9|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.00||||13.00|6.23|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.00||||13.00|6.51|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.00||||13.00|5.59|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|CHAMPVA [1240]|CHAMP VA [124000]|13.00||||13.00|9.75|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.00||||13.00|4.56|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.00||||13.00|8.45|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.00||||13.00|2.73|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.00||||13.00|7.8|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.00||||13.00|13|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.00||||13.00|5.59|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.00||||13.00|5.54|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|HEALTHNET [1495]|HEALTHNET [149500]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|GEHA [1415]|GEHA [141500]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|CORESOURCE [1315]|CORESOURCE [131500]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MULTIPLAN [1680]|IHC HS [168011]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|TRUSTMARK [2030]|STARMARK [203000]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.00||||13.00|11.7|13|2.73 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|AETNA [1015]|AETNA ACO WILCO [101532]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MULTIPLAN [1680]|HMA [168003]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.00||||13.00||| 27010229|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC HOLDER TUBE ENDOTRACHEAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.00||||13.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.00||||24.00|14.4|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.00||||24.00|10.32|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.00||||24.00|10.22|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MULTIPLAN [1680]|IHC HS [168011]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|HEALTHNET [1495]|HEALTHNET [149500]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|||24.00||||24.00|7.2|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.00||||24.00|15.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.00||||24.00|12.02|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.00||||24.00|8.42|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|TRUSTMARK [2030]|STARMARK [203000]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.00||||24.00|5.04|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|UMR [2035]|UMR OPTIONS [203501]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|CHAMPVA [1240]|CHAMP VA [124000]|24.00||||24.00|18|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|GEHA [1415]|GEHA [141500]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.00||||24.00|10.32|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|CORESOURCE [1315]|CORESOURCE [131500]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.00||||24.00|11.51|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.00||||24.00|21.6|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.00||||24.00|24|24|5.04 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MULTIPLAN [1680]|HMA [168003]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|AETNA [1015]|AETNA ACO WILCO [101532]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.00||||24.00||| 27010307|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC MDI AEROCHAMBER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.00||||24.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|||263.00||||263.00|78.9|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263.00||||263.00|170.95|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|UMR [2035]|UMR OPTIONS [203501]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263.00||||263.00|113.09|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263.00||||263.00|126.11|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|HEALTHNET [1495]|HEALTHNET [149500]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263.00||||263.00|263|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|263.00||||263.00|112.04|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263.00||||263.00|92.31|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MULTIPLAN [1680]|IHC HS [168011]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|263.00||||263.00|131.76|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263.00||||263.00|157.8|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263.00||||263.00|55.23|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|TRUSTMARK [2030]|STARMARK [203000]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263.00||||263.00|113.09|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|CORESOURCE [1315]|CORESOURCE [131500]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|CHAMPVA [1240]|CHAMP VA [124000]|263.00||||263.00|197.25|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|GEHA [1415]|GEHA [141500]|263.00||||263.00|236.7|263|55.23 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|AETNA [1015]|AETNA ACO WILCO [101532]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|MULTIPLAN [1680]|HMA [168003]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|263.00||||263.00||| 27010330|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN / DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|263.00||||263.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.00||||46.00|23.05|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.00||||46.00|19.6|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.00||||46.00|27.6|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|TRUSTMARK [2030]|STARMARK [203000]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MULTIPLAN [1680]|IHC HS [168011]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|HEALTHNET [1495]|HEALTHNET [149500]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|UMR [2035]|UMR OPTIONS [203501]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.00||||46.00|9.66|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.00||||46.00|16.15|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.00||||46.00|29.9|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.00||||46.00|22.06|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|GEHA [1415]|GEHA [141500]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.00||||46.00|19.78|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.00||||46.00|46|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|CHAMPVA [1240]|CHAMP VA [124000]|46.00||||46.00|34.5|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|||46.00||||46.00|13.8|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|CORESOURCE [1315]|CORESOURCE [131500]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.00||||46.00|19.78|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.00||||46.00|41.4|46|9.66 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|AETNA [1015]|AETNA ACO WILCO [101532]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|MULTIPLAN [1680]|HMA [168003]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.00||||46.00||| 27010333|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC OXYGEN SET UP SUPPLIES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.00||||46.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206.00||||206.00|133.9|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|||206.00||||206.00|61.8|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|CORESOURCE [1315]|CORESOURCE [131500]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206.00||||206.00|206|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206.00||||206.00|43.26|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|CHAMPVA [1240]|CHAMP VA [124000]|206.00||||206.00|154.5|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|GEHA [1415]|GEHA [141500]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206.00||||206.00|88.58|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|FMH BENEFIT SERVICES [1390]|FMH [139000]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|FIRST HEALTH [1375]|QUALCHOICE [137513]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|UMR [2035]|UMR OPTIONS [203501]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206.00||||206.00|98.78|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206.00||||206.00|88.58|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206.00||||206.00|72.31|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|HEALTHNET [1495]|HEALTHNET [149500]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|206.00||||206.00|103.21|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|TRUSTMARK [2030]|STARMARK [203000]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|206.00||||206.00|87.76|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206.00||||206.00|123.6|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MULTIPLAN [1680]|IHC HS [168011]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206.00||||206.00|185.4|206|43.26 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MULTIPLAN [1680]|HMA [168003]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|AETNA [1015]|AETNA ACO WILCO [101532]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206.00||||206.00||| 27010355|EAP|0271 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-NONST|HC PULSE OX PRB DISP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206.00||||206.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.00||||31.00|10.88|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|TRUSTMARK [2030]|STARMARK [203000]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|HEALTHNET [1495]|HEALTHNET [149500]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.00||||31.00|13.21|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.00||||31.00|13.33|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|UMR [2035]|UMR OPTIONS [203501]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MULTIPLAN [1680]|IHC HS [168011]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.00||||31.00|18.6|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.00||||31.00|15.53|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.00||||31.00|20.15|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|CORESOURCE [1315]|CORESOURCE [131500]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.00||||31.00|6.51|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|||31.00||||31.00|9.3|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.00||||31.00|14.86|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|CHAMPVA [1240]|CHAMP VA [124000]|31.00||||31.00|23.25|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|GEHA [1415]|GEHA [141500]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.00||||31.00|31|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.00||||31.00|13.33|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.00||||31.00|27.9|31|6.51 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MULTIPLAN [1680]|HMA [168003]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|AETNA [1015]|AETNA ACO WILCO [101532]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.00||||31.00||| 27010386|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-CLENS EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.00||||31.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00|39|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|||39.00||||39.00|11.7|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|39|8.19 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 27010387|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SAF-GEL EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|413.00||||413.00|206.91|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|FMH BENEFIT SERVICES [1390]|FMH [139000]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|HEALTHNET [1495]|HEALTHNET [149500]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MULTIPLAN [1680]|IHC HS [168011]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|413.00||||413.00|177.59|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|413.00||||413.00|413|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|FIRST HEALTH [1375]|QUALCHOICE [137513]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|413.00||||413.00|86.73|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|413.00||||413.00|198.03|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|413.00||||413.00|268.45|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|TRUSTMARK [2030]|STARMARK [203000]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|||413.00||||413.00|123.9|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|UMR [2035]|UMR OPTIONS [203501]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|413.00||||413.00|247.8|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|GEHA [1415]|GEHA [141500]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|413.00||||413.00|144.96|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|413.00||||413.00|175.94|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|CHAMPVA [1240]|CHAMP VA [124000]|413.00||||413.00|309.75|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|CORESOURCE [1315]|CORESOURCE [131500]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|413.00||||413.00|177.59|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|413.00||||413.00|371.7|413|86.73 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|AETNA [1015]|AETNA ACO WILCO [101532]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MULTIPLAN [1680]|HMA [168003]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|413.00||||413.00||| 27010395|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SEQUENTIAL COMPRES SLVE PAIR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|413.00||||413.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|||55.00||||55.00|16.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|CORESOURCE [1315]|CORESOURCE [131500]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55.00||||55.00|35.75|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55.00||||55.00|55|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|CHAMPVA [1240]|CHAMP VA [124000]|55.00||||55.00|41.25|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|FIRST HEALTH [1375]|QUALCHOICE [137513]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|FMH BENEFIT SERVICES [1390]|FMH [139000]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|UMR [2035]|UMR OPTIONS [203501]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|TRUSTMARK [2030]|STARMARK [203000]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55.00||||55.00|23.43|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55.00||||55.00|23.65|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55.00||||55.00|26.37|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55.00||||55.00|11.55|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|GEHA [1415]|GEHA [141500]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55.00||||55.00|27.56|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55.00||||55.00|23.65|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55.00||||55.00|19.31|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55.00||||55.00|33|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|HEALTHNET [1495]|HEALTHNET [149500]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MULTIPLAN [1680]|IHC HS [168011]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55.00||||55.00|49.5|55|11.55 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|AETNA [1015]|AETNA ACO WILCO [101532]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MULTIPLAN [1680]|HMA [168003]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55.00||||55.00||| 27010408|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPIROMETER INCENTIVE DEV 500ML|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55.00||||55.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.00||||48.00|20.64|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.00||||48.00|16.85|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|HEALTHNET [1495]|HEALTHNET [149500]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48.00||||48.00|24.05|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48.00||||48.00|20.45|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.00||||48.00|20.64|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MULTIPLAN [1680]|IHC HS [168011]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|UMR [2035]|UMR OPTIONS [203501]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|TRUSTMARK [2030]|STARMARK [203000]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|||48.00||||48.00|14.4|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.00||||48.00|31.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.00||||48.00|10.08|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.00||||48.00|28.8|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|CHAMPVA [1240]|CHAMP VA [124000]|48.00||||48.00|36|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.00||||48.00|48|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|CORESOURCE [1315]|CORESOURCE [131500]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.00||||48.00|23.02|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|GEHA [1415]|GEHA [141500]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.00||||48.00|43.2|48|10.08 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MULTIPLAN [1680]|HMA [168003]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|AETNA [1015]|AETNA ACO WILCO [101532]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48.00||||48.00||| 27010494|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SUPPLIES SET UP AEROSOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48.00||||48.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|CORESOURCE [1315]|CORESOURCE [131500]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|CHAMPVA [1240]|CHAMP VA [124000]|58.00||||58.00|43.5|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.00||||58.00|37.7|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.00||||58.00|58|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.00||||58.00|24.94|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.00||||58.00|27.81|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|UMR [2035]|UMR OPTIONS [203501]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|||58.00||||58.00|17.4|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MULTIPLAN [1680]|IHC HS [168011]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|GEHA [1415]|GEHA [141500]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|TRUSTMARK [2030]|STARMARK [203000]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.00||||58.00|29.06|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.00||||58.00|24.94|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.00||||58.00|24.71|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.00||||58.00|34.8|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|HEALTHNET [1495]|HEALTHNET [149500]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.00||||58.00|20.36|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.00||||58.00|12.18|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.00||||58.00|52.2|58|12.18 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MULTIPLAN [1680]|HMA [168003]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|AETNA [1015]|AETNA ACO WILCO [101532]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.00||||58.00||| 27010518|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY LARGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.00||||58.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70.00||||70.00|24.57|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MULTIPLAN [1680]|IHC HS [168011]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|TRUSTMARK [2030]|STARMARK [203000]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|HEALTHNET [1495]|HEALTHNET [149500]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70.00||||70.00|42|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70.00||||70.00|30.1|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70.00||||70.00|70|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70.00||||70.00|29.82|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70.00||||70.00|33.57|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70.00||||70.00|45.5|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|||70.00||||70.00|21|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70.00||||70.00|14.7|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|GEHA [1415]|GEHA [141500]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|UMR [2035]|UMR OPTIONS [203501]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|CHAMPVA [1240]|CHAMP VA [124000]|70.00||||70.00|52.5|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70.00||||70.00|35.07|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|CORESOURCE [1315]|CORESOURCE [131500]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70.00||||70.00|30.1|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70.00||||70.00|63|70|14.7 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|AETNA [1015]|AETNA ACO WILCO [101532]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|MULTIPLAN [1680]|HMA [168003]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70.00||||70.00||| 27010519|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WEDGE POSEY X-LARGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70.00||||70.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.00||||48.00|31.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|||48.00||||48.00|14.4|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|CORESOURCE [1315]|CORESOURCE [131500]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.00||||48.00|10.08|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.00||||48.00|48|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.00||||48.00|23.02|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|UMR [2035]|UMR OPTIONS [203501]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|CHAMPVA [1240]|CHAMP VA [124000]|48.00||||48.00|36|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.00||||48.00|20.64|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MULTIPLAN [1680]|IHC HS [168011]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|GEHA [1415]|GEHA [141500]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|TRUSTMARK [2030]|STARMARK [203000]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.00||||48.00|20.64|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.00||||48.00|16.85|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48.00||||48.00|20.45|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.00||||48.00|28.8|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|HEALTHNET [1495]|HEALTHNET [149500]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48.00||||48.00|24.05|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.00||||48.00|43.2|48|10.08 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MULTIPLAN [1680]|HMA [168003]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|AETNA [1015]|AETNA ACO WILCO [101532]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.00||||48.00||| 27010641|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC SPLINT WRIST D-RING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.00||||48.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.00||||19.00|8.17|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.00||||19.00|11.4|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.00||||19.00|9.52|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.00||||19.00|6.67|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|HEALTHNET [1495]|HEALTHNET [149500]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|TRUSTMARK [2030]|STARMARK [203000]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.00||||19.00|8.09|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MULTIPLAN [1680]|IHC HS [168011]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.00||||19.00|8.17|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.00||||19.00|19|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.00||||19.00|12.35|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|||19.00||||19.00|5.7|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|UMR [2035]|UMR OPTIONS [203501]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|CHAMPVA [1240]|CHAMP VA [124000]|19.00||||19.00|14.25|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|CORESOURCE [1315]|CORESOURCE [131500]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|GEHA [1415]|GEHA [141500]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.00||||19.00|9.11|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.00||||19.00|17.1|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.00||||19.00|3.99|19|3.99 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|AETNA [1015]|AETNA ACO WILCO [101532]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|MULTIPLAN [1680]|HMA [168003]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.00||||19.00||| 27010642|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC GLOVE COMPRESS NORCO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.00||||19.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84.00||||84.00|36.12|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84.00||||84.00|29.48|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84.00||||84.00|35.78|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84.00||||84.00|42.08|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84.00||||84.00|50.4|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|GEHA [1415]|GEHA [141500]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|||84.00||||84.00|25.2|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84.00||||84.00|40.28|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84.00||||84.00|84|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84.00||||84.00|17.64|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84.00||||84.00|54.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|UMR [2035]|UMR OPTIONS [203501]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|CORESOURCE [1315]|CORESOURCE [131500]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84.00||||84.00|36.12|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|FIRST HEALTH [1375]|QUALCHOICE [137513]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|FMH BENEFIT SERVICES [1390]|FMH [139000]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MULTIPLAN [1680]|IHC HS [168011]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|CHAMPVA [1240]|CHAMP VA [124000]|84.00||||84.00|63|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|HEALTHNET [1495]|HEALTHNET [149500]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|TRUSTMARK [2030]|STARMARK [203000]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84.00||||84.00|75.6|84|17.64 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|AETNA [1015]|AETNA ACO WILCO [101532]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84.00||||84.00||| 27010643|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC CMC SPLINT|MULTIPLAN [1680]|HMA [168003]|84.00||||84.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|||10.00||||10.00|3|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|||10.00||||10.00|3|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27049|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXCARBAZEPINE 150 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|||150.00||||150.00|45|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|64.5|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|64.5|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|31.5 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 27201729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH URINARY ALL SIZES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|935.00||||935.00|467.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|935.00||||935.00|561|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|935.00||||935.00|328.19|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|935.00||||935.00|398.31|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|TRUSTMARK [2030]|STARMARK [203000]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|935.00||||935.00|402.05|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MULTIPLAN [1680]|IHC HS [168011]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|FMH BENEFIT SERVICES [1390]|FMH [139000]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|FIRST HEALTH [1375]|QUALCHOICE [137513]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|935.00||||935.00|402.05|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|HEALTHNET [1495]|HEALTHNET [149500]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|935.00||||935.00|196.35|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|935.00||||935.00|448.33|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|935.00||||935.00|607.75|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|||935.00||||935.00|280.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|935.00||||935.00|935|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|935.00||||935.00|468.44|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|UMR [2035]|UMR OPTIONS [203501]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|CHAMPVA [1240]|CHAMP VA [124000]|935.00||||935.00|701.25|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|CORESOURCE [1315]|CORESOURCE [131500]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|GEHA [1415]|GEHA [141500]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|935.00||||935.00|841.5|935|196.35 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|AETNA [1015]|AETNA ACO WILCO [101532]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MULTIPLAN [1680]|HMA [168003]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|935.00||||935.00||| 27201751|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC PICC DUAL LUMEN 5F W/SHERLOCK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|935.00||||935.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|CORESOURCE [1315]|CORESOURCE [131500]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|CHAMPVA [1240]|CHAMP VA [124000]|1241.00||||1241.00|930.75|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1241.00||||1241.00|806.65|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1241.00||||1241.00|595.06|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1241.00||||1241.00|1241|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1241.00||||1241.00|260.61|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|UMR [2035]|UMR OPTIONS [203501]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1241.00||||1241.00|533.63|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|||1241.00||||1241.00|372.3|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|GEHA [1415]|GEHA [141500]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|FIRST HEALTH [1375]|QUALCHOICE [137513]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|FMH BENEFIT SERVICES [1390]|FMH [139000]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MULTIPLAN [1680]|IHC HS [168011]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|HEALTHNET [1495]|HEALTHNET [149500]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|TRUSTMARK [2030]|STARMARK [203000]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1241.00||||1241.00|533.63|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1241.00||||1241.00|621.74|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1241.00||||1241.00|435.59|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1241.00||||1241.00|528.67|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1241.00||||1241.00|744.6|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1241.00||||1241.00|620.5|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1241.00||||1241.00|1116.9|1241|260.61 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|AETNA [1015]|AETNA ACO WILCO [101532]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MULTIPLAN [1680]|HMA [168003]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1241.00||||1241.00||| 27201754|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC FTMAX SOLO 5FR W/3CG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1241.00||||1241.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1175.00||||1175.00|587.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1175.00||||1175.00|705|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1175.00||||1175.00|588.68|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|TRUSTMARK [2030]|STARMARK [203000]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MULTIPLAN [1680]|IHC HS [168011]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1175.00||||1175.00|505.25|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|HEALTHNET [1495]|HEALTHNET [149500]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1175.00||||1175.00|412.43|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1175.00||||1175.00|500.55|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1175.00||||1175.00|1175|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|||1175.00||||1175.00|352.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1175.00||||1175.00|763.75|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1175.00||||1175.00|246.75|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1175.00||||1175.00|505.25|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|UMR [2035]|UMR OPTIONS [203501]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1175.00||||1175.00|563.41|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|CHAMPVA [1240]|CHAMP VA [124000]|1175.00||||1175.00|881.25|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|CORESOURCE [1315]|CORESOURCE [131500]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|GEHA [1415]|GEHA [141500]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1175.00||||1175.00|1057.5|1175|246.75 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|AETNA [1015]|AETNA ACO WILCO [101532]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MULTIPLAN [1680]|HMA [168003]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1175.00||||1175.00||| 27201756|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC CATH PIC MAX SOLO 4FR FULL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1175.00||||1175.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|CORESOURCE [1315]|CORESOURCE [131500]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|CHAMPVA [1240]|CHAMP VA [124000]|17.00||||17.00|12.75|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|||17.00||||17.00|5.1|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.00||||17.00|8.15|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.00||||17.00|17|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.00||||17.00|3.57|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|UMR [2035]|UMR OPTIONS [203501]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.00||||17.00|7.31|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MULTIPLAN [1680]|IHC HS [168011]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|GEHA [1415]|GEHA [141500]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.00||||17.00|11.05|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|TRUSTMARK [2030]|STARMARK [203000]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.00||||17.00|7.31|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.00||||17.00|8.52|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.00||||17.00|5.97|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|HEALTHNET [1495]|HEALTHNET [149500]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.00||||17.00|7.24|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.00||||17.00|10.2|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.00||||17.00|15.3|17|3.57 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MULTIPLAN [1680]|HMA [168003]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|AETNA [1015]|AETNA ACO WILCO [101532]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.00||||17.00||| 27210002|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ADAPT STOMA POWDER 2 PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.00||||17.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.00||||37.00|22.2|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.00||||37.00|18.54|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.00||||37.00|12.99|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.00||||37.00|15.76|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|TRUSTMARK [2030]|STARMARK [203000]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|HEALTHNET [1495]|HEALTHNET [149500]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MULTIPLAN [1680]|IHC HS [168011]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.00||||37.00|15.91|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.00||||37.00|15.91|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|UMR [2035]|UMR OPTIONS [203501]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.00||||37.00|7.77|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.00||||37.00|37|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.00||||37.00|24.05|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|||37.00||||37.00|11.1|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.00||||37.00|17.74|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|CHAMPVA [1240]|CHAMP VA [124000]|37.00||||37.00|27.75|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|CORESOURCE [1315]|CORESOURCE [131500]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|GEHA [1415]|GEHA [141500]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.00||||37.00|33.3|37|7.77 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|AETNA [1015]|AETNA ACO WILCO [101532]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MULTIPLAN [1680]|HMA [168003]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.00||||37.00||| 27210013|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/2 PS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.00||||37.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|CHAMPVA [1240]|CHAMP VA [124000]|32.00||||32.00|24|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.00||||32.00|15.34|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.00||||32.00|32|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.00||||32.00|20.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.00||||32.00|6.72|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|UMR [2035]|UMR OPTIONS [203501]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.00||||32.00|13.76|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|GEHA [1415]|GEHA [141500]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|HEALTHNET [1495]|HEALTHNET [149500]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|||32.00||||32.00|9.6|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|CORESOURCE [1315]|CORESOURCE [131500]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.00||||32.00|13.76|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32.00||||32.00|16.03|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.00||||32.00|11.23|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32.00||||32.00|13.63|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|TRUSTMARK [2030]|STARMARK [203000]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.00||||32.00|19.2|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MULTIPLAN [1680]|IHC HS [168011]|32.00||||32.00|28.8|32|6.72 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MULTIPLAN [1680]|HMA [168003]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|AETNA [1015]|AETNA ACO WILCO [101532]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.00||||32.00||| 27210014|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ALGIDEX AG 1/4 PS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.00||||32.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.00||||20.00|12|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|20.00||||20.00|10.02|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|TRUSTMARK [2030]|STARMARK [203000]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.00||||20.00|7.02|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MULTIPLAN [1680]|IHC HS [168011]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.00||||20.00|8.6|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|HEALTHNET [1495]|HEALTHNET [149500]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|20.00||||20.00|8.52|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.00||||20.00|20|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.00||||20.00|9.59|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|||20.00||||20.00|6|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.00||||20.00|13|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.00||||20.00|4.2|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|UMR [2035]|UMR OPTIONS [203501]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|CHAMPVA [1240]|CHAMP VA [124000]|20.00||||20.00|15|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|CORESOURCE [1315]|CORESOURCE [131500]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|GEHA [1415]|GEHA [141500]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.00||||20.00|18|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.00||||20.00|8.6|20|4.2 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|AETNA [1015]|AETNA ACO WILCO [101532]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MULTIPLAN [1680]|HMA [168003]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|20.00||||20.00||| 27210020|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL 4X4 2 PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|20.00||||20.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|CORESOURCE [1315]|CORESOURCE [131500]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|CHAMPVA [1240]|CHAMP VA [124000]|46.00||||46.00|34.5|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|GEHA [1415]|GEHA [141500]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|||46.00||||46.00|13.8|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.00||||46.00|29.9|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.00||||46.00|22.06|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.00||||46.00|46|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.00||||46.00|9.66|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|UMR [2035]|UMR OPTIONS [203501]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.00||||46.00|19.78|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MULTIPLAN [1680]|IHC HS [168011]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|TRUSTMARK [2030]|STARMARK [203000]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.00||||46.00|19.78|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.00||||46.00|23.05|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|HEALTHNET [1495]|HEALTHNET [149500]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.00||||46.00|16.15|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.00||||46.00|19.6|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.00||||46.00|27.6|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.00||||46.00|41.4|46|9.66 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MULTIPLAN [1680]|HMA [168003]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|AETNA [1015]|AETNA ACO WILCO [101532]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.00||||46.00||| 27210021|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 4X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.00||||46.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104.00||||104.00|62.4|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.00||||104.00|36.5|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104.00||||104.00|44.3|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|TRUSTMARK [2030]|STARMARK [203000]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.00||||104.00|44.72|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MULTIPLAN [1680]|IHC HS [168011]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.00||||104.00|44.72|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|HEALTHNET [1495]|HEALTHNET [149500]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.00||||104.00|67.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|||104.00||||104.00|31.2|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.00||||104.00|49.87|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104.00||||104.00|52.1|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.00||||104.00|21.84|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|UMR [2035]|UMR OPTIONS [203501]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|CHAMPVA [1240]|CHAMP VA [124000]|104.00||||104.00|78|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|CORESOURCE [1315]|CORESOURCE [131500]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|GEHA [1415]|GEHA [141500]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.00||||104.00|93.6|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.00||||104.00|104|104|21.84 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|AETNA [1015]|AETNA ACO WILCO [101532]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MULTIPLAN [1680]|HMA [168003]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.00||||104.00||| 27210022|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG 6X6 EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104.00||||104.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|CORESOURCE [1315]|CORESOURCE [131500]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|CHAMPVA [1240]|CHAMP VA [124000]|138.00||||138.00|103.5|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|||138.00||||138.00|41.4|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138.00||||138.00|66.17|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138.00||||138.00|138|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138.00||||138.00|28.98|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|UMR [2035]|UMR OPTIONS [203501]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138.00||||138.00|59.34|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|GEHA [1415]|GEHA [141500]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MULTIPLAN [1680]|IHC HS [168011]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|HEALTHNET [1495]|HEALTHNET [149500]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138.00||||138.00|89.7|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|TRUSTMARK [2030]|STARMARK [203000]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138.00||||138.00|59.34|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138.00||||138.00|69.14|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138.00||||138.00|48.44|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138.00||||138.00|58.79|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138.00||||138.00|82.8|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138.00||||138.00|124.2|138|28.98 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MULTIPLAN [1680]|HMA [168003]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|AETNA [1015]|AETNA ACO WILCO [101532]|138.00||||138.00||| 27210023|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG ROPE EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138.00||||138.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26.00||||26.00|15.6|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26.00||||26.00|13.03|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|TRUSTMARK [2030]|STARMARK [203000]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26.00||||26.00|11.18|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MULTIPLAN [1680]|IHC HS [168011]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|HEALTHNET [1495]|HEALTHNET [149500]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26.00||||26.00|9.13|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26.00||||26.00|11.08|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26.00||||26.00|26|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|||26.00||||26.00|7.8|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26.00||||26.00|16.9|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26.00||||26.00|5.46|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|UMR [2035]|UMR OPTIONS [203501]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26.00||||26.00|12.47|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|CHAMPVA [1240]|CHAMP VA [124000]|26.00||||26.00|19.5|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|CORESOURCE [1315]|CORESOURCE [131500]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26.00||||26.00|11.18|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|GEHA [1415]|GEHA [141500]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26.00||||26.00|23.4|26|5.46 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|AETNA [1015]|AETNA ACO WILCO [101532]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MULTIPLAN [1680]|HMA [168003]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26.00||||26.00||| 27210025|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUASORB EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26.00||||26.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MULTIPLAN [1680]|IHC HS [168011]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|HEALTHNET [1495]|HEALTHNET [149500]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|TRUSTMARK [2030]|STARMARK [203000]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.00||||64.00|27.52|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64.00||||64.00|32.06|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.00||||64.00|22.46|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64.00||||64.00|27.26|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.00||||64.00|38.4|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|GEHA [1415]|GEHA [141500]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|CORESOURCE [1315]|CORESOURCE [131500]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|CHAMPVA [1240]|CHAMP VA [124000]|64.00||||64.00|48|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|||64.00||||64.00|19.2|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.00||||64.00|41.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.00||||64.00|30.69|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.00||||64.00|64|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.00||||64.00|13.44|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|UMR [2035]|UMR OPTIONS [203501]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.00||||64.00|57.6|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.00||||64.00|27.52|64|13.44 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|AETNA [1015]|AETNA ACO WILCO [101532]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MULTIPLAN [1680]|HMA [168003]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64.00||||64.00||| 27210050|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC BIOPATCH 1.9CM & 2.5CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.00||||64.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6.00||||6.00|3.6|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6.00||||6.00|3.01|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6.00||||6.00|2.11|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6.00||||6.00|2.56|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|TRUSTMARK [2030]|STARMARK [203000]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|HEALTHNET [1495]|HEALTHNET [149500]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MULTIPLAN [1680]|IHC HS [168011]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|FMH BENEFIT SERVICES [1390]|FMH [139000]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|FIRST HEALTH [1375]|QUALCHOICE [137513]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.00||||6.00|2.58|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|UMR [2035]|UMR OPTIONS [203501]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6.00||||6.00|1.26|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6.00||||6.00|6|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.00||||6.00|2.88|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6.00||||6.00|3.9|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6.00||||6.00|2.58|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|||6.00||||6.00|1.8|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|CHAMPVA [1240]|CHAMP VA [124000]|6.00||||6.00|4.5|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|CORESOURCE [1315]|CORESOURCE [131500]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|GEHA [1415]|GEHA [141500]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6.00||||6.00|5.4|6|1.26 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MULTIPLAN [1680]|HMA [168003]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|AETNA [1015]|AETNA ACO WILCO [101532]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6.00||||6.00||| 27210086|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CANNULA HIGH FLOW PED/ADULT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6.00||||6.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|GEHA [1415]|GEHA [141500]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|CORESOURCE [1315]|CORESOURCE [131500]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|CHAMPVA [1240]|CHAMP VA [124000]|142.00||||142.00|106.5|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|||142.00||||142.00|42.6|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142.00||||142.00|92.3|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142.00||||142.00|68.09|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142.00||||142.00|142|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142.00||||142.00|29.82|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|UMR [2035]|UMR OPTIONS [203501]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142.00||||142.00|61.06|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MULTIPLAN [1680]|IHC HS [168011]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|HEALTHNET [1495]|HEALTHNET [149500]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|TRUSTMARK [2030]|STARMARK [203000]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142.00||||142.00|61.06|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|142.00||||142.00|71.14|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142.00||||142.00|49.84|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|142.00||||142.00|60.49|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142.00||||142.00|85.2|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142.00||||142.00|127.8|142|29.82 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MULTIPLAN [1680]|HMA [168003]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|AETNA [1015]|AETNA ACO WILCO [101532]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142.00||||142.00||| 27210196|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH POWERGLIDE 20G 8CM BASIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142.00||||142.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167.00||||167.00|100.2|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167.00||||167.00|71.81|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|167.00||||167.00|83.67|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|167.00||||167.00|71.14|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|TRUSTMARK [2030]|STARMARK [203000]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MULTIPLAN [1680]|IHC HS [168011]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|HEALTHNET [1495]|HEALTHNET [149500]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167.00||||167.00|71.81|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|UMR [2035]|UMR OPTIONS [203501]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167.00||||167.00|35.07|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167.00||||167.00|167|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167.00||||167.00|58.62|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167.00||||167.00|80.08|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167.00||||167.00|108.55|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|||167.00||||167.00|50.1|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|CHAMPVA [1240]|CHAMP VA [124000]|167.00||||167.00|125.25|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|CORESOURCE [1315]|CORESOURCE [131500]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|GEHA [1415]|GEHA [141500]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167.00||||167.00|150.3|167|35.07 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|AETNA [1015]|AETNA ACO WILCO [101532]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|MULTIPLAN [1680]|HMA [168003]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|167.00||||167.00||| 27210203|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC CATH TRAY MIDLINE 4FR 20CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|167.00||||167.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|GEHA [1415]|GEHA [141500]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|CORESOURCE [1315]|CORESOURCE [131500]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|CHAMPVA [1240]|CHAMP VA [124000]|19.00||||19.00|14.25|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|||19.00||||19.00|5.7|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.00||||19.00|9.11|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.00||||19.00|19|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.00||||19.00|3.99|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|UMR [2035]|UMR OPTIONS [203501]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.00||||19.00|8.17|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MULTIPLAN [1680]|IHC HS [168011]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|HEALTHNET [1495]|HEALTHNET [149500]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.00||||19.00|12.35|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|TRUSTMARK [2030]|STARMARK [203000]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.00||||19.00|8.17|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.00||||19.00|9.52|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.00||||19.00|6.67|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.00||||19.00|8.09|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.00||||19.00|11.4|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.00||||19.00|17.1|19|3.99 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MULTIPLAN [1680]|HMA [168003]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|AETNA [1015]|AETNA ACO WILCO [101532]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.00||||19.00||| 27210260|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DETECTION WINDOW END TIDAL CO2|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.00||||19.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9.00||||9.00|4.5|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9.00||||9.00|5.4|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|9.00||||9.00|4.51|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9.00||||9.00|3.16|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|9.00||||9.00|3.83|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9.00||||9.00|25.2|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|TRUSTMARK [2030]|STARMARK [203000]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|HEALTHNET [1495]|HEALTHNET [149500]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MULTIPLAN [1680]|IHC HS [168011]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|FMH BENEFIT SERVICES [1390]|FMH [139000]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|FIRST HEALTH [1375]|QUALCHOICE [137513]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9.00||||9.00|3.87|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|9.00||||9.00|9|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|UMR [2035]|UMR OPTIONS [203501]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9.00||||9.00|1.89|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9.00||||9.00|9|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9.00||||9.00|9|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9.00||||9.00|4.32|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9.00||||9.00|5.85|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9.00||||9.00|3.87|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|||9.00||||9.00|2.7|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9.00||||9.00|25.2|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9.00||||9.00|9|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|CHAMPVA [1240]|CHAMP VA [124000]|9.00||||9.00|6.75|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|CORESOURCE [1315]|CORESOURCE [131500]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|GEHA [1415]|GEHA [141500]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9.00||||9.00|8.1|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|9.00||||9.00|26.19|26.19|1.89 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|AETNA [1015]|AETNA ACO WILCO [101532]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MULTIPLAN [1680]|HMA [168003]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9.00||||9.00||| 27210286|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRESSING AQUACEL EXTRA 4X5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|9.00||||9.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|CORESOURCE [1315]|CORESOURCE [131500]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|CHAMPVA [1240]|CHAMP VA [124000]|57.00||||57.00|42.75|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|||57.00||||57.00|17.1|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.00||||57.00|37.05|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.00||||57.00|27.33|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.00||||57.00|57|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.00||||57.00|11.97|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|UMR [2035]|UMR OPTIONS [203501]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.00||||57.00|24.51|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MULTIPLAN [1680]|IHC HS [168011]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|HEALTHNET [1495]|HEALTHNET [149500]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|TRUSTMARK [2030]|STARMARK [203000]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|GEHA [1415]|GEHA [141500]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.00||||57.00|24.51|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.00||||57.00|28.56|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.00||||57.00|20.01|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.00||||57.00|24.28|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.00||||57.00|34.2|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.00||||57.00|51.3|57|11.97 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MULTIPLAN [1680]|HMA [168003]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|AETNA [1015]|AETNA ACO WILCO [101532]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.00||||57.00||| 27210373|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG DUODERM 5.5X5.5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.00||||57.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9.00||||9.00|5.4|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9.00||||9.00|3.87|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|9.00||||9.00|4.51|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|9.00||||9.00|3.83|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|TRUSTMARK [2030]|STARMARK [203000]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MULTIPLAN [1680]|IHC HS [168011]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9.00||||9.00|3.87|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|HEALTHNET [1495]|HEALTHNET [149500]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|UMR [2035]|UMR OPTIONS [203501]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9.00||||9.00|1.89|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9.00||||9.00|9|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9.00||||9.00|4.32|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9.00||||9.00|5.85|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|||9.00||||9.00|2.7|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9.00||||9.00|3.16|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|CHAMPVA [1240]|CHAMP VA [124000]|9.00||||9.00|6.75|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|CORESOURCE [1315]|CORESOURCE [131500]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|GEHA [1415]|GEHA [141500]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9.00||||9.00|8.1|9|1.89 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|AETNA [1015]|AETNA ACO WILCO [101532]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MULTIPLAN [1680]|HMA [168003]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|9.00||||9.00||| 27210395|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX FOAM 4X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|9.00||||9.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|GEHA [1415]|GEHA [141500]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|CORESOURCE [1315]|CORESOURCE [131500]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|CHAMPVA [1240]|CHAMP VA [124000]|15.00||||15.00|11.25|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|||15.00||||15.00|4.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.00||||15.00|7.19|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.00||||15.00|15|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.00||||15.00|3.15|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|UMR [2035]|UMR OPTIONS [203501]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.00||||15.00|6.45|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MULTIPLAN [1680]|IHC HS [168011]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|HEALTHNET [1495]|HEALTHNET [149500]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.00||||15.00|9.75|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|TRUSTMARK [2030]|STARMARK [203000]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.00||||15.00|6.45|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15.00||||15.00|7.52|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.00||||15.00|5.27|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15.00||||15.00|6.39|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.00||||15.00|9|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.00||||15.00|13.5|15|3.15 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MULTIPLAN [1680]|HMA [168003]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|AETNA [1015]|AETNA ACO WILCO [101532]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.00||||15.00||| 27210396|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPITEL 3X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.00||||15.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.00||||27.00|16.2|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.00||||27.00|11.61|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.00||||27.00|13.53|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.00||||27.00|9.48|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.00||||27.00|11.5|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|TRUSTMARK [2030]|STARMARK [203000]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|HEALTHNET [1495]|HEALTHNET [149500]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MULTIPLAN [1680]|IHC HS [168011]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.00||||27.00|11.61|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|UMR [2035]|UMR OPTIONS [203501]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.00||||27.00|5.67|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.00||||27.00|27|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.00||||27.00|12.95|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.00||||27.00|17.55|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|||27.00||||27.00|8.1|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|CHAMPVA [1240]|CHAMP VA [124000]|27.00||||27.00|20.25|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|CORESOURCE [1315]|CORESOURCE [131500]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|GEHA [1415]|GEHA [141500]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.00||||27.00|24.3|27|5.67 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|AETNA [1015]|AETNA ACO WILCO [101532]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MULTIPLAN [1680]|HMA [168003]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.00||||27.00||| 27210399|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPORE PRO ALL SZ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.00||||27.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|CORESOURCE [1315]|CORESOURCE [131500]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|CHAMPVA [1240]|CHAMP VA [124000]|2.00||||2.00|1.5|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|||2.00||||2.00|0.6|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2.00||||2.00|1.3|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2.00||||2.00|0.96|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2.00||||2.00|2|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2.00||||2.00|0.42|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|UMR [2035]|UMR OPTIONS [203501]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2.00||||2.00|0.86|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|FIRST HEALTH [1375]|QUALCHOICE [137513]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|FMH BENEFIT SERVICES [1390]|FMH [139000]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MULTIPLAN [1680]|IHC HS [168011]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|HEALTHNET [1495]|HEALTHNET [149500]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|TRUSTMARK [2030]|STARMARK [203000]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|GEHA [1415]|GEHA [141500]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2.00||||2.00|0.86|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2.00||||2.00|1|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2.00||||2.00|0.7|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2.00||||2.00|0.85|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2.00||||2.00|1.2|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2.00||||2.00|1.8|2|0.42 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MULTIPLAN [1680]|HMA [168003]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|AETNA [1015]|AETNA ACO WILCO [101532]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2.00||||2.00||| 27210416|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG XEROFOAM 5X9|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2.00||||2.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4.00||||4.00|2.4|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4.00||||4.00|1.72|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4.00||||4.00|2|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4.00||||4.00|1.7|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|TRUSTMARK [2030]|STARMARK [203000]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MULTIPLAN [1680]|IHC HS [168011]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4.00||||4.00|1.72|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|HEALTHNET [1495]|HEALTHNET [149500]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|UMR [2035]|UMR OPTIONS [203501]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4.00||||4.00|0.84|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4.00||||4.00|4|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4.00||||4.00|1.4|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4.00||||4.00|1.92|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4.00||||4.00|2.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|||4.00||||4.00|1.2|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|CHAMPVA [1240]|CHAMP VA [124000]|4.00||||4.00|3|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|CORESOURCE [1315]|CORESOURCE [131500]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|GEHA [1415]|GEHA [141500]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4.00||||4.00|3.6|4|0.84 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|AETNA [1015]|AETNA ACO WILCO [101532]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MULTIPLAN [1680]|HMA [168003]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4.00||||4.00||| 27210423|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 4X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4.00||||4.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|GEHA [1415]|GEHA [141500]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|CORESOURCE [1315]|CORESOURCE [131500]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|CHAMPVA [1240]|CHAMP VA [124000]|8.00||||8.00|6|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|||8.00||||8.00|2.4|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8.00||||8.00|5.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8.00||||8.00|3.84|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8.00||||8.00|8|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8.00||||8.00|1.68|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|UMR [2035]|UMR OPTIONS [203501]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8.00||||8.00|3.44|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MULTIPLAN [1680]|IHC HS [168011]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|HEALTHNET [1495]|HEALTHNET [149500]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|TRUSTMARK [2030]|STARMARK [203000]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8.00||||8.00|3.44|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|8.00||||8.00|4.01|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8.00||||8.00|2.81|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|8.00||||8.00|3.41|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8.00||||8.00|4.8|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8.00||||8.00|7.2|8|1.68 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MULTIPLAN [1680]|HMA [168003]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|AETNA [1015]|AETNA ACO WILCO [101532]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8.00||||8.00||| 27210424|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DUODERM EX THIN 6X6 EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8.00||||8.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.00||||36.00|21.6|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36.00||||36.00|18.04|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.00||||36.00|12.64|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36.00||||36.00|15.34|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|TRUSTMARK [2030]|STARMARK [203000]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|HEALTHNET [1495]|HEALTHNET [149500]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MULTIPLAN [1680]|IHC HS [168011]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.00||||36.00|15.48|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|UMR [2035]|UMR OPTIONS [203501]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.00||||36.00|7.56|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.00||||36.00|36|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.00||||36.00|15.48|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.00||||36.00|17.26|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.00||||36.00|23.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|||36.00||||36.00|10.8|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|CHAMPVA [1240]|CHAMP VA [124000]|36.00||||36.00|27|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|CORESOURCE [1315]|CORESOURCE [131500]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|GEHA [1415]|GEHA [141500]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.00||||36.00|32.4|36|7.56 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MULTIPLAN [1680]|HMA [168003]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|AETNA [1015]|AETNA ACO WILCO [101532]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36.00||||36.00||| 27210533|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 10GM EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36.00||||36.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|CORESOURCE [1315]|CORESOURCE [131500]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|CHAMPVA [1240]|CHAMP VA [124000]|177.00||||177.00|132.75|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|||177.00||||177.00|53.1|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177.00||||177.00|115.05|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177.00||||177.00|84.87|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177.00||||177.00|177|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177.00||||177.00|37.17|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|UMR [2035]|UMR OPTIONS [203501]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177.00||||177.00|76.11|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MULTIPLAN [1680]|IHC HS [168011]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|HEALTHNET [1495]|HEALTHNET [149500]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|TRUSTMARK [2030]|STARMARK [203000]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|GEHA [1415]|GEHA [141500]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177.00||||177.00|76.11|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|177.00||||177.00|88.68|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177.00||||177.00|62.13|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|177.00||||177.00|75.4|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177.00||||177.00|106.2|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177.00||||177.00|159.3|177|37.17 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MULTIPLAN [1680]|HMA [168003]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|AETNA [1015]|AETNA ACO WILCO [101532]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177.00||||177.00||| 27210534|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC IODOSORB GEL 40GM EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177.00||||177.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281.00||||281.00|168.6|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281.00||||281.00|120.83|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|281.00||||281.00|140.78|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281.00||||281.00|98.63|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|281.00||||281.00|119.71|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|TRUSTMARK [2030]|STARMARK [203000]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|HEALTHNET [1495]|HEALTHNET [149500]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MULTIPLAN [1680]|IHC HS [168011]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281.00||||281.00|120.83|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|UMR [2035]|UMR OPTIONS [203501]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281.00||||281.00|59.01|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281.00||||281.00|281|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281.00||||281.00|134.74|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281.00||||281.00|182.65|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|||281.00||||281.00|84.3|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|CHAMPVA [1240]|CHAMP VA [124000]|281.00||||281.00|210.75|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|CORESOURCE [1315]|CORESOURCE [131500]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|GEHA [1415]|GEHA [141500]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281.00||||281.00|252.9|281|59.01 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|AETNA [1015]|AETNA ACO WILCO [101532]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|MULTIPLAN [1680]|HMA [168003]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|281.00||||281.00||| 27210547|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 1000ML EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|281.00||||281.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|GEHA [1415]|GEHA [141500]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|CORESOURCE [1315]|CORESOURCE [131500]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|CHAMPVA [1240]|CHAMP VA [124000]|176.00||||176.00|132|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|||176.00||||176.00|52.8|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176.00||||176.00|84.39|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176.00||||176.00|176|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176.00||||176.00|36.96|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|UMR [2035]|UMR OPTIONS [203501]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176.00||||176.00|75.68|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MULTIPLAN [1680]|IHC HS [168011]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|HEALTHNET [1495]|HEALTHNET [149500]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176.00||||176.00|114.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|TRUSTMARK [2030]|STARMARK [203000]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176.00||||176.00|75.68|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|176.00||||176.00|88.18|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176.00||||176.00|61.78|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|176.00||||176.00|74.98|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176.00||||176.00|105.6|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176.00||||176.00|158.4|176|36.96 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MULTIPLAN [1680]|HMA [168003]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|AETNA [1015]|AETNA ACO WILCO [101532]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176.00||||176.00||| 27210548|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI CANISTER 500ML EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176.00||||176.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.00||||22.00|13.2|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22.00||||22.00|11.02|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.00||||22.00|7.72|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22.00||||22.00|9.37|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|TRUSTMARK [2030]|STARMARK [203000]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|HEALTHNET [1495]|HEALTHNET [149500]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MULTIPLAN [1680]|IHC HS [168011]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.00||||22.00|9.46|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|UMR [2035]|UMR OPTIONS [203501]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.00||||22.00|4.62|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.00||||22.00|22|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.00||||22.00|10.55|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.00||||22.00|14.3|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.00||||22.00|9.46|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|||22.00||||22.00|6.6|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|CHAMPVA [1240]|CHAMP VA [124000]|22.00||||22.00|16.5|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|CORESOURCE [1315]|CORESOURCE [131500]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|GEHA [1415]|GEHA [141500]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.00||||22.00|19.8|22|4.62 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|AETNA [1015]|AETNA ACO WILCO [101532]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MULTIPLAN [1680]|HMA [168003]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22.00||||22.00||| 27210549|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI DRAPE ONLY EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.00||||22.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|GEHA [1415]|GEHA [141500]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|CORESOURCE [1315]|CORESOURCE [131500]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|CHAMPVA [1240]|CHAMP VA [124000]|123.00||||123.00|92.25|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|||123.00||||123.00|36.9|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.00||||123.00|79.95|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.00||||123.00|58.98|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.00||||123.00|123|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.00||||123.00|25.83|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|UMR [2035]|UMR OPTIONS [203501]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.00||||123.00|52.89|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MULTIPLAN [1680]|IHC HS [168011]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|HEALTHNET [1495]|HEALTHNET [149500]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|TRUSTMARK [2030]|STARMARK [203000]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.00||||123.00|52.89|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123.00||||123.00|61.62|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.00||||123.00|43.17|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123.00||||123.00|52.4|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.00||||123.00|73.8|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.00||||123.00|110.7|123|25.83 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MULTIPLAN [1680]|HMA [168003]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|AETNA [1015]|AETNA ACO WILCO [101532]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.00||||123.00||| 27210550|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM LG EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.00||||123.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|521.00||||521.00|312.6|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|521.00||||521.00|224.03|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|521.00||||521.00|261.02|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|521.00||||521.00|221.95|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|TRUSTMARK [2030]|STARMARK [203000]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MULTIPLAN [1680]|IHC HS [168011]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|HEALTHNET [1495]|HEALTHNET [149500]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|521.00||||521.00|224.03|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|UMR [2035]|UMR OPTIONS [203501]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|521.00||||521.00|109.41|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|521.00||||521.00|521|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|521.00||||521.00|182.87|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|521.00||||521.00|249.82|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|521.00||||521.00|338.65|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|||521.00||||521.00|156.3|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|CHAMPVA [1240]|CHAMP VA [124000]|521.00||||521.00|390.75|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|CORESOURCE [1315]|CORESOURCE [131500]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|GEHA [1415]|GEHA [141500]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|521.00||||521.00|468.9|521|109.41 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|AETNA [1015]|AETNA ACO WILCO [101532]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|MULTIPLAN [1680]|HMA [168003]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|521.00||||521.00||| 27210551|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI GRANUFOAM X-LG EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|521.00||||521.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|GEHA [1415]|GEHA [141500]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|CORESOURCE [1315]|CORESOURCE [131500]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|CHAMPVA [1240]|CHAMP VA [124000]|98.00||||98.00|73.5|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|||98.00||||98.00|29.4|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98.00||||98.00|46.99|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98.00||||98.00|98|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98.00||||98.00|20.58|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|UMR [2035]|UMR OPTIONS [203501]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98.00||||98.00|42.14|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MULTIPLAN [1680]|IHC HS [168011]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|HEALTHNET [1495]|HEALTHNET [149500]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98.00||||98.00|63.7|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|TRUSTMARK [2030]|STARMARK [203000]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98.00||||98.00|42.14|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|98.00||||98.00|49.1|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98.00||||98.00|34.4|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|98.00||||98.00|41.75|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98.00||||98.00|58.8|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98.00||||98.00|88.2|98|20.58 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MULTIPLAN [1680]|HMA [168003]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|AETNA [1015]|AETNA ACO WILCO [101532]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98.00||||98.00||| 27210552|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED GRANUFOAM EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98.00||||98.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.00||||194.00|116.4|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|194.00||||194.00|97.19|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|194.00||||194.00|68.09|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|194.00||||194.00|82.64|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|TRUSTMARK [2030]|STARMARK [203000]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|HEALTHNET [1495]|HEALTHNET [149500]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MULTIPLAN [1680]|IHC HS [168011]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|194.00||||194.00|83.42|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|UMR [2035]|UMR OPTIONS [203501]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|194.00||||194.00|40.74|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|194.00||||194.00|194|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.00||||194.00|93.02|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|194.00||||194.00|126.1|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|194.00||||194.00|83.42|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|||194.00||||194.00|58.2|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|CHAMPVA [1240]|CHAMP VA [124000]|194.00||||194.00|145.5|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|CORESOURCE [1315]|CORESOURCE [131500]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|GEHA [1415]|GEHA [141500]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|194.00||||194.00|174.6|194|40.74 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|AETNA [1015]|AETNA ACO WILCO [101532]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MULTIPLAN [1680]|HMA [168003]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|194.00||||194.00||| 27210553|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI MED SIMPLACE EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|194.00||||194.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|||90.00||||90.00|27|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00|90|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|90|18.9 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 27210554|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SENSI TRAC PAD EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.00||||43.00|25.8|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.00||||43.00|18.49|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43.00||||43.00|21.54|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43.00||||43.00|18.32|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|TRUSTMARK [2030]|STARMARK [203000]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MULTIPLAN [1680]|IHC HS [168011]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.00||||43.00|18.49|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|HEALTHNET [1495]|HEALTHNET [149500]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|UMR [2035]|UMR OPTIONS [203501]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.00||||43.00|9.03|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.00||||43.00|43|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.00||||43.00|15.09|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.00||||43.00|20.62|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.00||||43.00|27.95|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|||43.00||||43.00|12.9|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|CHAMPVA [1240]|CHAMP VA [124000]|43.00||||43.00|32.25|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|CORESOURCE [1315]|CORESOURCE [131500]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|GEHA [1415]|GEHA [141500]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.00||||43.00|38.7|43|9.03 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|AETNA [1015]|AETNA ACO WILCO [101532]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MULTIPLAN [1680]|HMA [168003]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43.00||||43.00||| 27210555|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM GRANUFOAM EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43.00||||43.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|GEHA [1415]|GEHA [141500]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|CORESOURCE [1315]|CORESOURCE [131500]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|CHAMPVA [1240]|CHAMP VA [124000]|154.00||||154.00|115.5|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|||154.00||||154.00|46.2|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154.00||||154.00|73.84|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154.00||||154.00|154|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154.00||||154.00|32.34|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|UMR [2035]|UMR OPTIONS [203501]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154.00||||154.00|66.22|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MULTIPLAN [1680]|IHC HS [168011]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|HEALTHNET [1495]|HEALTHNET [149500]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154.00||||154.00|100.1|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|TRUSTMARK [2030]|STARMARK [203000]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154.00||||154.00|66.22|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|154.00||||154.00|77.15|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154.00||||154.00|54.05|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|154.00||||154.00|65.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154.00||||154.00|92.4|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154.00||||154.00|138.6|154|32.34 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MULTIPLAN [1680]|HMA [168003]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|AETNA [1015]|AETNA ACO WILCO [101532]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154.00||||154.00||| 27210556|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI SM SIMPLACE EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154.00||||154.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173.00||||173.00|103.8|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173.00||||173.00|74.39|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|173.00||||173.00|86.67|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173.00||||173.00|60.72|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|173.00||||173.00|73.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|TRUSTMARK [2030]|STARMARK [203000]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|HEALTHNET [1495]|HEALTHNET [149500]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MULTIPLAN [1680]|IHC HS [168011]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|FMH BENEFIT SERVICES [1390]|FMH [139000]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|FIRST HEALTH [1375]|QUALCHOICE [137513]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173.00||||173.00|74.39|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|UMR [2035]|UMR OPTIONS [203501]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173.00||||173.00|36.33|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173.00||||173.00|173|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173.00||||173.00|82.95|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173.00||||173.00|112.45|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|||173.00||||173.00|51.9|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|CHAMPVA [1240]|CHAMP VA [124000]|173.00||||173.00|129.75|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|CORESOURCE [1315]|CORESOURCE [131500]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|GEHA [1415]|GEHA [141500]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173.00||||173.00|155.7|173|36.33 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|AETNA [1015]|AETNA ACO WILCO [101532]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MULTIPLAN [1680]|HMA [168003]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|173.00||||173.00||| 27210560|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERALINK CASSETTE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|173.00||||173.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|CORESOURCE [1315]|CORESOURCE [131500]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|CHAMPVA [1240]|CHAMP VA [124000]|236.00||||236.00|177|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|||236.00||||236.00|70.8|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236.00||||236.00|153.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236.00||||236.00|113.16|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236.00||||236.00|236|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236.00||||236.00|49.56|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|UMR [2035]|UMR OPTIONS [203501]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236.00||||236.00|101.48|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MULTIPLAN [1680]|IHC HS [168011]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|HEALTHNET [1495]|HEALTHNET [149500]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|TRUSTMARK [2030]|STARMARK [203000]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|GEHA [1415]|GEHA [141500]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236.00||||236.00|101.48|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|236.00||||236.00|118.24|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236.00||||236.00|82.84|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|236.00||||236.00|100.54|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236.00||||236.00|141.6|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236.00||||236.00|212.4|236|49.56 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MULTIPLAN [1680]|HMA [168003]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236.00||||236.00||| 27210561|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI VERATRAC DUO TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236.00||||236.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.00||||63.00|37.8|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.00||||63.00|27.09|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.00||||63.00|31.56|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.00||||63.00|26.84|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|TRUSTMARK [2030]|STARMARK [203000]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MULTIPLAN [1680]|IHC HS [168011]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.00||||63.00|27.09|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|HEALTHNET [1495]|HEALTHNET [149500]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|UMR [2035]|UMR OPTIONS [203501]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.00||||63.00|13.23|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.00||||63.00|63|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.00||||63.00|22.11|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.00||||63.00|30.21|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.00||||63.00|40.95|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|||63.00||||63.00|18.9|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|CHAMPVA [1240]|CHAMP VA [124000]|63.00||||63.00|47.25|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|CORESOURCE [1315]|CORESOURCE [131500]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|GEHA [1415]|GEHA [141500]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.00||||63.00|56.7|63|13.23 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|AETNA [1015]|AETNA ACO WILCO [101532]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MULTIPLAN [1680]|HMA [168003]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.00||||63.00||| 27210562|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE LG EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.00||||63.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|GEHA [1415]|GEHA [141500]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|CORESOURCE [1315]|CORESOURCE [131500]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|CHAMPVA [1240]|CHAMP VA [124000]|50.00||||50.00|37.5|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|||50.00||||50.00|15|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.00||||50.00|32.5|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.00||||50.00|23.98|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.00||||50.00|50|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.00||||50.00|10.5|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|UMR [2035]|UMR OPTIONS [203501]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.00||||50.00|21.5|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MULTIPLAN [1680]|IHC HS [168011]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|HEALTHNET [1495]|HEALTHNET [149500]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|TRUSTMARK [2030]|STARMARK [203000]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.00||||50.00|21.5|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.00||||50.00|25.05|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.00||||50.00|17.55|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.00||||50.00|21.3|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.00||||50.00|30|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.00||||50.00|45|50|10.5 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MULTIPLAN [1680]|HMA [168003]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|AETNA [1015]|AETNA ACO WILCO [101532]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.00||||50.00||| 27210563|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC KCI WHITE SM EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.00||||50.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|7.74|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|||18.00||||18.00|5.4|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|7.74|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 27210631|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 2X2 2PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.00||||22.00|9.46|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22.00||||22.00|11.02|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.00||||22.00|7.72|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22.00||||22.00|9.37|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.00||||22.00|13.2|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|||22.00||||22.00|6.6|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|UMR [2035]|UMR OPTIONS [203501]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|TRUSTMARK [2030]|STARMARK [203000]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|CHAMPVA [1240]|CHAMP VA [124000]|22.00||||22.00|16.5|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MULTIPLAN [1680]|IHC HS [168011]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|GEHA [1415]|GEHA [141500]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|CORESOURCE [1315]|CORESOURCE [131500]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|HEALTHNET [1495]|HEALTHNET [149500]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.00||||22.00|4.62|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.00||||22.00|14.3|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.00||||22.00|10.55|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.00||||22.00|19.8|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.00||||22.00|9.46|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.00||||22.00|22|22|4.62 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|AETNA [1015]|AETNA ACO WILCO [101532]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MULTIPLAN [1680]|HMA [168003]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.00||||22.00||| 27210632|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 3/4X12|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.00||||22.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|GEHA [1415]|GEHA [141500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.00||||28.00|14|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|CHAMPVA [1240]|CHAMP VA [124000]|28.00||||28.00|21|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28.00||||28.00|26.19|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.00||||28.00|23.18|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.00||||28.00|12.04|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|CORESOURCE [1315]|CORESOURCE [131500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MULTIPLAN [1680]|IHC HS [168011]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.00||||28.00|9.83|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.00||||28.00|13.43|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.00||||28.00|16.8|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|||28.00||||28.00|8.4|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28.00||||28.00|14.03|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28.00||||28.00|11.93|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|UMR [2035]|UMR OPTIONS [203501]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.00||||28.00|24.34|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.00||||28.00|18.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.00||||28.00|28|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.00||||28.00|12.04|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28.00||||28.00|28|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.00||||28.00|5.88|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|TRUSTMARK [2030]|STARMARK [203000]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|HEALTHNET [1495]|HEALTHNET [149500]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.00||||28.00|25.2|28|5.88 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|AETNA [1015]|AETNA ACO WILCO [101532]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MULTIPLAN [1680]|HMA [168003]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.00||||28.00||| 27210633|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY CA ALGINATE 4 X 5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28.00||||28.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.00||||14.00|5.96|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.00||||14.00|7.01|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.00||||14.00|4.91|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.00||||14.00|8.4|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|||14.00||||14.00|4.2|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.00||||14.00|6.71|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.00||||14.00|9.1|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|CHAMPVA [1240]|CHAMP VA [124000]|14.00||||14.00|10.5|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.00||||14.00|14|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.00||||14.00|6.02|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MULTIPLAN [1680]|IHC HS [168011]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|CORESOURCE [1315]|CORESOURCE [131500]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.00||||14.00|2.94|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|HEALTHNET [1495]|HEALTHNET [149500]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|GEHA [1415]|GEHA [141500]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|TRUSTMARK [2030]|STARMARK [203000]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.00||||14.00|6.02|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|UMR [2035]|UMR OPTIONS [203501]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.00||||14.00|12.6|14|2.94 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|AETNA [1015]|AETNA ACO WILCO [101532]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|MULTIPLAN [1680]|HMA [168003]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.00||||14.00||| 27210634|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 2X2|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.00||||14.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|TRUSTMARK [2030]|STARMARK [203000]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.00||||34.00|20.4|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.00||||34.00|14.48|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|HEALTHNET [1495]|HEALTHNET [149500]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MULTIPLAN [1680]|IHC HS [168011]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.00||||34.00|14.62|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.00||||34.00|22.1|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.00||||34.00|34|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.00||||34.00|16.3|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|||34.00||||34.00|10.2|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.00||||34.00|7.14|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.00||||34.00|17.03|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.00||||34.00|11.93|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|CORESOURCE [1315]|CORESOURCE [131500]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.00||||34.00|14.62|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|UMR [2035]|UMR OPTIONS [203501]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|GEHA [1415]|GEHA [141500]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.00||||34.00|30.6|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|CHAMPVA [1240]|CHAMP VA [124000]|34.00||||34.00|25.5|34|7.14 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|AETNA [1015]|AETNA ACO WILCO [101532]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MULTIPLAN [1680]|HMA [168003]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.00||||34.00||| 27210635|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL ADHESIVE 4X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.00||||34.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.00||||27.00|16.2|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|CORESOURCE [1315]|CORESOURCE [131500]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.00||||27.00|5.67|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|HEALTHNET [1495]|HEALTHNET [149500]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|||27.00||||27.00|8.1|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|CHAMPVA [1240]|CHAMP VA [124000]|27.00||||27.00|20.25|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.00||||27.00|12.95|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.00||||27.00|27|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MULTIPLAN [1680]|IHC HS [168011]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|UMR [2035]|UMR OPTIONS [203501]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|GEHA [1415]|GEHA [141500]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.00||||27.00|17.55|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.00||||27.00|11.61|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.00||||27.00|11.5|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.00||||27.00|13.53|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.00||||27.00|11.61|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.00||||27.00|9.48|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|TRUSTMARK [2030]|STARMARK [203000]|27.00||||27.00|24.3|27|5.67 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MULTIPLAN [1680]|HMA [168003]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|AETNA [1015]|AETNA ACO WILCO [101532]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.00||||27.00||| 27210636|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY COLL NONADHEV 4X5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.00||||27.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.00||||22.00|7.72|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.00||||22.00|13.2|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22.00||||22.00|9.37|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|HEALTHNET [1495]|HEALTHNET [149500]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|TRUSTMARK [2030]|STARMARK [203000]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.00||||22.00|10.55|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.00||||22.00|22|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.00||||22.00|4.62|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.00||||22.00|9.46|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.00||||22.00|14.3|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.00||||22.00|9.46|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22.00||||22.00|11.02|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|GEHA [1415]|GEHA [141500]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MULTIPLAN [1680]|IHC HS [168011]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|CORESOURCE [1315]|CORESOURCE [131500]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|||22.00||||22.00|6.6|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|UMR [2035]|UMR OPTIONS [203501]|22.00||||22.00|19.8|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|CHAMPVA [1240]|CHAMP VA [124000]|22.00||||22.00|16.5|22|4.62 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|AETNA [1015]|AETNA ACO WILCO [101532]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MULTIPLAN [1680]|HMA [168003]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.00||||22.00||| 27210637|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY GEL 0.5 OZ 2 PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22.00||||22.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|CORESOURCE [1315]|CORESOURCE [131500]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.00||||16.00|3.36|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.00||||16.00|7.67|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.00||||16.00|10.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|GEHA [1415]|GEHA [141500]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|||16.00||||16.00|4.8|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.00||||16.00|16|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|TRUSTMARK [2030]|STARMARK [203000]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MULTIPLAN [1680]|IHC HS [168011]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|UMR [2035]|UMR OPTIONS [203501]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.00||||16.00|6.88|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|CHAMPVA [1240]|CHAMP VA [124000]|16.00||||16.00|12|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.00||||16.00|6.88|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.00||||16.00|6.82|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.00||||16.00|8.02|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.00||||16.00|9.6|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.00||||16.00|5.62|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|HEALTHNET [1495]|HEALTHNET [149500]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.00||||16.00|14.4|16|3.36 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|AETNA [1015]|AETNA ACO WILCO [101532]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MULTIPLAN [1680]|HMA [168003]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.00||||16.00||| 27210638|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 3X3|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.00||||16.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.00||||37.00|15.76|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.00||||37.00|12.99|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MULTIPLAN [1680]|IHC HS [168011]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.00||||37.00|15.91|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|TRUSTMARK [2030]|STARMARK [203000]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|||37.00||||37.00|11.1|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.00||||37.00|17.74|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.00||||37.00|24.05|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.00||||37.00|37|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|CHAMPVA [1240]|CHAMP VA [124000]|37.00||||37.00|27.75|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.00||||37.00|18.54|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.00||||37.00|7.77|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|UMR [2035]|UMR OPTIONS [203501]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|CORESOURCE [1315]|CORESOURCE [131500]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|HEALTHNET [1495]|HEALTHNET [149500]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|GEHA [1415]|GEHA [141500]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.00||||37.00|33.3|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.00||||37.00|22.2|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.00||||37.00|15.91|37|7.77 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|AETNA [1015]|AETNA ACO WILCO [101532]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MULTIPLAN [1680]|HMA [168003]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.00||||37.00||| 27210639|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS ADHESIVE 4X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.00||||37.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|GEHA [1415]|GEHA [141500]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|CHAMPVA [1240]|CHAMP VA [124000]|28.00||||28.00|21|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.00||||28.00|5.88|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.00||||28.00|13.43|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|CORESOURCE [1315]|CORESOURCE [131500]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.00||||28.00|18.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.00||||28.00|12.04|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|UMR [2035]|UMR OPTIONS [203501]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|TRUSTMARK [2030]|STARMARK [203000]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.00||||28.00|28|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|HEALTHNET [1495]|HEALTHNET [149500]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|||28.00||||28.00|8.4|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MULTIPLAN [1680]|IHC HS [168011]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.00||||28.00|12.04|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.00||||28.00|9.83|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28.00||||28.00|11.93|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.00||||28.00|16.8|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.00||||28.00|25.2|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28.00||||28.00|14.03|28|5.88 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MULTIPLAN [1680]|HMA [168003]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|AETNA [1015]|AETNA ACO WILCO [101532]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.00||||28.00||| 27210640|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HCS NONADHEV 4X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.00||||28.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|7.74|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|||18.00||||18.00|5.4|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|7.74|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 27210641|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEDIHONEY HONEYCOLLOID 2X2 2PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|||39.00||||39.00|11.7|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00|39|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|39|8.19 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 27210645|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X12 EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00|39|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|||39.00||||39.00|11.7|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|39|8.19 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 27210647|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|GEHA [1415]|GEHA [141500]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|CORESOURCE [1315]|CORESOURCE [131500]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.00||||19.00|9.11|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|||19.00||||19.00|5.7|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.00||||19.00|12.35|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.00||||19.00|19|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|UMR [2035]|UMR OPTIONS [203501]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MULTIPLAN [1680]|IHC HS [168011]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|CHAMPVA [1240]|CHAMP VA [124000]|19.00||||19.00|14.25|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|HEALTHNET [1495]|HEALTHNET [149500]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|TRUSTMARK [2030]|STARMARK [203000]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.00||||19.00|3.99|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.00||||19.00|8.17|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.00||||19.00|8.17|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.00||||19.00|9.52|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.00||||19.00|6.67|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.00||||19.00|11.4|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.00||||19.00|17.1|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.00||||19.00|8.09|19|3.99 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MULTIPLAN [1680]|HMA [168003]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|AETNA [1015]|AETNA ACO WILCO [101532]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.00||||19.00||| 27210648|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER 4X8 EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.00||||19.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26.00||||26.00|11.08|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26.00||||26.00|12.79|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26.00||||26.00|12.35|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26.00||||26.00|11.18|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|TRUSTMARK [2030]|STARMARK [203000]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26.00||||26.00|15.6|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MULTIPLAN [1680]|IHC HS [168011]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|FIRST HEALTH [1375]|QUALCHOICE [137513]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26.00||||26.00|14.62|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26.00||||26.00|16.9|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|UMR [2035]|UMR OPTIONS [203501]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26.00||||26.00|5.46|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26.00||||26.00|26|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26.00||||26.00|12.47|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26.00||||26.00|13|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|FMH BENEFIT SERVICES [1390]|FMH [139000]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|||26.00||||26.00|7.8|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26.00||||26.00|13.03|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|HEALTHNET [1495]|HEALTHNET [149500]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26.00||||26.00|9.13|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26.00||||26.00|12.79|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26.00||||26.00|11.18|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|CHAMPVA [1240]|CHAMP VA [124000]|26.00||||26.00|19.5|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|GEHA [1415]|GEHA [141500]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26.00||||26.00|11.77|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|CORESOURCE [1315]|CORESOURCE [131500]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26.00||||26.00|23.4|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26.00||||26.00|13.29|26|5.46 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|AETNA [1015]|AETNA ACO WILCO [101532]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|MULTIPLAN [1680]|HMA [168003]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26.00||||26.00||| 27210650|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC DRSG MEPILEX BORDER 6X6|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26.00||||26.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|CHAMPVA [1240]|CHAMP VA [124000]|46.00||||46.00|34.5|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|||46.00||||46.00|13.8|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.00||||46.00|22.06|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|GEHA [1415]|GEHA [141500]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.00||||46.00|29.9|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.00||||46.00|46|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.00||||46.00|19.78|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|UMR [2035]|UMR OPTIONS [203501]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.00||||46.00|9.66|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|TRUSTMARK [2030]|STARMARK [203000]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|CORESOURCE [1315]|CORESOURCE [131500]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|HEALTHNET [1495]|HEALTHNET [149500]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.00||||46.00|23.05|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.00||||46.00|16.15|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.00||||46.00|27.6|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.00||||46.00|19.78|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MULTIPLAN [1680]|IHC HS [168011]|46.00||||46.00|41.4|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.00||||46.00|19.6|46|9.66 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|AETNA [1015]|AETNA ACO WILCO [101532]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MULTIPLAN [1680]|HMA [168003]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.00||||46.00||| 27210654|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 2X5 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.00||||46.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.00||||53.00|22.79|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53.00||||53.00|11.13|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53.00||||53.00|53|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53.00||||53.00|34.45|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|UMR [2035]|UMR OPTIONS [203501]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.00||||53.00|25.41|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|||53.00||||53.00|15.9|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|GEHA [1415]|GEHA [141500]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|CORESOURCE [1315]|CORESOURCE [131500]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|CHAMPVA [1240]|CHAMP VA [124000]|53.00||||53.00|39.75|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53.00||||53.00|22.79|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53.00||||53.00|18.6|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53.00||||53.00|31.8|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53.00||||53.00|22.58|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53.00||||53.00|26.55|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|TRUSTMARK [2030]|STARMARK [203000]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|HEALTHNET [1495]|HEALTHNET [149500]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MULTIPLAN [1680]|IHC HS [168011]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53.00||||53.00|47.7|53|11.13 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|AETNA [1015]|AETNA ACO WILCO [101532]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|MULTIPLAN [1680]|HMA [168003]|53.00||||53.00||| 27210655|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX BORDER LITE 3X3 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53.00||||53.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|||25.00||||25.00|7.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00|25|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|10.75|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|10.75|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|25|5.25 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 27210658|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM 4X8 EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|10.75|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|10.75|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00|25|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|||25.00||||25.00|7.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|25|5.25 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00||| 27210660|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX HEEL EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|GEHA [1415]|GEHA [141500]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|CHAMPVA [1240]|CHAMP VA [124000]|15.00||||15.00|11.25|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|||15.00||||15.00|4.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.00||||15.00|9.75|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.00||||15.00|15|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.00||||15.00|3.15|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MULTIPLAN [1680]|IHC HS [168011]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|HEALTHNET [1495]|HEALTHNET [149500]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|TRUSTMARK [2030]|STARMARK [203000]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.00||||15.00|7.19|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.00||||15.00|6.45|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|CORESOURCE [1315]|CORESOURCE [131500]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|UMR [2035]|UMR OPTIONS [203501]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.00||||15.00|6.45|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15.00||||15.00|7.52|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.00||||15.00|5.27|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.00||||15.00|9|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.00||||15.00|13.5|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15.00||||15.00|6.39|15|3.15 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MULTIPLAN [1680]|HMA [168003]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|AETNA [1015]|AETNA ACO WILCO [101532]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.00||||15.00||| 27210723|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OINTMENT ANTIFUNGAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.00||||15.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.00||||32.00|13.76|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.00||||32.00|11.23|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32.00||||32.00|13.63|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.00||||32.00|19.2|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|HEALTHNET [1495]|HEALTHNET [149500]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MULTIPLAN [1680]|IHC HS [168011]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.00||||32.00|13.76|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|UMR [2035]|UMR OPTIONS [203501]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.00||||32.00|6.72|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|TRUSTMARK [2030]|STARMARK [203000]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.00||||32.00|32|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.00||||32.00|15.34|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.00||||32.00|20.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|||32.00||||32.00|9.6|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32.00||||32.00|16.03|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|CORESOURCE [1315]|CORESOURCE [131500]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|CHAMPVA [1240]|CHAMP VA [124000]|32.00||||32.00|24|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|GEHA [1415]|GEHA [141500]|32.00||||32.00|28.8|32|6.72 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|AETNA [1015]|AETNA ACO WILCO [101532]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|MULTIPLAN [1680]|HMA [168003]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32.00||||32.00||| 27210729|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OSTOMY CATH ACCESS PORT EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.00||||32.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.00||||31.00|14.86|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|GEHA [1415]|GEHA [141500]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|CORESOURCE [1315]|CORESOURCE [131500]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.00||||31.00|20.15|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.00||||31.00|6.51|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MULTIPLAN [1680]|IHC HS [168011]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|HEALTHNET [1495]|HEALTHNET [149500]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|TRUSTMARK [2030]|STARMARK [203000]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.00||||31.00|31|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.00||||31.00|13.33|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|||31.00||||31.00|9.3|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|CHAMPVA [1240]|CHAMP VA [124000]|31.00||||31.00|23.25|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.00||||31.00|13.33|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|UMR [2035]|UMR OPTIONS [203501]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.00||||31.00|15.53|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.00||||31.00|10.88|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.00||||31.00|27.9|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.00||||31.00|18.6|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.00||||31.00|13.21|31|6.51 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MULTIPLAN [1680]|HMA [168003]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|AETNA [1015]|AETNA ACO WILCO [101532]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.00||||31.00||| 27210736|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXIMAX FOREHEAD OXIMETRY MAXFA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.00||||31.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|TRUSTMARK [2030]|STARMARK [203000]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6.00||||6.00|3.01|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6.00||||6.00|2.58|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6.00||||6.00|2.11|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6.00||||6.00|3.6|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|HEALTHNET [1495]|HEALTHNET [149500]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|FMH BENEFIT SERVICES [1390]|FMH [139000]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|FIRST HEALTH [1375]|QUALCHOICE [137513]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|UMR [2035]|UMR OPTIONS [203501]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6.00||||6.00|1.26|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.00||||6.00|2.58|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6.00||||6.00|6|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.00||||6.00|2.88|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6.00||||6.00|3.9|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|||6.00||||6.00|1.8|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6.00||||6.00|2.56|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MULTIPLAN [1680]|IHC HS [168011]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|CHAMPVA [1240]|CHAMP VA [124000]|6.00||||6.00|4.5|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|GEHA [1415]|GEHA [141500]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|CORESOURCE [1315]|CORESOURCE [131500]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6.00||||6.00|5.4|6|1.26 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|AETNA [1015]|AETNA ACO WILCO [101532]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MULTIPLAN [1680]|HMA [168003]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6.00||||6.00||| 27210737|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC OXYGEN BUBBLE HUMIDIFIER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.00||||6.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|||29.00||||29.00|8.7|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00|29|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|29|6.09 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 27210768|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC PASTE ADAPT 2 OZ TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.00||||41.00|24.6|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.00||||41.00|17.63|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.00||||41.00|14.39|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|TRUSTMARK [2030]|STARMARK [203000]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|HEALTHNET [1495]|HEALTHNET [149500]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.00||||41.00|17.63|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|UMR [2035]|UMR OPTIONS [203501]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.00||||41.00|8.61|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.00||||41.00|41|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.00||||41.00|19.66|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.00||||41.00|26.65|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|||41.00||||41.00|12.3|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.00||||41.00|17.47|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.00||||41.00|20.54|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|CORESOURCE [1315]|CORESOURCE [131500]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|GEHA [1415]|GEHA [141500]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|CHAMPVA [1240]|CHAMP VA [124000]|41.00||||41.00|30.75|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MULTIPLAN [1680]|IHC HS [168011]|41.00||||41.00|36.9|41|8.61 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|AETNA [1015]|AETNA ACO WILCO [101532]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|MULTIPLAN [1680]|HMA [168003]|41.00||||41.00||| 27210783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 1 PC EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.00||||41.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|||35.00||||35.00|10.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|GEHA [1415]|GEHA [141500]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35.00||||35.00|22.75|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35.00||||35.00|16.78|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35.00||||35.00|7.35|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|UMR [2035]|UMR OPTIONS [203501]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|35.00||||35.00|26.25|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MULTIPLAN [1680]|IHC HS [168011]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35.00||||35.00|35|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|TRUSTMARK [2030]|STARMARK [203000]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35.00||||35.00|15.05|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35.00||||35.00|15.05|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35.00||||35.00|17.54|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35.00||||35.00|12.29|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35.00||||35.00|31.5|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35.00||||35.00|21|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35.00||||35.00|14.91|35|7.35 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MULTIPLAN [1680]|HMA [168003]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35.00||||35.00||| 27210784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2 PC 1 3/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35.00||||35.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.00||||123.00|73.8|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.00||||123.00|52.89|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.00||||123.00|43.17|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|TRUSTMARK [2030]|STARMARK [203000]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|UMR [2035]|UMR OPTIONS [203501]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.00||||123.00|25.83|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.00||||123.00|52.89|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.00||||123.00|123|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.00||||123.00|58.98|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.00||||123.00|79.95|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|||123.00||||123.00|36.9|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123.00||||123.00|52.4|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123.00||||123.00|61.62|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MULTIPLAN [1680]|IHC HS [168011]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|123.00||||123.00|92.25|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|GEHA [1415]|GEHA [141500]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|123.00||||123.00|110.7|123|25.83 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MULTIPLAN [1680]|HMA [168003]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123.00||||123.00||| 27210785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 1/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123.00||||123.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|GEHA [1415]|GEHA [141500]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|139.00||||139.00|104.25|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|||139.00||||139.00|41.7|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.00||||139.00|90.35|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.00||||139.00|139|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.00||||139.00|59.77|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MULTIPLAN [1680]|IHC HS [168011]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|TRUSTMARK [2030]|STARMARK [203000]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.00||||139.00|29.19|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.00||||139.00|66.65|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|UMR [2035]|UMR OPTIONS [203501]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.00||||139.00|59.77|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139.00||||139.00|69.64|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.00||||139.00|48.79|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.00||||139.00|83.4|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.00||||139.00|125.1|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139.00||||139.00|59.21|139|29.19 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MULTIPLAN [1680]|HMA [168003]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.00||||139.00||| 27210786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH HI-OUT 2PC 2 3/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.00||||139.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|40.85|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|40.85|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|||95.00||||95.00|28.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|19.95 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00||| 27210790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 1 PIECE BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.00||||61.00|29.25|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|GEHA [1415]|GEHA [141500]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|61.00||||61.00|45.75|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.00||||61.00|39.65|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.00||||61.00|61|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.00||||61.00|12.81|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MULTIPLAN [1680]|IHC HS [168011]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|TRUSTMARK [2030]|STARMARK [203000]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.00||||61.00|26.23|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|||61.00||||61.00|18.3|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.00||||61.00|26.23|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|UMR [2035]|UMR OPTIONS [203501]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.00||||61.00|30.56|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.00||||61.00|21.41|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.00||||61.00|54.9|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.00||||61.00|36.6|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.00||||61.00|25.99|61|12.81 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MULTIPLAN [1680]|HMA [168003]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.00||||61.00||| 27210791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 1 3/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.00||||61.00|25.99|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.00||||61.00|26.23|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.00||||61.00|30.56|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|TRUSTMARK [2030]|STARMARK [203000]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|UMR [2035]|UMR OPTIONS [203501]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.00||||61.00|12.81|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.00||||61.00|26.23|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.00||||61.00|61|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.00||||61.00|29.25|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.00||||61.00|36.6|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.00||||61.00|21.41|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.00||||61.00|39.65|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|||61.00||||61.00|18.3|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MULTIPLAN [1680]|IHC HS [168011]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|61.00||||61.00|45.75|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|GEHA [1415]|GEHA [141500]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.00||||61.00|54.9|61|12.81 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|MULTIPLAN [1680]|HMA [168003]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.00||||61.00||| 27210792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|||61.00||||61.00|18.3|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.00||||61.00|39.65|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.00||||61.00|61|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|UMR [2035]|UMR OPTIONS [203501]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.00||||61.00|26.23|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MULTIPLAN [1680]|IHC HS [168011]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|TRUSTMARK [2030]|STARMARK [203000]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.00||||61.00|12.81|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.00||||61.00|29.25|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.00||||61.00|26.23|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.00||||61.00|30.56|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.00||||61.00|21.41|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.00||||61.00|25.99|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.00||||61.00|36.6|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|GEHA [1415]|GEHA [141500]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|61.00||||61.00|45.75|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.00||||61.00|54.9|61|12.81 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MULTIPLAN [1680]|HMA [168003]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.00||||61.00||| 27210793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 2 3/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.00||||61.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55.00||||55.00|33|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55.00||||55.00|23.65|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55.00||||55.00|19.31|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55.00||||55.00|23.43|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|HEALTHNET [1495]|HEALTHNET [149500]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MULTIPLAN [1680]|IHC HS [168011]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55.00||||55.00|23.65|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|TRUSTMARK [2030]|STARMARK [203000]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|UMR [2035]|UMR OPTIONS [203501]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55.00||||55.00|11.55|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55.00||||55.00|55|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55.00||||55.00|26.37|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55.00||||55.00|27.56|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55.00||||55.00|35.75|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|||55.00||||55.00|16.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|CHAMPVA [1240]|CHAMP VA [124000]|55.00||||55.00|41.25|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|CORESOURCE [1315]|CORESOURCE [131500]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|GEHA [1415]|GEHA [141500]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55.00||||55.00|49.5|55|11.55 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|AETNA [1015]|AETNA ACO WILCO [101532]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MULTIPLAN [1680]|HMA [168003]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55.00||||55.00||| 27210794|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY 2PC 4IN BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55.00||||55.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|GEHA [1415]|GEHA [141500]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|CHAMPVA [1240]|CHAMP VA [124000]|17.00||||17.00|12.75|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|||17.00||||17.00|5.1|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.00||||17.00|11.05|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.00||||17.00|8.15|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.00||||17.00|3.57|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|UMR [2035]|UMR OPTIONS [203501]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.00||||17.00|7.31|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MULTIPLAN [1680]|IHC HS [168011]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.00||||17.00|17|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|HEALTHNET [1495]|HEALTHNET [149500]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|TRUSTMARK [2030]|STARMARK [203000]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|CORESOURCE [1315]|CORESOURCE [131500]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.00||||17.00|7.31|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.00||||17.00|8.52|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.00||||17.00|5.97|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.00||||17.00|7.24|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.00||||17.00|10.2|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.00||||17.00|15.3|17|3.57 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MULTIPLAN [1680]|HMA [168003]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|AETNA [1015]|AETNA ACO WILCO [101532]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.00||||17.00||| 27210796|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HIGH OUTPUT 2 1/4 IN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.00||||17.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|7.74|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|7.74|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|||18.00||||18.00|5.4|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 27210797|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY HOLLISTER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|GEHA [1415]|GEHA [141500]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|CORESOURCE [1315]|CORESOURCE [131500]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|CHAMPVA [1240]|CHAMP VA [124000]|41.00||||41.00|30.75|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|||41.00||||41.00|12.3|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.00||||41.00|26.65|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.00||||41.00|19.66|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.00||||41.00|41|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.00||||41.00|8.61|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.00||||41.00|17.63|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|UMR [2035]|UMR OPTIONS [203501]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MULTIPLAN [1680]|IHC HS [168011]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|HEALTHNET [1495]|HEALTHNET [149500]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|TRUSTMARK [2030]|STARMARK [203000]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.00||||41.00|17.63|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.00||||41.00|20.54|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.00||||41.00|14.39|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.00||||41.00|17.47|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.00||||41.00|24.6|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.00||||41.00|36.9|41|8.61 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MULTIPLAN [1680]|HMA [168003]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|AETNA [1015]|AETNA ACO WILCO [101532]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.00||||41.00||| 27210798|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH OSTOMY WOUND MANAGER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.00||||41.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|40.85|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|40.85|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|||95.00||||95.00|28.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|19.95 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00||| 27210801|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 1 PIECE BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|GEHA [1415]|GEHA [141500]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|CHAMPVA [1240]|CHAMP VA [124000]|35.00||||35.00|26.25|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35.00||||35.00|22.75|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35.00||||35.00|16.78|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35.00||||35.00|7.35|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|UMR [2035]|UMR OPTIONS [203501]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35.00||||35.00|15.05|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|FIRST HEALTH [1375]|QUALCHOICE [137513]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|FMH BENEFIT SERVICES [1390]|FMH [139000]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MULTIPLAN [1680]|IHC HS [168011]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35.00||||35.00|35|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|HEALTHNET [1495]|HEALTHNET [149500]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|||35.00||||35.00|10.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|TRUSTMARK [2030]|STARMARK [203000]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|CORESOURCE [1315]|CORESOURCE [131500]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35.00||||35.00|15.05|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35.00||||35.00|17.54|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35.00||||35.00|12.29|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35.00||||35.00|14.91|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35.00||||35.00|21|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35.00||||35.00|31.5|35|7.35 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MULTIPLAN [1680]|HMA [168003]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|AETNA [1015]|AETNA ACO WILCO [101532]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35.00||||35.00||| 27210802|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2 PC 2 3/4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35.00||||35.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|40.85|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|40.85|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|||95.00||||95.00|28.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|19.95 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00||| 27210803|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 1 3/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|||95.00||||95.00|28.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|40.85|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|40.85|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|19.95 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00||| 27210804|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH UROSTOMY 2PC 2 1/4 BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.00||||49.00|29.4|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.00||||49.00|21.07|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.00||||49.00|17.2|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.00||||49.00|20.87|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|TRUSTMARK [2030]|STARMARK [203000]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|HEALTHNET [1495]|HEALTHNET [149500]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MULTIPLAN [1680]|IHC HS [168011]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.00||||49.00|21.07|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|UMR [2035]|UMR OPTIONS [203501]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.00||||49.00|10.29|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.00||||49.00|49|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.00||||49.00|24.55|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.00||||49.00|23.5|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.00||||49.00|31.85|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|||49.00||||49.00|14.7|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|CHAMPVA [1240]|CHAMP VA [124000]|49.00||||49.00|36.75|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|CORESOURCE [1315]|CORESOURCE [131500]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|GEHA [1415]|GEHA [141500]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.00||||49.00|44.1|49|10.29 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|AETNA [1015]|AETNA ACO WILCO [101532]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MULTIPLAN [1680]|HMA [168003]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.00||||49.00||| 27210805|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC POUCH WOUND DRAINAGE EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.00||||49.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|7.74|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|||18.00||||18.00|5.4|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|7.74|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 27210830|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2 INCH 3 PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118.00||||118.00|50.74|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118.00||||118.00|59.12|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118.00||||118.00|41.42|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118.00||||118.00|50.27|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|TRUSTMARK [2030]|STARMARK [203000]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|HEALTHNET [1495]|HEALTHNET [149500]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MULTIPLAN [1680]|IHC HS [168011]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118.00||||118.00|50.74|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|UMR [2035]|UMR OPTIONS [203501]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118.00||||118.00|24.78|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118.00||||118.00|118|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118.00||||118.00|56.58|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118.00||||118.00|70.8|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118.00||||118.00|76.7|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|||118.00||||118.00|35.4|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|CHAMPVA [1240]|CHAMP VA [124000]|118.00||||118.00|88.5|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|CORESOURCE [1315]|CORESOURCE [131500]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|GEHA [1415]|GEHA [141500]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118.00||||118.00|106.2|118|24.78 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|AETNA [1015]|AETNA ACO WILCO [101532]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|MULTIPLAN [1680]|HMA [168003]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118.00||||118.00||| 27210831|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 2IN BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118.00||||118.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|||18.00||||18.00|5.4|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|7.74|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|7.74|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 27210832|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC RING ADAPT 4 INCH 3 PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|10.75|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|10.75|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00|25|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|||25.00||||25.00|7.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|25|5.25 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 27210847|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE ADHESIVE RELEAS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00|25|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|10.75|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|||25.00||||25.00|7.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|10.75|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|25|5.25 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 27210848|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SENSI CARE SKIN BARRIER SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.00||||15.00|9|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.00||||15.00|6.45|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15.00||||15.00|7.52|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.00||||15.00|5.27|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|TRUSTMARK [2030]|STARMARK [203000]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|HEALTHNET [1495]|HEALTHNET [149500]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MULTIPLAN [1680]|IHC HS [168011]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.00||||15.00|6.45|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|UMR [2035]|UMR OPTIONS [203501]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.00||||15.00|3.15|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15.00||||15.00|6.39|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.00||||15.00|15|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.00||||15.00|7.19|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.00||||15.00|9.75|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|||15.00||||15.00|4.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|CHAMPVA [1240]|CHAMP VA [124000]|15.00||||15.00|11.25|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|CORESOURCE [1315]|CORESOURCE [131500]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|GEHA [1415]|GEHA [141500]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.00||||15.00|13.5|15|3.15 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|AETNA [1015]|AETNA ACO WILCO [101532]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|MULTIPLAN [1680]|HMA [168003]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15.00||||15.00||| 27210881|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC SORBASAN 4X8 EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15.00||||15.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|GEHA [1415]|GEHA [141500]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|CORESOURCE [1315]|CORESOURCE [131500]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|||58.00||||58.00|17.4|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.00||||58.00|37.7|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.00||||58.00|58|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|UMR [2035]|UMR OPTIONS [203501]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.00||||58.00|24.94|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MULTIPLAN [1680]|IHC HS [168011]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.00||||58.00|12.18|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|HEALTHNET [1495]|HEALTHNET [149500]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.00||||58.00|27.81|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|TRUSTMARK [2030]|STARMARK [203000]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.00||||58.00|24.94|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.00||||58.00|29.06|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.00||||58.00|20.36|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.00||||58.00|24.71|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.00||||58.00|34.8|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|CHAMPVA [1240]|CHAMP VA [124000]|58.00||||58.00|43.5|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.00||||58.00|52.2|58|12.18 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MULTIPLAN [1680]|HMA [168003]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|AETNA [1015]|AETNA ACO WILCO [101532]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.00||||58.00||| 27211215|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC TRIAD PASTE EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.00||||58.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.00||||41.00|24.6|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.00||||41.00|17.63|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.00||||41.00|14.39|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.00||||41.00|17.47|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|HEALTHNET [1495]|HEALTHNET [149500]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MULTIPLAN [1680]|IHC HS [168011]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.00||||41.00|17.63|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|TRUSTMARK [2030]|STARMARK [203000]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|UMR [2035]|UMR OPTIONS [203501]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.00||||41.00|8.61|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.00||||41.00|41|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.00||||41.00|19.66|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.00||||41.00|20.54|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.00||||41.00|26.65|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|||41.00||||41.00|12.3|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|CHAMPVA [1240]|CHAMP VA [124000]|41.00||||41.00|30.75|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|CORESOURCE [1315]|CORESOURCE [131500]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|GEHA [1415]|GEHA [141500]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.00||||41.00|36.9|41|8.61 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MULTIPLAN [1680]|HMA [168003]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|AETNA [1015]|AETNA ACO WILCO [101532]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.00||||41.00||| 27211276|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC ULTRASORB 24X36 BAG OF 10|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.00||||41.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|||18.00||||18.00|5.4|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|7.74|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|7.74|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 27211279|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC UNNA-Z CALAMINE NONUNNA 4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66.00||||66.00|28.38|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66.00||||66.00|33.07|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66.00||||66.00|23.17|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|TRUSTMARK [2030]|STARMARK [203000]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|HEALTHNET [1495]|HEALTHNET [149500]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.00||||66.00|28.38|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MULTIPLAN [1680]|IHC HS [168011]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|UMR [2035]|UMR OPTIONS [203501]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66.00||||66.00|13.86|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66.00||||66.00|28.12|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66.00||||66.00|66|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.00||||66.00|31.65|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66.00||||66.00|39.6|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66.00||||66.00|42.9|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|||66.00||||66.00|19.8|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|CHAMPVA [1240]|CHAMP VA [124000]|66.00||||66.00|49.5|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|CORESOURCE [1315]|CORESOURCE [131500]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|GEHA [1415]|GEHA [141500]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66.00||||66.00|59.4|66|13.86 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|AETNA [1015]|AETNA ACO WILCO [101532]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|MULTIPLAN [1680]|HMA [168003]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66.00||||66.00||| 27211296|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 1 3/4 BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|GEHA [1415]|GEHA [141500]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|CORESOURCE [1315]|CORESOURCE [131500]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|CHAMPVA [1240]|CHAMP VA [124000]|66.00||||66.00|49.5|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|||66.00||||66.00|19.8|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66.00||||66.00|42.9|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66.00||||66.00|66|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66.00||||66.00|13.86|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.00||||66.00|28.38|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|UMR [2035]|UMR OPTIONS [203501]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MULTIPLAN [1680]|IHC HS [168011]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.00||||66.00|31.65|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|HEALTHNET [1495]|HEALTHNET [149500]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|TRUSTMARK [2030]|STARMARK [203000]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66.00||||66.00|28.38|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66.00||||66.00|33.07|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66.00||||66.00|23.17|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66.00||||66.00|28.12|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66.00||||66.00|39.6|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66.00||||66.00|59.4|66|13.86 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MULTIPLAN [1680]|HMA [168003]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|AETNA [1015]|AETNA ACO WILCO [101532]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66.00||||66.00||| 27211297|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 1/4 BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66.00||||66.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106.00||||106.00|63.6|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.00||||106.00|45.58|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|106.00||||106.00|53.11|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.00||||106.00|37.21|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|106.00||||106.00|45.16|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|HEALTHNET [1495]|HEALTHNET [149500]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MULTIPLAN [1680]|IHC HS [168011]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.00||||106.00|45.58|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|UMR [2035]|UMR OPTIONS [203501]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|TRUSTMARK [2030]|STARMARK [203000]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.00||||106.00|22.26|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.00||||106.00|106|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.00||||106.00|50.83|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.00||||106.00|68.9|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|||106.00||||106.00|31.8|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|CHAMPVA [1240]|CHAMP VA [124000]|106.00||||106.00|79.5|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|CORESOURCE [1315]|CORESOURCE [131500]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|GEHA [1415]|GEHA [141500]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.00||||106.00|95.4|106|22.26 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|AETNA [1015]|AETNA ACO WILCO [101532]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MULTIPLAN [1680]|HMA [168003]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|106.00||||106.00||| 27211298|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS CONVEX 2 3/4 BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|106.00||||106.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|GEHA [1415]|GEHA [141500]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|CHAMPVA [1240]|CHAMP VA [124000]|43.00||||43.00|32.25|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.00||||43.00|27.95|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.00||||43.00|20.62|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.00||||43.00|9.03|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|UMR [2035]|UMR OPTIONS [203501]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.00||||43.00|18.49|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MULTIPLAN [1680]|IHC HS [168011]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.00||||43.00|43|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|HEALTHNET [1495]|HEALTHNET [149500]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|TRUSTMARK [2030]|STARMARK [203000]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|||43.00||||43.00|12.9|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|CORESOURCE [1315]|CORESOURCE [131500]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.00||||43.00|18.49|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43.00||||43.00|21.54|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.00||||43.00|15.09|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43.00||||43.00|18.32|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.00||||43.00|25.8|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.00||||43.00|38.7|43|9.03 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MULTIPLAN [1680]|HMA [168003]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|AETNA [1015]|AETNA ACO WILCO [101532]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.00||||43.00||| 27211299|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 1 3/4 BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.00||||43.00|18.49|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43.00||||43.00|21.54|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.00||||43.00|15.09|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43.00||||43.00|18.32|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|TRUSTMARK [2030]|STARMARK [203000]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|HEALTHNET [1495]|HEALTHNET [149500]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MULTIPLAN [1680]|IHC HS [168011]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.00||||43.00|18.49|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|UMR [2035]|UMR OPTIONS [203501]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.00||||43.00|9.03|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.00||||43.00|43|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.00||||43.00|20.62|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.00||||43.00|25.8|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.00||||43.00|27.95|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|||43.00||||43.00|12.9|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|CHAMPVA [1240]|CHAMP VA [124000]|43.00||||43.00|32.25|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|CORESOURCE [1315]|CORESOURCE [131500]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|GEHA [1415]|GEHA [141500]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.00||||43.00|38.7|43|9.03 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|AETNA [1015]|AETNA ACO WILCO [101532]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|MULTIPLAN [1680]|HMA [168003]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43.00||||43.00||| 27211300|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 1/4 BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|GEHA [1415]|GEHA [141500]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|CORESOURCE [1315]|CORESOURCE [131500]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|||43.00||||43.00|12.9|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.00||||43.00|27.95|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.00||||43.00|20.62|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.00||||43.00|43|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.00||||43.00|18.49|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|UMR [2035]|UMR OPTIONS [203501]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.00||||43.00|9.03|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MULTIPLAN [1680]|IHC HS [168011]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|HEALTHNET [1495]|HEALTHNET [149500]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|TRUSTMARK [2030]|STARMARK [203000]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|CHAMPVA [1240]|CHAMP VA [124000]|43.00||||43.00|32.25|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.00||||43.00|18.49|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43.00||||43.00|21.54|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.00||||43.00|15.09|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43.00||||43.00|18.32|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.00||||43.00|25.8|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.00||||43.00|38.7|43|9.03 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MULTIPLAN [1680]|HMA [168003]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|AETNA [1015]|AETNA ACO WILCO [101532]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.00||||43.00||| 27211301|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 2 3/4 BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.00||||43.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98.00||||98.00|58.8|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98.00||||98.00|42.14|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98.00||||98.00|34.4|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|98.00||||98.00|41.75|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|TRUSTMARK [2030]|STARMARK [203000]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|HEALTHNET [1495]|HEALTHNET [149500]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MULTIPLAN [1680]|IHC HS [168011]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|FMH BENEFIT SERVICES [1390]|FMH [139000]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|FIRST HEALTH [1375]|QUALCHOICE [137513]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98.00||||98.00|42.14|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|UMR [2035]|UMR OPTIONS [203501]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98.00||||98.00|20.58|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98.00||||98.00|98|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|98.00||||98.00|49.1|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98.00||||98.00|46.99|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98.00||||98.00|63.7|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|||98.00||||98.00|29.4|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|CHAMPVA [1240]|CHAMP VA [124000]|98.00||||98.00|73.5|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|CORESOURCE [1315]|CORESOURCE [131500]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|GEHA [1415]|GEHA [141500]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98.00||||98.00|88.2|98|20.58 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|AETNA [1015]|AETNA ACO WILCO [101532]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MULTIPLAN [1680]|HMA [168003]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|98.00||||98.00||| 27211302|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC WAFERS FLAT 4 IN BOX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|98.00||||98.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|GEHA [1415]|GEHA [141500]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|CHAMPVA [1240]|CHAMP VA [124000]|43.00||||43.00|32.25|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.00||||43.00|27.95|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.00||||43.00|20.62|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.00||||43.00|9.03|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|UMR [2035]|UMR OPTIONS [203501]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.00||||43.00|18.49|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MULTIPLAN [1680]|IHC HS [168011]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|HEALTHNET [1495]|HEALTHNET [149500]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.00||||43.00|43|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|||43.00||||43.00|12.9|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|TRUSTMARK [2030]|STARMARK [203000]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|CORESOURCE [1315]|CORESOURCE [131500]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.00||||43.00|18.49|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43.00||||43.00|21.54|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.00||||43.00|15.09|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43.00||||43.00|18.32|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.00||||43.00|25.8|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.00||||43.00|38.7|43|9.03 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MULTIPLAN [1680]|HMA [168003]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|AETNA [1015]|AETNA ACO WILCO [101532]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.00||||43.00||| 27211303|EAP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|HC WASH WOUND SALINE EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.00||||43.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.00||||31.00|15.5|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.00||||31.00|13.33|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.00||||31.00|15.53|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.00||||31.00|10.88|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.00||||31.00|13.21|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.00||||31.00|11.46|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.00||||31.00|11.07|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|TRUSTMARK [2030]|STARMARK [203000]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|HEALTHNET [1495]|HEALTHNET [149500]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MULTIPLAN [1680]|IHC HS [168011]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.00||||31.00|13.33|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.00||||31.00|13.11|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|UMR [2035]|UMR OPTIONS [203501]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.00||||31.00|6.51|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.00||||31.00|31|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.00||||31.00|14.86|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.00||||31.00|18.6|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.00||||31.00|20.15|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|||31.00||||31.00|9.3|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.00||||31.00|11.46|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.00||||31.00|10.54|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|CHAMPVA [1240]|CHAMP VA [124000]|31.00||||31.00|23.25|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|CORESOURCE [1315]|CORESOURCE [131500]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|GEHA [1415]|GEHA [141500]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.00||||31.00|27.9|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.00||||31.00|11.91|31|6.51 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|AETNA [1015]|AETNA ACO WILCO [101532]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|MULTIPLAN [1680]|HMA [168003]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.00||||31.00||| 27211505|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC MEPILEX FOAM AG 4X4 EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.00||||31.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|GEHA [1415]|GEHA [141500]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|CORESOURCE [1315]|CORESOURCE [131500]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|||6.00||||6.00|1.8|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6.00||||6.00|3.9|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6.00||||6.00|6|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.00||||6.00|2.58|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|FIRST HEALTH [1375]|QUALCHOICE [137513]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|FMH BENEFIT SERVICES [1390]|FMH [139000]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|UMR [2035]|UMR OPTIONS [203501]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MULTIPLAN [1680]|IHC HS [168011]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6.00||||6.00|1.26|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.00||||6.00|2.88|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|HEALTHNET [1495]|HEALTHNET [149500]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|TRUSTMARK [2030]|STARMARK [203000]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|CHAMPVA [1240]|CHAMP VA [124000]|6.00||||6.00|4.5|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6.00||||6.00|2.58|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6.00||||6.00|3.01|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6.00||||6.00|2.11|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6.00||||6.00|2.56|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6.00||||6.00|3.6|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6.00||||6.00|5.4|6|1.26 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MULTIPLAN [1680]|HMA [168003]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|AETNA [1015]|AETNA ACO WILCO [101532]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.00||||6.00||| 27211779|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM 4X4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6.00||||6.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.00||||13.00|7.8|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.00||||13.00|5.59|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.00||||13.00|4.56|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.00||||13.00|5.54|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|HEALTHNET [1495]|HEALTHNET [149500]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MULTIPLAN [1680]|IHC HS [168011]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.00||||13.00|5.59|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|TRUSTMARK [2030]|STARMARK [203000]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|UMR [2035]|UMR OPTIONS [203501]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.00||||13.00|2.73|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.00||||13.00|13|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.00||||13.00|6.23|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.00||||13.00|8.45|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|||13.00||||13.00|3.9|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.00||||13.00|6.51|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|CHAMPVA [1240]|CHAMP VA [124000]|13.00||||13.00|9.75|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|CORESOURCE [1315]|CORESOURCE [131500]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|GEHA [1415]|GEHA [141500]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.00||||13.00|11.7|13|2.73 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|AETNA [1015]|AETNA ACO WILCO [101532]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MULTIPLAN [1680]|HMA [168003]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.00||||13.00||| 27211780|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH 7 X 7|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.00||||13.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MULTIPLAN [1680]|IHC HS [168011]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|HEALTHNET [1495]|HEALTHNET [149500]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|TRUSTMARK [2030]|STARMARK [203000]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.00||||19.00|12.35|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.00||||19.00|8.17|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.00||||19.00|12.79|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.00||||19.00|8.17|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.00||||19.00|9.52|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.00||||19.00|6.67|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.00||||19.00|8.09|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.00||||19.00|11.4|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.00||||19.00|9.5|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.00||||19.00|3.99|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.00||||19.00|9.11|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.00||||19.00|12.35|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.00||||19.00|12.79|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|UMR [2035]|UMR OPTIONS [203501]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.00||||19.00|19|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|||19.00||||19.00|5.7|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.00||||19.00|14.62|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.00||||19.00|11.77|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|CORESOURCE [1315]|CORESOURCE [131500]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|GEHA [1415]|GEHA [141500]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|CHAMPVA [1240]|CHAMP VA [124000]|19.00||||19.00|14.25|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.00||||19.00|17.1|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.00||||19.00|13.29|19|3.99 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MULTIPLAN [1680]|HMA [168003]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|AETNA [1015]|AETNA ACO WILCO [101532]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.00||||19.00||| 27211781|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH HEEL 8 X 5.5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.00||||19.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|HEALTHNET [1495]|HEALTHNET [149500]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.00||||15.00|9.75|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|||15.00||||15.00|4.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|UMR [2035]|UMR OPTIONS [203501]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.00||||15.00|5.27|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.00||||15.00|3.15|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|CHAMPVA [1240]|CHAMP VA [124000]|15.00||||15.00|11.25|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.00||||15.00|15|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.00||||15.00|6.45|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|GEHA [1415]|GEHA [141500]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MULTIPLAN [1680]|IHC HS [168011]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|CORESOURCE [1315]|CORESOURCE [131500]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.00||||15.00|9|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.00||||15.00|7.19|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15.00||||15.00|7.52|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.00||||15.00|6.45|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15.00||||15.00|6.39|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|TRUSTMARK [2030]|STARMARK [203000]|15.00||||15.00|13.5|15|3.15 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MULTIPLAN [1680]|HMA [168003]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|AETNA [1015]|AETNA ACO WILCO [101532]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.00||||15.00||| 27211782|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL 8 X 7|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.00||||15.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.00||||21.00|9.03|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.00||||21.00|8.95|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.00||||21.00|7.37|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.00||||21.00|10.52|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|TRUSTMARK [2030]|STARMARK [203000]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.00||||21.00|12.6|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.00||||21.00|13.65|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|GEHA [1415]|GEHA [141500]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.00||||21.00|9.03|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|||21.00||||21.00|6.3|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|CORESOURCE [1315]|CORESOURCE [131500]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MULTIPLAN [1680]|IHC HS [168011]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.00||||21.00|10.07|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|UMR [2035]|UMR OPTIONS [203501]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.00||||21.00|4.41|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|HEALTHNET [1495]|HEALTHNET [149500]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.00||||21.00|21|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.00||||21.00|18.9|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|CHAMPVA [1240]|CHAMP VA [124000]|21.00||||21.00|15.75|21|4.41 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|AETNA [1015]|AETNA ACO WILCO [101532]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|MULTIPLAN [1680]|HMA [168003]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.00||||21.00||| 27211783|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM ADH SACRAL LG5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.00||||21.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54.00||||54.00|27.05|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MULTIPLAN [1680]|IHC HS [168011]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54.00||||54.00|18.95|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54.00||||54.00|23|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|HEALTHNET [1495]|HEALTHNET [149500]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|FIRST HEALTH [1375]|QUALCHOICE [137513]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|FMH BENEFIT SERVICES [1390]|FMH [139000]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54.00||||54.00|11.34|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54.00||||54.00|23.22|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|UMR [2035]|UMR OPTIONS [203501]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|||54.00||||54.00|16.2|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|CORESOURCE [1315]|CORESOURCE [131500]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54.00||||54.00|23.22|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54.00||||54.00|25.89|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|GEHA [1415]|GEHA [141500]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54.00||||54.00|32.4|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54.00||||54.00|35.1|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|TRUSTMARK [2030]|STARMARK [203000]|54.00||||54.00|48.6|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54.00||||54.00|54|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|CHAMPVA [1240]|CHAMP VA [124000]|54.00||||54.00|40.5|54|11.34 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MULTIPLAN [1680]|HMA [168003]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|AETNA [1015]|AETNA ACO WILCO [101532]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54.00||||54.00||| 27211784|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG AG FOAM ADH HEEL 8 IN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54.00||||54.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|TRUSTMARK [2030]|STARMARK [203000]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15.00||||15.00|7.52|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.00||||15.00|9|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15.00||||15.00|6.45|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15.00||||15.00|5.27|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15.00||||15.00|6.39|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|UMR [2035]|UMR OPTIONS [203501]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|CORESOURCE [1315]|CORESOURCE [131500]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|FIRST HEALTH [1375]|QUALCHOICE [137513]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|CHAMPVA [1240]|CHAMP VA [124000]|15.00||||15.00|11.25|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|GEHA [1415]|GEHA [141500]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MULTIPLAN [1680]|IHC HS [168011]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|||15.00||||15.00|4.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.00||||15.00|6.45|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.00||||15.00|7.19|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15.00||||15.00|9.75|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15.00||||15.00|15|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|HEALTHNET [1495]|HEALTHNET [149500]|15.00||||15.00|13.5|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15.00||||15.00|3.15|15|3.15 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|AETNA [1015]|AETNA ACO WILCO [101532]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MULTIPLAN [1680]|HMA [168003]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15.00||||15.00||| 27211785|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO SMALL 8X7|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15.00||||15.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|TRUSTMARK [2030]|STARMARK [203000]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.00||||23.00|8.07|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|||23.00||||23.00|6.9|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.00||||23.00|13.8|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23.00||||23.00|11.52|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|CHAMPVA [1240]|CHAMP VA [124000]|23.00||||23.00|17.25|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MULTIPLAN [1680]|IHC HS [168011]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.00||||23.00|4.83|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|UMR [2035]|UMR OPTIONS [203501]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.00||||23.00|9.89|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23.00||||23.00|9.8|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|GEHA [1415]|GEHA [141500]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.00||||23.00|9.89|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.00||||23.00|23|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|CORESOURCE [1315]|CORESOURCE [131500]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|HEALTHNET [1495]|HEALTHNET [149500]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.00||||23.00|11.03|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.00||||23.00|20.7|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.00||||23.00|14.95|23|4.83 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|AETNA [1015]|AETNA ACO WILCO [101532]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MULTIPLAN [1680]|HMA [168003]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.00||||23.00||| 27211786|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG FOAM PRO LG 9.4 X 8.4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.00||||23.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|HEALTHNET [1495]|HEALTHNET [149500]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5.00||||5.00|11.72|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|CHAMPVA [1240]|CHAMP VA [124000]|5.00||||5.00|3.75|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5.00||||5.00|5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5.00||||5.00|2.51|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5.00||||5.00|5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.00||||5.00|2.15|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|||5.00||||5.00|1.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|FIRST HEALTH [1375]|QUALCHOICE [137513]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MULTIPLAN [1680]|IHC HS [168011]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5.00||||5.00|5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|UMR [2035]|UMR OPTIONS [203501]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|GEHA [1415]|GEHA [141500]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5.00||||5.00|11.28|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|TRUSTMARK [2030]|STARMARK [203000]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5.00||||5.00|1.76|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.00||||5.00|2.4|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5.00||||5.00|2.13|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5.00||||5.00|5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5.00||||5.00|11.28|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5.00||||5.00|2.15|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5.00||||5.00|3|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|CORESOURCE [1315]|CORESOURCE [131500]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.00||||5.00|2.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5.00||||5.00|4.5|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5.00||||5.00|1.05|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5.00||||5.00|3.25|11.72|1.05 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MULTIPLAN [1680]|HMA [168003]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|AETNA [1015]|AETNA ACO WILCO [101532]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5.00||||5.00||| 27211787|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 5x5CM(2x2IN)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.00||||5.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|7.74|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|7.74|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|||18.00||||18.00|5.4|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00||| 27211788|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 6 X 6|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.00||||13.00|6.51|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.00||||13.00|4.56|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.00||||13.00|7.8|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.00||||13.00|5.59|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.00||||13.00|5.54|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MULTIPLAN [1680]|IHC HS [168011]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|GEHA [1415]|GEHA [141500]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|UMR [2035]|UMR OPTIONS [203501]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|||13.00||||13.00|3.9|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.00||||13.00|6.23|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.00||||13.00|2.73|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.00||||13.00|13|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.00||||13.00|8.45|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|CHAMPVA [1240]|CHAMP VA [124000]|13.00||||13.00|9.75|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|CORESOURCE [1315]|CORESOURCE [131500]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.00||||13.00|5.59|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|HEALTHNET [1495]|HEALTHNET [149500]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|TRUSTMARK [2030]|STARMARK [203000]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.00||||13.00|11.7|13|2.73 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MULTIPLAN [1680]|HMA [168003]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|AETNA [1015]|AETNA ACO WILCO [101532]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.00||||13.00||| 27211789|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 5 X 5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.00||||13.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23.00||||23.00|11.52|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|||23.00||||23.00|6.9|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23.00||||23.00|8.07|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|HEALTHNET [1495]|HEALTHNET [149500]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.00||||23.00|11.03|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23.00||||23.00|13.8|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23.00||||23.00|9.8|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|TRUSTMARK [2030]|STARMARK [203000]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MULTIPLAN [1680]|IHC HS [168011]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|FIRST HEALTH [1375]|QUALCHOICE [137513]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23.00||||23.00|9.89|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.00||||23.00|9.89|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23.00||||23.00|4.83|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23.00||||23.00|23|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|GEHA [1415]|GEHA [141500]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|CORESOURCE [1315]|CORESOURCE [131500]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|CHAMPVA [1240]|CHAMP VA [124000]|23.00||||23.00|17.25|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|UMR [2035]|UMR OPTIONS [203501]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.00||||23.00|14.95|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23.00||||23.00|20.7|23|4.83 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|AETNA [1015]|AETNA ACO WILCO [101532]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MULTIPLAN [1680]|HMA [168003]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.00||||23.00||| 27211790|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 10 X 12|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23.00||||23.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|GEHA [1415]|GEHA [141500]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.00||||52.00|33.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.00||||52.00|10.92|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.00||||52.00|18.25|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.00||||52.00|22.36|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MULTIPLAN [1680]|IHC HS [168011]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|TRUSTMARK [2030]|STARMARK [203000]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.00||||52.00|22.15|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.00||||52.00|31.2|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|UMR [2035]|UMR OPTIONS [203501]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.00||||52.00|52|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|CHAMPVA [1240]|CHAMP VA [124000]|52.00||||52.00|39|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.00||||52.00|26.05|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|CORESOURCE [1315]|CORESOURCE [131500]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|||52.00||||52.00|15.6|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|HEALTHNET [1495]|HEALTHNET [149500]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.00||||52.00|22.36|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.00||||52.00|24.93|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.00||||52.00|46.8|52|10.92 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|AETNA [1015]|AETNA ACO WILCO [101532]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MULTIPLAN [1680]|HMA [168003]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.00||||52.00||| 27211791|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG DRSG EXTRA 15 X 15|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.00||||52.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28.00||||28.00|11.93|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28.00||||28.00|16.8|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28.00||||28.00|12.04|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28.00||||28.00|9.83|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28.00||||28.00|14.03|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MULTIPLAN [1680]|IHC HS [168011]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28.00||||28.00|12.04|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|FIRST HEALTH [1375]|QUALCHOICE [137513]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|FMH BENEFIT SERVICES [1390]|FMH [139000]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|UMR [2035]|UMR OPTIONS [203501]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|||28.00||||28.00|8.4|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28.00||||28.00|13.43|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28.00||||28.00|28|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28.00||||28.00|18.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28.00||||28.00|5.88|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|GEHA [1415]|GEHA [141500]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|CORESOURCE [1315]|CORESOURCE [131500]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|HEALTHNET [1495]|HEALTHNET [149500]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|TRUSTMARK [2030]|STARMARK [203000]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28.00||||28.00|25.2|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|CHAMPVA [1240]|CHAMP VA [124000]|28.00||||28.00|21|28|5.88 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|AETNA [1015]|AETNA ACO WILCO [101532]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|MULTIPLAN [1680]|HMA [168003]|28.00||||28.00||| 27211792|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL AG RIBBON W/SF .75 X 18|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28.00||||28.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|||9.00||||9.00|2.7|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|GEHA [1415]|GEHA [141500]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9.00||||9.00|5.4|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9.00||||9.00|3.16|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9.00||||9.00|3.87|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9.00||||9.00|5.85|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9.00||||9.00|9|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|TRUSTMARK [2030]|STARMARK [203000]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9.00||||9.00|3.87|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MULTIPLAN [1680]|IHC HS [168011]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|FMH BENEFIT SERVICES [1390]|FMH [139000]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9.00||||9.00|1.89|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|FIRST HEALTH [1375]|QUALCHOICE [137513]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|HEALTHNET [1495]|HEALTHNET [149500]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|UMR [2035]|UMR OPTIONS [203501]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|CORESOURCE [1315]|CORESOURCE [131500]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9.00||||9.00|4.32|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9.00||||9.00|8.1|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|9.00||||9.00|3.83|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|9.00||||9.00|4.51|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|CHAMPVA [1240]|CHAMP VA [124000]|9.00||||9.00|6.75|9|1.89 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|AETNA [1015]|AETNA ACO WILCO [101532]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MULTIPLAN [1680]|HMA [168003]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9.00||||9.00||| 27211793|EAP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|HC AQUACEL DRSG EXTRA 4X5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9.00||||9.00||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47.78||||47.78|10.03|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47.78||||47.78|28.67|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47.78||||47.78|20.55|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47.78||||47.78|16.77|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|HEALTHNET [1495]|HEALTHNET [149500]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MULTIPLAN [1680]|HMA [168003]|47.78||||47.78|16.72|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47.78||||47.78|20.55|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|47.78||||47.78|20.35|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47.78||||47.78|31.06|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|TRUSTMARK [2030]|STARMARK [203000]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|UMR [2035]|UMR OPTIONS [203501]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47.78||||47.78|5.6|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|CHAMPVA [1240]|CHAMP VA [124000]|47.78||||47.78|35.84|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|47.78||||47.78|23.94|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MULTIPLAN [1680]|IHC HS [168011]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47.78||||47.78|22.91|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|GEHA [1415]|GEHA [141500]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|CORESOURCE [1315]|CORESOURCE [131500]|47.78||||47.78|43|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|||47.78||||47.78|14.33|43|5.6 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|AETNA [1015]|AETNA ACO WILCO [101532]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47.78||||47.78||| 27283|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM INTRAVENOUS SOLUTION ADD-VANTAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|47.78||||47.78||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.33||||13.33|5.73|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|||13.33||||13.33|4|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.33||||13.33|6.39|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UMR [2035]|UMR OPTIONS [203501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.33||||13.33|8.66|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MULTIPLAN [1680]|IHC HS [168011]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UMR [2035]|UMR OPTIONS [203501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MULTIPLAN [1680]|IHC HS [168011]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHNET [1495]|HEALTHNET [149500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.33||||13.33|2.8|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|||13.33||||13.33|4|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|TRUSTMARK [2030]|STARMARK [203000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|TRUSTMARK [2030]|STARMARK [203000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.33||||13.33|2.8|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.33||||13.33|6.39|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHNET [1495]|HEALTHNET [149500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.33||||13.33|8.66|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.33||||13.33|5.73|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.33||||13.33|6.68|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.33||||13.33|4.68|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.33||||13.33|5.73|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.33||||13.33|4.68|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.33||||13.33|8|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.33||||13.33|5.73|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.33||||13.33|5.68|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.33||||13.33|8|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.33||||13.33|6.68|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.33||||13.33|5.68|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|GEHA [1415]|GEHA [141500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MULTIPLAN [1680]|HMA [168003]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA [1015]|AETNA ACO WILCO [101532]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MULTIPLAN [1680]|HMA [168003]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA [1015]|AETNA ACO WILCO [101532]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|GEHA [1415]|GEHA [141500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CORESOURCE [1315]|CORESOURCE [131500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CORESOURCE [1315]|CORESOURCE [131500]|13.33||||13.33|12|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CHAMPVA [1240]|CHAMP VA [124000]|13.33||||13.33|10|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|CHAMPVA [1240]|CHAMP VA [124000]|13.33||||13.33|10|12|2.8 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.33||||13.33||| 27466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.33||||13.33||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|||10.00||||10.00|3|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|||10.00||||10.00|3|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27474|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|85.68||||85.68|64.26|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|||85.68||||85.68|25.7|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|||85.68||||85.68|25.7|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85.68||||85.68|41.08|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85.68||||85.68|55.69|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85.68||||85.68|41.08|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85.68||||85.68|41.08|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85.68||||85.68|17.99|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85.68||||85.68|17.99|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85.68||||85.68|55.69|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|||85.68||||85.68|25.7|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85.68||||85.68|36.84|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85.68||||85.68|36.84|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85.68||||85.68|36.84|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|85.68||||85.68|64.26|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|85.68||||85.68|64.26|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85.68||||85.68|55.69|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85.68||||85.68|17.99|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85.68||||85.68|36.84|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85.68||||85.68|30.07|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85.68||||85.68|36.84|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85.68||||85.68|42.93|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85.68||||85.68|36.84|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85.68||||85.68|36.5|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85.68||||85.68|42.93|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85.68||||85.68|36.5|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85.68||||85.68|30.07|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85.68||||85.68|42.93|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85.68||||85.68|30.07|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85.68||||85.68|36.5|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85.68||||85.68|51.41|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85.68||||85.68|51.41|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85.68||||85.68|51.41|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85.68||||85.68|77.11|77.11|17.99 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85.68||||85.68||| 27505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85.68||||85.68||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144.10||||144.10|86.46|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144.10||||144.10|86.46|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144.10||||144.10|61.96|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144.10||||144.10|50.58|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|144.10||||144.10|61.39|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144.10||||144.10|50.58|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|144.10||||144.10|61.39|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|144.10||||144.10|72.19|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|144.10||||144.10|72.19|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144.10||||144.10|61.96|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144.10||||144.10|61.96|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144.10||||144.10|61.96|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144.10||||144.10|69.1|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|||144.10||||144.10|43.23|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|144.10||||144.10|108.08|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|144.10||||144.10|108.08|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|||144.10||||144.10|43.23|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144.10||||144.10|93.67|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144.10||||144.10|93.67|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144.10||||144.10|69.1|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|144.10||||144.10||| 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144.10||||144.10|30.26|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144.10||||144.10|30.26|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144.10||||144.10|129.69|129.69|30.26 27506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144.10||||144.10||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|200.13||||200.13|150.1|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|||200.13||||200.13|60.04|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200.13||||200.13|130.08|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200.13||||200.13|95.96|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200.13||||200.13|86.06|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200.13||||200.13|42.03|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200.13||||200.13|86.06|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200.13||||200.13|120.08|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|200.13||||200.13|85.26|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|200.13||||200.13|100.27|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200.13||||200.13|70.25|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200.13||||200.13|180.12|180.12|42.03 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200.13||||200.13||| 27507|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200.13||||200.13||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|||10.00||||10.00|3|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|||10.00||||10.00|3|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27631|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX 125 MG CAPSULE,DELAYED RELEASE SPRINKLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|||10.00||||10.00|3|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|||10.00||||10.00|3|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27634|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 100 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.06||||14.06|8.44|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.06||||14.06|8.44|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.06||||14.06|6.05|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.06||||14.06|7.04|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.06||||14.06|5.99|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.06||||14.06|6.05|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.06||||14.06|5.99|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.06||||14.06|7.04|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.06||||14.06|5.99|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.06||||14.06|4.94|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.06||||14.06|6.05|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.06||||14.06|6.05|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.06||||14.06|7.04|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.06||||14.06|6.05|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.06||||14.06|4.94|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.06||||14.06|6.05|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.06||||14.06|2.95|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.06||||14.06|2.95|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.06||||14.06|2.95|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.06||||14.06|6.74|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.06||||14.06|6.74|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.06||||14.06|6.74|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.06||||14.06|9.14|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.06||||14.06|9.14|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.06||||14.06|9.14|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|||14.06||||14.06|4.22|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|||14.06||||14.06|4.22|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|||14.06||||14.06|4.22|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.06||||14.06|4.94|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.06||||14.06|8.44|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|14.06||||14.06|12.65|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|14.06||||14.06|10.55|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|14.06||||14.06|10.55|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|14.06||||14.06|10.55|12.65|2.95 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.06||||14.06||| 27636|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBAMAZEPINE ER 400 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.06||||14.06||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|GEHA [1415]|GEHA [141500]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|CORESOURCE [1315]|CORESOURCE [131500]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|CHAMPVA [1240]|CHAMP VA [124000]|39.76||||39.76|29.82|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|||39.76||||39.76|11.93|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.76||||39.76|25.84|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.76||||39.76|19.06|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|UMR [2035]|UMR OPTIONS [203501]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.76||||39.76|17.1|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.76||||39.76|8.35|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MULTIPLAN [1680]|IHC HS [168011]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|HEALTHNET [1495]|HEALTHNET [149500]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|TRUSTMARK [2030]|STARMARK [203000]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.76||||39.76|35.78|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.76||||39.76|17.1|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.76||||39.76|19.92|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.76||||39.76|16.94|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.76||||39.76|13.96|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.76||||39.76|23.86|35.78|8.35 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MULTIPLAN [1680]|HMA [168003]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|AETNA [1015]|AETNA ACO WILCO [101532]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.76||||39.76||| 27644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 25 MG-DIPYRIDAMOLE 200 MG CAPSULE,EXT.RELEASE 12 HR MULTIPHASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.76||||39.76||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|||10.00||||10.00|3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|||10.00||||10.00|3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|||10.00||||10.00|3|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27680|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TROLAMINE SALICYLATE 10 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.04|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|||10.00||||10.00|3|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.04 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27697|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ONDANSETRON 4 MG DISINTEGRATING TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|287.41||||287.41|215.56|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|180.20||||180.20|135.15|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|292.20||||292.20|219.15|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|180.20||||180.20|135.15|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|435.28||||435.28|326.46|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|180.20||||180.20|135.15|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|||180.20||||180.20|54.06|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|||287.41||||287.41|86.22|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|||292.20||||292.20|87.66|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|||180.20||||180.20|54.06|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|||435.28||||435.28|130.58|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435.28||||435.28|282.93|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|287.41||||287.41|186.82|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|180.20||||180.20|117.13|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|180.20||||180.20|117.13|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|292.20||||292.20|189.93|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|180.20||||180.20|86.41|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435.28||||435.28|208.72|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|287.41||||287.41|137.81|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|292.20||||292.20|140.11|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|180.20||||180.20|86.41|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|287.41||||287.41|60.36|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435.28||||435.28|91.41|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|180.20||||180.20|37.84|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|180.20||||180.20|37.84|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|292.20||||292.20|7.95|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|180.20||||180.20|5.3|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|180.20||||180.20|5.3|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435.28||||435.28|15.9|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|287.41||||287.41|6.36|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|287.41||||287.41|123.59|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|292.20||||292.20|125.65|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|180.20||||180.20|77.49|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435.28||||435.28|187.17|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|180.20||||180.20|77.49|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|180.20||||180.20|77.49|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|180.20||||180.20|5.3|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|292.20||||292.20|61.36|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|180.20||||180.20|37.84|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|180.20||||180.20|86.41|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|180.20||||180.20|117.13|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|||180.20||||180.20|54.06|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|435.28||||435.28|185.43|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435.28||||435.28|152.78|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|180.20||||180.20|63.25|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435.28||||435.28|187.17|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|435.28||||435.28|218.08|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|180.20||||180.20|77.49|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|180.20||||180.20|90.28|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|180.20||||180.20|63.25|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|180.20||||180.20|77.49|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|180.20||||180.20|76.77|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|180.20||||180.20|63.25|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|180.20||||180.20|76.77|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|180.20||||180.20|90.28|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|287.41||||287.41|100.88|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|180.20||||180.20|77.49|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|180.20||||180.20|76.77|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|180.20||||180.20|90.28|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|287.41||||287.41|123.59|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|287.41||||287.41|143.99|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|292.20||||292.20|102.56|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|287.41||||287.41|122.44|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|292.20||||292.20|125.65|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|292.20||||292.20|146.39|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|292.20||||292.20|124.48|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|180.20||||180.20|108.12|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435.28||||435.28|261.17|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|180.20||||180.20|108.12|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|287.41||||287.41|172.45|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|292.20||||292.20|175.32|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|180.20||||180.20|108.12|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435.28||||435.28|217.64|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|180.20||||180.20|90.1|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|180.20||||180.20|90.1|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|292.20||||292.20|146.1|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|287.41||||287.41|143.71|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|180.20||||180.20|90.1|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435.28||||435.28|391.75|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|292.20||||292.20|262.98|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|180.20||||180.20|162.18|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|287.41||||287.41|258.67|391.75|5.3 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|287.41||||287.41||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435.28||||435.28||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|292.20||||292.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|180.20||||180.20||| 27737|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|IOPAMIDOL 61 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|180.20||||180.20||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZONISAMIDE 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45600.00||||45600.00|21636.83|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|GEHA [1415]|GEHA [141500]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|CORESOURCE [1315]|CORESOURCE [131500]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|CHAMPVA [1240]|CHAMP VA [124000]|45600.00||||45600.00|34200|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45600.00||||45600.00|19148.1|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45600.00||||45600.00|20817.15|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|||45600.00||||45600.00|13680|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45600.00||||45600.00|29640|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45600.00||||45600.00|21865.2|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45600.00||||45600.00|45600|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45600.00||||45600.00|9576|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45600.00||||45600.00|40913.69|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|UMR [2035]|UMR OPTIONS [203501]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45600.00||||45600.00|23800.51|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45600.00||||45600.00|17433.4|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45600.00||||45600.00|19608|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|FIRST HEALTH [1375]|QUALCHOICE [137513]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|FMH BENEFIT SERVICES [1390]|FMH [139000]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MULTIPLAN [1680]|IHC HS [168011]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45600.00||||45600.00|40530.83|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MULTIPLAN [1680]|HMA [168003]|45600.00||||45600.00|15960|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|HEALTHNET [1495]|HEALTHNET [149500]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|AETNA [1015]|AETNA ACO WILCO [101532]|45600.00||||45600.00|15960|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|TRUSTMARK [2030]|STARMARK [203000]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45600.00||||45600.00|20106.05|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45600.00||||45600.00|40530.83|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45600.00||||45600.00|18800.72|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45600.00||||45600.00|20817.15|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45600.00||||45600.00|19608|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45600.00||||45600.00|22845.6|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45600.00||||45600.00|16005.6|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45600.00||||45600.00|19425.6|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45600.00||||45600.00|27360|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45600.00||||45600.00|17946.14|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45600.00||||45600.00|39739.81|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45600.00||||45600.00|17091.57|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45600.00||||45600.00|18800.72|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45600.00||||45600.00|41040|45600|9576 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45600.00||||45600.00||| 27802616|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC BRACHYTX YTTRIUM-90 NON-STR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45600.00||||45600.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3100.00||||3100.00|1553.1|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3100.00||||3100.00|1333|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3100.00||||3100.00|1088.1|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3100.00||||3100.00|1550|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3100.00||||3100.00|1860|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|AETNA [1015]|AETNA ACO WILCO [101532]|3100.00||||3100.00|1085|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|HEALTHNET [1495]|HEALTHNET [149500]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3100.00||||3100.00|1085|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MULTIPLAN [1680]|HMA [168003]|3100.00||||3100.00|1085|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MULTIPLAN [1680]|IHC HS [168011]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3100.00||||3100.00|1333|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|TRUSTMARK [2030]|STARMARK [203000]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|UMR [2035]|UMR OPTIONS [203501]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3100.00||||3100.00|651|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3100.00||||3100.00|3100|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3100.00||||3100.00|1320.6|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3100.00||||3100.00|1486.45|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3100.00||||3100.00|2015|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|||3100.00||||3100.00|930|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|CHAMPVA [1240]|CHAMP VA [124000]|3100.00||||3100.00|2325|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3100.00||||3100.00|1085|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|CORESOURCE [1315]|CORESOURCE [131500]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|GEHA [1415]|GEHA [141500]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3100.00||||3100.00|2790|3100|651 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3100.00||||3100.00||| 27811045|EAP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HC IMPLANTABLE LEAD NEUROSTIMULATOR TEST KIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3100.00||||3100.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|||90.00||||90.00|27|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|||90.00||||90.00|27|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|||90.00||||90.00|27|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.69|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|31.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|1.35|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|||90.00||||90.00|27|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|||90.00||||90.00|27|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 27838|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION *BAG*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27857|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27859|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|||10.00||||10.00|3|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 27863|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.34||||19.34|11.6|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.34||||19.34|8.32|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|||19.34||||19.34|5.8|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.34||||19.34|8.32|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.34||||19.34|4.06|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.34||||19.34|9.27|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.34||||19.34|12.57|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.34||||19.34|9.69|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.34||||19.34|6.79|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.34||||19.34|8.24|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|19.34||||19.34|14.51|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.34||||19.34|17.41|17.41|4.06 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.34||||19.34||| 27905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 25 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.34||||19.34||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.46||||41.46|14.55|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.46||||41.46|14.55|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.46||||41.46|17.66|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.46||||41.46|17.66|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.46||||41.46|20.77|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.46||||41.46|17.66|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.46||||41.46|24.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.46||||41.46|24.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.46||||41.46|14.55|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.46||||41.46|14.55|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.46||||41.46|20.77|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.46||||41.46|24.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.46||||41.46|24.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.46||||41.46|20.77|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.46||||41.46|20.77|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.46||||41.46|17.66|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.46||||41.46|24.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.46||||41.46|17.66|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.46||||41.46|20.77|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.46||||41.46|14.55|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|41.46||||41.46|31.1|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|41.46||||41.46|31.1|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|41.46||||41.46|31.1|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|41.46||||41.46|31.1|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|||41.46||||41.46|12.44|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|||41.46||||41.46|12.44|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|||41.46||||41.46|12.44|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|||41.46||||41.46|12.44|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.46||||41.46|26.95|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.46||||41.46|26.95|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.46||||41.46|26.95|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.46||||41.46|19.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.46||||41.46|19.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.46||||41.46|19.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.46||||41.46|8.71|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.46||||41.46|8.71|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.46||||41.46|8.71|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.46||||41.46|8.71|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.46||||41.46|8.71|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.46||||41.46|19.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|||41.46||||41.46|12.44|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.46||||41.46|26.95|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.46||||41.46|26.95|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.46||||41.46|19.88|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.46||||41.46|17.83|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|41.46||||41.46|31.1|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.46||||41.46|37.31|37.31|8.71 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|41.46||||41.46||| 27906|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 50 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.46||||41.46||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.33||||52.33|22.29|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.33||||52.33|22.29|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.33||||52.33|18.37|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.33||||52.33|31.4|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.33||||52.33|31.4|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.33||||52.33|31.4|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.33||||52.33|26.22|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.33||||52.33|22.5|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.33||||52.33|22.5|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.33||||52.33|26.22|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.33||||52.33|18.37|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.33||||52.33|22.29|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.33||||52.33|26.22|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.33||||52.33|18.37|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.33||||52.33|22.5|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.33||||52.33|22.5|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.33||||52.33|22.5|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.33||||52.33|10.99|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.33||||52.33|10.99|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.33||||52.33|10.99|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.33||||52.33|25.09|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.33||||52.33|25.09|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.33||||52.33|34.01|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.33||||52.33|34.01|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|||52.33||||52.33|15.7|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|||52.33||||52.33|15.7|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.33||||52.33|34.01|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|||52.33||||52.33|15.7|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.33||||52.33|25.09|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.33||||52.33|22.5|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|52.33||||52.33|39.25|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|52.33||||52.33|39.25|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|52.33||||52.33|39.25|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.33||||52.33|47.1|47.1|10.99 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.33||||52.33||| 27907|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 75 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.33||||52.33||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|62.67||||62.67|47|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|62.67||||62.67|47|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|||62.67||||62.67|18.8|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|||62.67||||62.67|18.8|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.67||||62.67|40.74|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.67||||62.67|40.74|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.67||||62.67|30.05|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.67||||62.67|30.05|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.67||||62.67|26.95|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.67||||62.67|31.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.67||||62.67|22|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.67||||62.67|26.95|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.67||||62.67|26.7|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.67||||62.67|31.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.67||||62.67|22|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.67||||62.67|26.7|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.67||||62.67|37.6|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.67||||62.67|37.6|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.67||||62.67|26.95|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.67||||62.67|26.95|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.67||||62.67|13.16|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.67||||62.67|13.16|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.67||||62.67|56.4|56.4|13.16 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.67||||62.67||| 27908|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 100 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.67||||62.67||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|713.60||||713.60|250.47|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|713.60||||713.60|306.85|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|713.60||||713.60|149.86|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|713.60||||713.60|342.17|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|713.60||||713.60|463.84|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|||713.60||||713.60|214.08|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|713.60||||713.60|535.2|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|713.60||||713.60|357.51|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|713.60||||713.60|303.99|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|713.60||||713.60|306.85|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|713.60||||713.60|428.16|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|713.60||||713.60|642.24|642.24|149.86 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|713.60||||713.60||| 27927|ERX|0250 - PHARMACY-GENERAL|AMINO ACID 4.25 % IN DEXTROSE 5 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|713.60||||713.60||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83.48||||83.48|40.03|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|GEHA [1415]|GEHA [141500]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|83.48||||83.48|62.61|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|||83.48||||83.48|25.04|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83.48||||83.48|54.26|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83.48||||83.48|17.53|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.48||||83.48|35.9|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83.48||||83.48|29.3|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83.48||||83.48|50.09|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|83.48||||83.48|41.82|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83.48||||83.48|35.9|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|83.48||||83.48|35.56|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83.48||||83.48|75.13|75.13|17.53 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83.48||||83.48||| 27980|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARTIFICIAL TEARS (HYPROMELLOSE) 0.5 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83.48||||83.48||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33.38||||33.38|20.03|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33.38||||33.38|16.72|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33.38||||33.38|11.72|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|HEALTHNET [1495]|HEALTHNET [149500]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|UMR [2035]|UMR OPTIONS [203501]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.38||||33.38|16.01|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|CHAMPVA [1240]|CHAMP VA [124000]|33.38||||33.38|25.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|CORESOURCE [1315]|CORESOURCE [131500]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|||33.38||||33.38|10.01|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|GEHA [1415]|GEHA [141500]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33.38||||33.38|21.7|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33.38||||33.38|7.01|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.38||||33.38|14.35|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MULTIPLAN [1680]|IHC HS [168011]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|TRUSTMARK [2030]|STARMARK [203000]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33.38||||33.38|14.35|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33.38||||33.38|14.22|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33.38||||33.38|30.04|30.04|7.01 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MULTIPLAN [1680]|HMA [168003]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.38||||33.38||| 27992|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33.38||||33.38||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|GEHA [1415]|GEHA [141500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|GEHA [1415]|GEHA [141500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CORESOURCE [1315]|CORESOURCE [131500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CHAMPVA [1240]|CHAMP VA [124000]|14.98||||14.98|11.24|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CORESOURCE [1315]|CORESOURCE [131500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|||14.98||||14.98|4.49|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|||14.98||||14.98|4.49|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.98||||14.98|9.74|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.98||||14.98|9.74|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.98||||14.98|7.18|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UMR [2035]|UMR OPTIONS [203501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UMR [2035]|UMR OPTIONS [203501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.98||||14.98|6.44|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.98||||14.98|6.44|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MULTIPLAN [1680]|IHC HS [168011]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHNET [1495]|HEALTHNET [149500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHNET [1495]|HEALTHNET [149500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MULTIPLAN [1680]|IHC HS [168011]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.98||||14.98|5.26|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CHAMPVA [1240]|CHAMP VA [124000]|14.98||||14.98|11.24|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.98||||14.98|7.18|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.98||||14.98|6.44|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.98||||14.98|7.5|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.98||||14.98|5.26|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.98||||14.98|6.38|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.98||||14.98|6.38|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.98||||14.98|7.5|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.98||||14.98|6.44|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.98||||14.98|8.99|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.98||||14.98|8.99|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MULTIPLAN [1680]|HMA [168003]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MULTIPLAN [1680]|HMA [168003]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA [1015]|AETNA ACO WILCO [101532]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA [1015]|AETNA ACO WILCO [101532]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.98||||14.98|3.15|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.98||||14.98|3.15|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|TRUSTMARK [2030]|STARMARK [203000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|TRUSTMARK [2030]|STARMARK [203000]|14.98||||14.98|13.48|13.48|3.15 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.98||||14.98||| 28055|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALAMINE 8 %-ZINC OXIDE 8 % LOTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.98||||14.98||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.68||||31.68|13.62|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.68||||31.68|15.87|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.68||||31.68|13.5|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.68||||31.68|13.5|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.68||||31.68|13.62|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.68||||31.68|19.01|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.68||||31.68|11.12|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.68||||31.68|13.62|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.68||||31.68|13.62|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UMR [2035]|UMR OPTIONS [203501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.68||||31.68|6.65|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.68||||31.68|6.65|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UMR [2035]|UMR OPTIONS [203501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.68||||31.68|15.19|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.68||||31.68|15.19|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.68||||31.68|20.59|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.68||||31.68|19.01|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.68||||31.68|11.12|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.68||||31.68|15.87|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.68||||31.68|20.59|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|||31.68||||31.68|9.5|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|||31.68||||31.68|9.5|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|31.68||||31.68|23.76|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|31.68||||31.68|23.76|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|GEHA [1415]|GEHA [141500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|GEHA [1415]|GEHA [141500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MULTIPLAN [1680]|HMA [168003]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MULTIPLAN [1680]|HMA [168003]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.68||||31.68|28.51|28.51|6.65 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.68||||31.68||| 28203|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.68||||31.68||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|380.95||||380.95|163.81|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|380.95||||380.95|190.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|380.95||||380.95|133.71|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|380.95||||380.95|162.28|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|380.95||||380.95|228.57|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|380.95||||380.95|285.71|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|380.95||||380.95|247.62|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|380.95||||380.95|182.67|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|||380.95||||380.95|114.28|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|380.95||||380.95|80|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|GEHA [1415]|GEHA [141500]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|380.95||||380.95|163.81|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|380.95||||380.95|342.86|342.86|80 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|380.95||||380.95||| 28224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LINEZOLID 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|380.95||||380.95||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|444.89||||444.89|266.93|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|444.89||||444.89|191.3|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|444.89||||444.89|189.52|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|444.89||||444.89|222.89|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|444.89||||444.89|156.16|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|444.89||||444.89|24.66|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|444.89||||444.89|23.8|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|444.89||||444.89|155.71|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|444.89||||444.89|191.3|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|444.89||||444.89|28.19|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|444.89||||444.89|23.88|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|444.89||||444.89|93.43|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|444.89||||444.89|213.32|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|444.89||||444.89|289.18|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|||444.89||||444.89|133.47|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|444.89||||444.89|24.66|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|444.89||||444.89|22.67|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|444.89||||444.89|333.67|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|444.89||||444.89|400.4|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|444.89||||444.89|25.63|400.4|22.67 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|444.89||||444.89||| 28226|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|444.89||||444.89||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|24.25||||24.25|18.19|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|24.25||||24.25|18.19|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|||24.25||||24.25|7.27|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|||24.25||||24.25|7.27|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.25||||24.25|15.76|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.25||||24.25|15.76|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.25||||24.25|11.63|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.25||||24.25|11.63|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.25||||24.25|5.09|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.25||||24.25|10.43|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.25||||24.25|10.43|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.25||||24.25|5.09|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.25||||24.25|10.43|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.25||||24.25|12.15|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.25||||24.25|8.51|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.25||||24.25|10.43|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.25||||24.25|10.33|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.25||||24.25|12.15|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.25||||24.25|8.51|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.25||||24.25|10.33|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.25||||24.25|14.55|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.25||||24.25|14.55|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.25||||24.25|21.83|21.83|5.09 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.25||||24.25||| 28278|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RIVASTIGMINE 1.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.25||||24.25||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237.67||||237.67|102.2|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|237.67||||237.67|119.07|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237.67||||237.67|83.42|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|237.67||||237.67|83.18|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237.67||||237.67|102.2|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237.67||||237.67|184.44|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237.67||||237.67|49.91|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237.67||||237.67|113.96|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237.67||||237.67|154.49|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|||237.67||||237.67|71.3|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|237.67||||237.67|101.25|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237.67||||237.67|142.6|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|237.67||||237.67|178.25|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|GEHA [1415]|GEHA [141500]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237.67||||237.67|213.9|213.9|49.91 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237.67||||237.67||| 28282|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN GLARGINE (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|237.67||||237.67||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28384|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53.55||||53.55|32.13|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53.55||||53.55|26.83|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53.55||||53.55|18.8|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53.55||||53.55|22.81|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.55||||53.55|23.03|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53.55||||53.55|11.25|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.55||||53.55|25.68|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53.55||||53.55|23.03|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53.55||||53.55|34.81|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|||53.55||||53.55|16.06|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|53.55||||53.55|40.16|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53.55||||53.55|48.2|48.2|11.25 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53.55||||53.55||| 28409|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53.55||||53.55||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28643|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.87||||31.87|19.12|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.87||||31.87|19.12|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.87||||31.87|19.12|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.87||||31.87|15.97|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.87||||31.87|11.19|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.87||||31.87|13.58|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.87||||31.87|15.97|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.87||||31.87|11.19|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.87||||31.87|13.58|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.87||||31.87|11.19|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.87||||31.87|13.58|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.87||||31.87|11.19|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.87||||31.87|13.58|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.87||||31.87|6.69|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.87||||31.87|6.69|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.87||||31.87|6.69|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.87||||31.87|6.69|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.87||||31.87|15.28|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.87||||31.87|15.28|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.87||||31.87|15.28|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.87||||31.87|15.28|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.87||||31.87|20.72|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.87||||31.87|20.72|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.87||||31.87|20.72|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.87||||31.87|20.72|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|||31.87||||31.87|9.56|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|||31.87||||31.87|9.56|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|||31.87||||31.87|9.56|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|||31.87||||31.87|9.56|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.87||||31.87|15.97|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.87||||31.87|15.97|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.87||||31.87|13.7|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.87||||31.87|19.12|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|31.87||||31.87|23.9|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|31.87||||31.87|23.9|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|31.87||||31.87|23.9|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|31.87||||31.87|23.9|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.87||||31.87|28.68|28.68|6.69 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.87||||31.87||| 28774|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.87||||31.87||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|37.50||||37.50|28.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|37.50||||37.50|28.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|37.50||||37.50|28.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|||37.50||||37.50|11.25|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|||37.50||||37.50|11.25|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|||37.50||||37.50|11.25|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.50||||37.50|24.38|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.50||||37.50|24.38|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.50||||37.50|24.38|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.50||||37.50|24.38|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.50||||37.50|17.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.50||||37.50|17.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.50||||37.50|17.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.50||||37.50|7.88|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.50||||37.50|7.88|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.50||||37.50|7.88|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.50||||37.50|7.88|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.50||||37.50|17.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|||37.50||||37.50|11.25|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.50||||37.50|15.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.50||||37.50|13.16|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.50||||37.50|15.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.50||||37.50|13.16|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.50||||37.50|15.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.50||||37.50|15.98|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.50||||37.50|13.16|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.50||||37.50|16.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.50||||37.50|18.79|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.50||||37.50|18.79|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.50||||37.50|13.16|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.50||||37.50|18.79|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.50||||37.50|18.79|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.50||||37.50|22.5|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.50||||37.50|22.5|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.50||||37.50|22.5|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.50||||37.50|22.5|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|37.50||||37.50|28.13|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.50||||37.50|33.75|33.75|7.88 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.50||||37.50||| 28775|ERX|0250 - PHARMACY-GENERAL|BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.50||||37.50||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 28842|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|GEHA [1415]|GEHA [141500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|GEHA [1415]|GEHA [141500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|96.39||||96.39|72.29|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|96.39||||96.39|72.29|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|96.39||||96.39|72.29|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|||96.39||||96.39|28.92|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|||96.39||||96.39|28.92|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.39||||96.39|62.65|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.39||||96.39|62.65|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.39||||96.39|62.65|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.39||||96.39|46.22|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.39||||96.39|46.22|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.39||||96.39|20.24|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.39||||96.39|20.24|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.39||||96.39|20.24|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UMR [2035]|UMR OPTIONS [203501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UMR [2035]|UMR OPTIONS [203501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.39||||96.39|41.45|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.39||||96.39|41.45|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.39||||96.39|41.45|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UMR [2035]|UMR OPTIONS [203501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|HMA [168003]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|HMA [168003]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MULTIPLAN [1680]|HMA [168003]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.39||||96.39|46.22|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|||96.39||||96.39|28.92|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.39||||96.39|41.45|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.39||||96.39|48.29|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.39||||96.39|33.83|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.39||||96.39|41.06|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.39||||96.39|41.45|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.39||||96.39|48.29|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.39||||96.39|33.83|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.39||||96.39|41.06|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.39||||96.39|41.45|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.39||||96.39|48.29|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.39||||96.39|33.83|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.39||||96.39|41.06|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.39||||96.39|57.83|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.39||||96.39|57.83|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.39||||96.39|57.83|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|GEHA [1415]|GEHA [141500]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.39||||96.39|86.75|86.75|20.24 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.39||||96.39||| 2888|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.39||||96.39||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 28995|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METFORMIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|||10.00||||10.00|3|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29048|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 70 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|||10.00||||10.00|3|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29072|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALENDRONATE 35 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|82.56|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00|23.32|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00|67.2|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|||192.00||||192.00|57.6|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|82.56|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|172.8|23.32 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00||| 29132|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|305.21||||305.21|183.13|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|305.21||||305.21|131.24|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|305.21||||305.21|152.91|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|305.21||||305.21|130.02|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|305.21||||305.21|131.24|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|305.21||||305.21|64.09|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|305.21||||305.21|107.13|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|305.21||||305.21|146.35|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|305.21||||305.21|198.39|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|||305.21||||305.21|91.56|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|305.21||||305.21|228.91|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|305.21||||305.21|274.69|274.69|64.09 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|305.21||||305.21||| 29169|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GABAPENTIN 250 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|305.21||||305.21||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29274|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 240 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM CD 300 MG CAPSULE,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|117.30||||117.30|87.98|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|||117.30||||117.30|35.19|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|117.30||||117.30|76.25|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|117.30||||117.30|24.63|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117.30||||117.30|56.25|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117.30||||117.30|70.38|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|117.30||||117.30|49.97|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|117.30||||117.30|50.44|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|117.30||||117.30|58.77|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|117.30||||117.30|41.17|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117.30||||117.30|50.44|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|117.30||||117.30|105.57|105.57|24.63 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|117.30||||117.30||| 29424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE-BETAMETHASONE 1 %-0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|117.30||||117.30||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|||10.00||||10.00|3|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29676|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|||10.00||||10.00|3|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29778|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 20 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.52||||57.52|12.08|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.52||||57.52|12.08|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.52||||57.52|27.58|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.52||||57.52|37.39|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|57.52||||57.52|43.14|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|GEHA [1415]|GEHA [141500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|57.52||||57.52|43.14|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.52||||57.52|37.39|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|||57.52||||57.52|17.26|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|||57.52||||57.52|17.26|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.52||||57.52|27.58|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|GEHA [1415]|GEHA [141500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.52||||57.52|24.73|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.52||||57.52|34.51|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.52||||57.52|24.73|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.52||||57.52|24.5|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.52||||57.52|24.5|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.52||||57.52|20.19|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.52||||57.52|28.82|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.52||||57.52|34.51|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.52||||57.52|24.73|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.52||||57.52|24.73|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.52||||57.52|28.82|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.52||||57.52|20.19|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|57.52||||57.52|51.77|51.77|12.08 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.52||||57.52||| 29780|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 60 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.52||||57.52||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|50.06||||50.06|37.55|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|50.06||||50.06|37.55|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|50.06||||50.06|37.55|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|GEHA [1415]|GEHA [141500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|GEHA [1415]|GEHA [141500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|GEHA [1415]|GEHA [141500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|||50.06||||50.06|15.02|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.06||||50.06|24|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.06||||50.06|32.54|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.06||||50.06|32.54|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.06||||50.06|24|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.06||||50.06|32.54|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|||50.06||||50.06|15.02|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.06||||50.06|10.51|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.06||||50.06|10.51|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.06||||50.06|21.53|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.06||||50.06|21.53|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.06||||50.06|21.53|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.06||||50.06|10.51|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|||50.06||||50.06|15.02|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.06||||50.06|24|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.06||||50.06|17.57|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.06||||50.06|21.53|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.06||||50.06|25.08|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.06||||50.06|25.08|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.06||||50.06|30.04|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.06||||50.06|30.04|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.06||||50.06|21.33|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.06||||50.06|17.57|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.06||||50.06|21.53|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.06||||50.06|21.33|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.06||||50.06|25.08|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.06||||50.06|17.57|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.06||||50.06|30.04|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.06||||50.06|21.53|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.06||||50.06|45.05|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.06||||50.06|21.33|45.05|10.51 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.06||||50.06||| 29781|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZIPRASIDONE 80 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.06||||50.06||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|||10.00||||10.00|3|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29833|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 29858|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 25 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 30070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 30071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL SUCCINATE ER 100 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|529.00||||529.00|150.25|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|529.00||||529.00|185.68|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|529.00||||529.00|225.35|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|529.00||||529.00|317.4|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|529.00||||529.00|143.42|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|529.00||||529.00|159.37|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|529.00||||529.00|86.84|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|529.00||||529.00|227.47|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|529.00||||529.00|165.01|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|TRUSTMARK [2030]|STARMARK [203000]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|529.00||||529.00|50.99|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MULTIPLAN [1680]|IHC HS [168011]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|529.00||||529.00|196.36|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|529.00||||529.00|227.47|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|UMR [2035]|UMR OPTIONS [203501]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|529.00||||529.00|529|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|529.00||||529.00|111.09|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MULTIPLAN [1680]|HMA [168003]|529.00||||529.00|204.89|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|529.00||||529.00|199.42|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|529.00||||529.00|253.66|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|529.00||||529.00|343.85|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|||529.00||||529.00|158.7|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|529.00||||529.00|188.66|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|529.00||||529.00|165.01|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|HEALTHNET [1495]|HEALTHNET [149500]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|529.00||||529.00|265.03|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|529.00||||529.00|345.93|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|529.00||||529.00|150.25|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|529.00||||529.00|136.59|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|529.00||||529.00|151.77|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|CHAMPVA [1240]|CHAMP VA [124000]|529.00||||529.00|396.75|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|529.00||||529.00|196.36|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|CORESOURCE [1315]|CORESOURCE [131500]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|GEHA [1415]|GEHA [141500]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|529.00||||529.00|139.32|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|529.00||||529.00|171.51|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|529.00||||529.00|476.1|529|50.99 30086922|EAP|0300 - LABORATORY-GENERAL|HC CROSSMATCH ANTIGLOB 1 UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|529.00||||529.00||| 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|GEHA [1415]|GEHA [141500]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|673.00||||673.00|164.5|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|673.00||||673.00|114.03|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|||673.00||||673.00|201.9|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|673.00||||673.00|437.45|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|CHAMPVA [1240]|CHAMP VA [124000]|673.00||||673.00|504.75|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|673.00||||673.00|673|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|673.00||||673.00|141.33|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|CORESOURCE [1315]|CORESOURCE [131500]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|673.00||||673.00|167.07|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|UMR [2035]|UMR OPTIONS [203501]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|673.00||||673.00|116.72|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|FIRST HEALTH [1375]|QUALCHOICE [137513]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|673.00||||673.00|141.74|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|673.00||||673.00|164.5|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|HEALTHNET [1495]|HEALTHNET [149500]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|TRUSTMARK [2030]|STARMARK [203000]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|AETNA [1015]|AETNA ACO WILCO [101532]|673.00||||673.00|162.77|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|673.00||||673.00|68.66|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|673.00||||673.00|128.85|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|673.00||||673.00|322.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|673.00||||673.00|123.97|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MULTIPLAN [1680]|IHC HS [168011]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|673.00||||673.00|119.74|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|673.00||||673.00|125.87|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|673.00||||673.00|123.97|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MULTIPLAN [1680]|HMA [168003]|673.00||||673.00|171.65|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|673.00||||673.00|120.15|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|673.00||||673.00|403.8|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|673.00||||673.00|336.5|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|673.00||||673.00|337.17|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|673.00||||673.00|236.22|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|673.00||||673.00|286.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|673.00||||673.00|114.43|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|FMH BENEFIT SERVICES [1390]|FMH [139000]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|673.00||||673.00|605.7|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|673.00||||673.00|125.87|673|68.66 30100480|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 1-7 CLASSES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|673.00||||673.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1735.00||||1735.00|608.99|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1735.00||||1735.00|246.92|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1735.00||||1735.00|867.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1735.00||||1735.00|258.38|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1735.00||||1735.00|1041|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1735.00||||1735.00|739.11|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|AETNA [1015]|AETNA ACO WILCO [101532]|1735.00||||1735.00|351.22|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|HEALTHNET [1495]|HEALTHNET [149500]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1735.00||||1735.00|305.86|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MULTIPLAN [1680]|IHC HS [168011]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1735.00||||1735.00|869.24|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1735.00||||1735.00|1735|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|TRUSTMARK [2030]|STARMARK [203000]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1735.00||||1735.00|148.15|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1735.00||||1735.00|831.93|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1735.00||||1735.00|1127.75|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1735.00||||1735.00|364.35|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1735.00||||1735.00|267.52|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|||1735.00||||1735.00|520.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1735.00||||1735.00|267.52|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1735.00||||1735.00|246.92|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|UMR [2035]|UMR OPTIONS [203501]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1735.00||||1735.00|246.07|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|CHAMPVA [1240]|CHAMP VA [124000]|1735.00||||1735.00|1301.25|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|CORESOURCE [1315]|CORESOURCE [131500]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1735.00||||1735.00|278.05|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|GEHA [1415]|GEHA [141500]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1735.00||||1735.00|1561.5|1735|148.15 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MULTIPLAN [1680]|HMA [168003]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1735.00||||1735.00||| 30100483|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST DEF 22 OR MORE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1735.00||||1735.00||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|GEHA [1415]|GEHA [141500]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|75.67||||75.67|56.75|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|||75.67||||75.67|22.7|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.67||||75.67|36.28|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.67||||75.67|15.89|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.67||||75.67|49.19|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.67||||75.67|32.54|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.67||||75.67|37.91|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.67||||75.67|26.56|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.67||||75.67|32.24|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.67||||75.67|45.4|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.67||||75.67|32.54|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.67||||75.67|68.1|68.1|15.89 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MULTIPLAN [1680]|HMA [168003]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.67||||75.67||| 30148|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALGANCICLOVIR 450 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.67||||75.67||| 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|373.00||||373.00|9.31|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|373.00||||373.00|130.92|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|373.00||||373.00|10.44|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|373.00||||373.00|223.8|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|373.00||||373.00|8.88|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|373.00||||373.00|9.16|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|373.00||||373.00|8.85|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|373.00||||373.00|186.5|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|373.00||||373.00|5.64|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|TRUSTMARK [2030]|STARMARK [203000]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|HEALTHNET [1495]|HEALTHNET [149500]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MULTIPLAN [1680]|HMA [168003]|373.00||||373.00|12.69|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MULTIPLAN [1680]|IHC HS [168011]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|373.00||||373.00|10.44|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|373.00||||373.00|10.48|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|UMR [2035]|UMR OPTIONS [203501]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|373.00||||373.00|12.16|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|373.00||||373.00|158.9|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|373.00||||373.00|13.37|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|373.00||||373.00|186.87|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|373.00||||373.00|373|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|373.00||||373.00|78.33|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|373.00||||373.00|12.35|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|373.00||||373.00|178.85|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|373.00||||373.00|9.31|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|373.00||||373.00|242.45|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|373.00||||373.00|8.63|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|||373.00||||373.00|111.9|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|373.00||||373.00|9.16|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|373.00||||373.00|8.46|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|373.00||||373.00|8.43|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|CHAMPVA [1240]|CHAMP VA [124000]|373.00||||373.00|279.75|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|373.00||||373.00|12.16|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|CORESOURCE [1315]|CORESOURCE [131500]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|373.00||||373.00|9.52|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|GEHA [1415]|GEHA [141500]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|373.00||||373.00|335.7|373|5.64 30180048|EAP|0301 - LABORATORY-CHEMISTRY|HC BASIC METABOLIC PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|373.00||||373.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|CORESOURCE [1315]|CORESOURCE [131500]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1068.00||||1068.00|662.16|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|||1068.00||||1068.00|320.4|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1068.00||||1068.00|694.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|CHAMPVA [1240]|CHAMP VA [124000]|1068.00||||1068.00|801|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1068.00||||1068.00|1068|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1068.00||||1068.00|224.28|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1068.00||||1068.00|663.23|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|UMR [2035]|UMR OPTIONS [203501]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1068.00||||1068.00|459.24|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|1068.00||||1068.00|61.85|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1068.00||||1068.00|277.68|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1068.00||||1068.00|28.33|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1068.00||||1068.00|512.11|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|HEALTHNET [1495]|HEALTHNET [149500]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1068.00||||1068.00|277.68|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1068.00||||1068.00|662.16|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|TRUSTMARK [2030]|STARMARK [203000]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1068.00||||1068.00|640.8|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1068.00||||1068.00|534|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MULTIPLAN [1680]|IHC HS [168011]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1068.00||||1068.00|374.87|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1068.00||||1068.00|454.97|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1068.00||||1068.00|535.07|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1068.00||||1068.00|459.24|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|GEHA [1415]|GEHA [141500]|1068.00||||1068.00|961.2|1068|28.33 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MULTIPLAN [1680]|HMA [168003]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1068.00||||1068.00||| 30180050|EAP|0301 - LABORATORY-CHEMISTRY|HC GENERAL HEALTH PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1068.00||||1068.00||| 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|266.00||||266.00|93.37|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|266.00||||266.00|8.66|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|266.00||||266.00|133.27|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|266.00||||266.00|7.36|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|266.00||||266.00|7.71|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|266.00||||266.00|7.33|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|266.00||||266.00|4.67|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|266.00||||266.00|159.6|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|266.00||||266.00|113.32|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|266.00||||266.00|11.08|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|TRUSTMARK [2030]|STARMARK [203000]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|HEALTHNET [1495]|HEALTHNET [149500]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MULTIPLAN [1680]|IHC HS [168011]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MULTIPLAN [1680]|HMA [168003]|266.00||||266.00|10.52|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|266.00||||266.00|8.69|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|266.00||||266.00|7.15|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|266.00||||266.00|10.08|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|UMR [2035]|UMR OPTIONS [203501]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|266.00||||266.00|55.86|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|266.00||||266.00|10.23|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|266.00||||266.00|266|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|266.00||||266.00|7.71|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|266.00||||266.00|133|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|266.00||||266.00|127.55|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|266.00||||266.00|7.6|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|266.00||||266.00|172.9|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|||266.00||||266.00|79.8|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|266.00||||266.00|7.6|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|266.00||||266.00|7.01|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|266.00||||266.00|6.98|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|CHAMPVA [1240]|CHAMP VA [124000]|266.00||||266.00|199.5|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|266.00||||266.00|10.08|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|CORESOURCE [1315]|CORESOURCE [131500]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|266.00||||266.00|8.66|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|GEHA [1415]|GEHA [141500]|266.00||||266.00|239.4|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|266.00||||266.00|7.9|266|4.67 30180051|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROLYTE PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|266.00||||266.00||| 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|480.00||||480.00|11.9|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|CHAMPVA [1240]|CHAMP VA [124000]|480.00||||480.00|360|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|480.00||||480.00|15.18|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|480.00||||480.00|10.53|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|480.00||||480.00|11.45|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|||480.00||||480.00|144|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|480.00||||480.00|312|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|480.00||||480.00|230.16|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|480.00||||480.00|480|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|480.00||||480.00|100.8|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|UMR [2035]|UMR OPTIONS [203501]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|480.00||||480.00|10.77|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|480.00||||480.00|13.04|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|480.00||||480.00|15.18|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MULTIPLAN [1680]|IHC HS [168011]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|HEALTHNET [1495]|HEALTHNET [149500]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|480.00||||480.00|16.7|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|480.00||||480.00|15.42|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|GEHA [1415]|GEHA [141500]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|CORESOURCE [1315]|CORESOURCE [131500]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|TRUSTMARK [2030]|STARMARK [203000]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|480.00||||480.00|7.04|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|480.00||||480.00|11.06|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MULTIPLAN [1680]|HMA [168003]|480.00||||480.00|15.84|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|480.00||||480.00|11.62|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|480.00||||480.00|11.45|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|480.00||||480.00|11.09|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|480.00||||480.00|288|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|480.00||||480.00|240|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|480.00||||480.00|204.48|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|480.00||||480.00|240.48|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|480.00||||480.00|13.1|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|480.00||||480.00|168.48|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|480.00||||480.00|13.04|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|480.00||||480.00|432|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|480.00||||480.00|11.62|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|480.00||||480.00|10.56|480|7.04 30180053|EAP|0301 - LABORATORY-CHEMISTRY|HC COMPREHENSIVE METABOLIC PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|480.00||||480.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232.00||||232.00|81.43|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232.00||||232.00|59.02|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|232.00||||232.00|98.83|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232.00||||232.00|139.2|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232.00||||232.00|51.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232.00||||232.00|50.03|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|232.00||||232.00|31.87|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|232.00||||232.00|75.56|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|TRUSTMARK [2030]|STARMARK [203000]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|HEALTHNET [1495]|HEALTHNET [149500]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MULTIPLAN [1680]|IHC HS [168011]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|232.00||||232.00|59.22|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|UMR [2035]|UMR OPTIONS [203501]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232.00||||232.00|48.72|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232.00||||232.00|232|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232.00||||232.00|111.24|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|232.00||||232.00|116.23|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232.00||||232.00|116|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232.00||||232.00|150.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|||232.00||||232.00|69.6|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232.00||||232.00|51.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232.00||||232.00|59.02|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232.00||||232.00|47.65|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|CHAMPVA [1240]|CHAMP VA [124000]|232.00||||232.00|174|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|CORESOURCE [1315]|CORESOURCE [131500]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|GEHA [1415]|GEHA [141500]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232.00||||232.00|208.8|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|232.00||||232.00|53.84|232|31.87 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MULTIPLAN [1680]|HMA [168003]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|232.00||||232.00||| 30180055|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB OBSTETRIC PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232.00||||232.00||| 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|GEHA [1415]|GEHA [141500]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|340.00||||340.00|19.25|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|340.00||||340.00|14.51|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|||340.00||||340.00|102|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|340.00||||340.00|221|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|CHAMPVA [1240]|CHAMP VA [124000]|340.00||||340.00|255|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|340.00||||340.00|340|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|340.00||||340.00|71.4|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|CORESOURCE [1315]|CORESOURCE [131500]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|340.00||||340.00|19.55|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|UMR [2035]|UMR OPTIONS [203501]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|340.00||||340.00|13.66|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|340.00||||340.00|16.53|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|340.00||||340.00|16.59|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|TRUSTMARK [2030]|STARMARK [203000]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MULTIPLAN [1680]|HMA [168003]|340.00||||340.00|20.09|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|HEALTHNET [1495]|HEALTHNET [149500]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|AETNA [1015]|AETNA ACO WILCO [101532]|340.00||||340.00|21.17|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|340.00||||340.00|15.08|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|340.00||||340.00|13.35|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|340.00||||340.00|163.03|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|340.00||||340.00|8.93|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MULTIPLAN [1680]|IHC HS [168011]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|340.00||||340.00|14.01|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|340.00||||340.00|14.73|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|340.00||||340.00|14.51|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|340.00||||340.00|19.25|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|340.00||||340.00|14.06|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|340.00||||340.00|204|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|340.00||||340.00|170|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|340.00||||340.00|144.84|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|340.00||||340.00|170.34|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|340.00||||340.00|119.34|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|340.00||||340.00|16.53|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|340.00||||340.00|13.39|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|340.00||||340.00|306|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|340.00||||340.00|14.73|340|8.93 30180061|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPID PROFILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|340.00||||340.00||| 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|372.00||||372.00|130.57|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|372.00||||372.00|186|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|372.00||||372.00|9.55|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|372.00||||372.00|9.08|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|372.00||||372.00|223.2|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|372.00||||372.00|5.79|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|372.00||||372.00|9.55|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|TRUSTMARK [2030]|STARMARK [203000]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|HEALTHNET [1495]|HEALTHNET [149500]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|372.00||||372.00|12.48|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MULTIPLAN [1680]|HMA [168003]|372.00||||372.00|13.02|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|372.00||||372.00|10.76|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|372.00||||372.00|8.85|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|372.00||||372.00|12.67|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MULTIPLAN [1680]|IHC HS [168011]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|372.00||||372.00|10.72|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|372.00||||372.00|372|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|372.00||||372.00|13.73|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|372.00||||372.00|178.37|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|372.00||||372.00|241.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|372.00||||372.00|78.12|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|372.00||||372.00|158.47|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|372.00||||372.00|9.11|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|372.00||||372.00|9.41|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|||372.00||||372.00|111.6|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|372.00||||372.00|9.41|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|372.00||||372.00|10.72|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|372.00||||372.00|8.68|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|UMR [2035]|UMR OPTIONS [203501]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|372.00||||372.00|186.37|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|372.00||||372.00|8.65|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|CHAMPVA [1240]|CHAMP VA [124000]|372.00||||372.00|279|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|372.00||||372.00|12.48|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|CORESOURCE [1315]|CORESOURCE [131500]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|GEHA [1415]|GEHA [141500]|372.00||||372.00|334.8|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|372.00||||372.00|9.78|372|5.79 30180069|EAP|0301 - LABORATORY-CHEMISTRY|HC RENAL FUNCTION PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|372.00||||372.00||| 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|UMR [2035]|UMR OPTIONS [203501]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|657.00||||657.00|48.58|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|657.00||||657.00|58.81|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MULTIPLAN [1680]|IHC HS [168011]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MULTIPLAN [1680]|HMA [168003]|657.00||||657.00|71.45|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|HEALTHNET [1495]|HEALTHNET [149500]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|657.00||||657.00|68.47|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|TRUSTMARK [2030]|STARMARK [203000]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|657.00||||657.00|75.29|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|657.00||||657.00|31.76|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|657.00||||657.00|51.6|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|657.00||||657.00|58.99|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|657.00||||657.00|50.01|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|657.00||||657.00|52.39|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|657.00||||657.00|394.2|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|657.00||||657.00|328.5|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|657.00||||657.00|69.54|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|657.00||||657.00|279.88|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|657.00||||657.00|49.84|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|657.00||||657.00|329.16|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|657.00||||657.00|230.61|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|657.00||||657.00|58.81|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|657.00||||657.00|52.39|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|GEHA [1415]|GEHA [141500]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|657.00||||657.00|53.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|CORESOURCE [1315]|CORESOURCE [131500]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|657.00||||657.00|68.47|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|CHAMPVA [1240]|CHAMP VA [124000]|657.00||||657.00|492.75|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|657.00||||657.00|47.47|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|657.00||||657.00|51.6|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|||657.00||||657.00|197.1|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|657.00||||657.00|427.05|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|657.00||||657.00|315.03|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|657.00||||657.00|47.63|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|657.00||||657.00|657|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|657.00||||657.00|591.3|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|657.00||||657.00|137.97|657|31.76 30180074|EAP|0301 - LABORATORY-CHEMISTRY|HC ACUTE HEPATITIS PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|657.00||||657.00||| 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|414.00||||414.00|8.99|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|414.00||||414.00|207.41|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|414.00||||414.00|176.36|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|414.00||||414.00|10.09|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|414.00||||414.00|145.31|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|414.00||||414.00|207|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|414.00||||414.00|248.4|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|414.00||||414.00|8.85|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|414.00||||414.00|8.55|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|414.00||||414.00|5.45|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|AETNA [1015]|AETNA ACO WILCO [101532]|414.00||||414.00|12.91|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|TRUSTMARK [2030]|STARMARK [203000]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|HEALTHNET [1495]|HEALTHNET [149500]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MULTIPLAN [1680]|IHC HS [168011]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MULTIPLAN [1680]|HMA [168003]|414.00||||414.00|12.26|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|414.00||||414.00|11.75|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|414.00||||414.00|10.12|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|414.00||||414.00|10.09|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|414.00||||414.00|8.33|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|UMR [2035]|UMR OPTIONS [203501]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|414.00||||414.00|11.93|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|414.00||||414.00|8.99|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|414.00||||414.00|86.94|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|414.00||||414.00|8.58|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|414.00||||414.00|414|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|414.00||||414.00|198.51|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|414.00||||414.00|269.1|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|||414.00||||414.00|124.2|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|414.00||||414.00|8.85|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|414.00||||414.00|8.17|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|414.00||||414.00|8.14|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|CHAMPVA [1240]|CHAMP VA [124000]|414.00||||414.00|310.5|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|414.00||||414.00|11.75|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|CORESOURCE [1315]|CORESOURCE [131500]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|414.00||||414.00|9.2|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|GEHA [1415]|GEHA [141500]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|414.00||||414.00|372.6|414|5.45 30180076|EAP|0301 - LABORATORY-CHEMISTRY|HC HEPATIC FUNCTION PANEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|414.00||||414.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|360.00||||360.00|16.98|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|CORESOURCE [1315]|CORESOURCE [131500]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|360.00||||360.00|15.03|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|||360.00||||360.00|108|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|360.00||||360.00|234|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|360.00||||360.00|360|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|360.00||||360.00|75.6|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|UMR [2035]|UMR OPTIONS [203501]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|360.00||||360.00|18.61|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|360.00||||360.00|18.68|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MULTIPLAN [1680]|IHC HS [168011]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|HEALTHNET [1495]|HEALTHNET [149500]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|TRUSTMARK [2030]|STARMARK [203000]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|AETNA [1015]|AETNA ACO WILCO [101532]|360.00||||360.00|23.82|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|360.00||||360.00|172.62|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|360.00||||360.00|16.34|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|360.00||||360.00|10.05|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|360.00||||360.00|15.78|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|CHAMPVA [1240]|CHAMP VA [124000]|360.00||||360.00|270|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|360.00||||360.00|16.34|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|GEHA [1415]|GEHA [141500]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|360.00||||360.00|216|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|360.00||||360.00|180|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|360.00||||360.00|180.36|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|360.00||||360.00|18.61|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|360.00||||360.00|126.36|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|360.00||||360.00|153.36|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|360.00||||360.00|324|360|10.05 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MULTIPLAN [1680]|HMA [168003]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|360.00||||360.00||| 30180150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMIKACIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|360.00||||360.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|419.00||||419.00|147.07|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|419.00||||419.00|209.92|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|419.00||||419.00|178.49|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|419.00||||419.00|251.4|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|419.00||||419.00|41.79|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|419.00||||419.00|40.37|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|419.00||||419.00|23.14|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|AETNA [1015]|AETNA ACO WILCO [101532]|419.00||||419.00|54.86|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|TRUSTMARK [2030]|STARMARK [203000]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|HEALTHNET [1495]|HEALTHNET [149500]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MULTIPLAN [1680]|IHC HS [168011]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|419.00||||419.00|47.78|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|419.00||||419.00|38.57|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|UMR [2035]|UMR OPTIONS [203501]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|419.00||||419.00|87.99|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|419.00||||419.00|419|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|419.00||||419.00|200.91|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|419.00||||419.00|209.5|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|419.00||||419.00|272.35|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|419.00||||419.00|38.57|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|||419.00||||419.00|125.7|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|419.00||||419.00|41.79|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|419.00||||419.00|38.45|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|CHAMPVA [1240]|CHAMP VA [124000]|419.00||||419.00|314.25|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|CORESOURCE [1315]|CORESOURCE [131500]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|419.00||||419.00|43.44|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|GEHA [1415]|GEHA [141500]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|419.00||||419.00|377.1|419|23.14 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MULTIPLAN [1680]|HMA [168003]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|419.00||||419.00||| 30180155|EAP|0301 - LABORATORY-CHEMISTRY|HC CAFFEINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|419.00||||419.00||| 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|GEHA [1415]|GEHA [141500]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|471.00||||471.00|16.41|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|471.00||||471.00|20.95|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|CHAMPVA [1240]|CHAMP VA [124000]|471.00||||471.00|353.25|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|471.00||||471.00|15.79|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|||471.00||||471.00|141.3|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|471.00||||471.00|306.15|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|471.00||||471.00|225.84|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|471.00||||471.00|471|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|471.00||||471.00|98.91|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|UMR [2035]|UMR OPTIONS [203501]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|471.00||||471.00|14.86|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|471.00||||471.00|17.98|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|471.00||||471.00|18.05|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|FIRST HEALTH [1375]|QUALCHOICE [137513]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|FMH BENEFIT SERVICES [1390]|FMH [139000]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|471.00||||471.00|21.27|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MULTIPLAN [1680]|HMA [168003]|471.00||||471.00|21.86|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|471.00||||471.00|20.95|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MULTIPLAN [1680]|IHC HS [168011]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|HEALTHNET [1495]|HEALTHNET [149500]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|TRUSTMARK [2030]|STARMARK [203000]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|AETNA [1015]|AETNA ACO WILCO [101532]|471.00||||471.00|23.02|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|471.00||||471.00|9.71|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|471.00||||471.00|14.52|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|471.00||||471.00|15.25|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|471.00||||471.00|16.03|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|CORESOURCE [1315]|CORESOURCE [131500]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|471.00||||471.00|15.79|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|471.00||||471.00|15.3|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|471.00||||471.00|282.6|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|471.00||||471.00|235.5|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|471.00||||471.00|165.32|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|471.00||||471.00|200.65|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|471.00||||471.00|235.97|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|471.00||||471.00|17.98|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|471.00||||471.00|14.57|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|471.00||||471.00|16.03|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|471.00||||471.00|423.9|471|9.71 30180156|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE (TEGRETOL)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|471.00||||471.00||| 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218.00||||218.00|14.58|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|218.00||||218.00|92.87|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|218.00||||218.00|109.22|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218.00||||218.00|16.36|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218.00||||218.00|109|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218.00||||218.00|130.8|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218.00||||218.00|14.36|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218.00||||218.00|13.87|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|218.00||||218.00|8.84|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|AETNA [1015]|AETNA ACO WILCO [101532]|218.00||||218.00|20.96|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|TRUSTMARK [2030]|STARMARK [203000]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|HEALTHNET [1495]|HEALTHNET [149500]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|218.00||||218.00|19.05|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MULTIPLAN [1680]|IHC HS [168011]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|218.00||||218.00|16.42|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218.00||||218.00|16.36|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MULTIPLAN [1680]|HMA [168003]|218.00||||218.00|19.88|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218.00||||218.00|13.52|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|UMR [2035]|UMR OPTIONS [203501]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218.00||||218.00|19.35|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218.00||||218.00|45.78|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218.00||||218.00|14.58|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218.00||||218.00|13.91|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218.00||||218.00|218|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218.00||||218.00|104.53|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218.00||||218.00|76.52|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218.00||||218.00|141.7|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|||218.00||||218.00|65.4|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218.00||||218.00|14.36|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218.00||||218.00|13.25|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218.00||||218.00|13.21|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|CHAMPVA [1240]|CHAMP VA [124000]|218.00||||218.00|163.5|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|218.00||||218.00|19.05|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|CORESOURCE [1315]|CORESOURCE [131500]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|218.00||||218.00|14.93|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|GEHA [1415]|GEHA [141500]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218.00||||218.00|196.2|218|8.84 30180157|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBAMAZEPINE FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|218.00||||218.00||| 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|561.00||||561.00|20.33|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|CORESOURCE [1315]|CORESOURCE [131500]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|561.00||||561.00|25.95|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|CHAMPVA [1240]|CHAMP VA [124000]|561.00||||561.00|420.75|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|561.00||||561.00|17.99|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|||561.00||||561.00|168.3|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|561.00||||561.00|364.65|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|561.00||||561.00|561|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|561.00||||561.00|117.81|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|561.00||||561.00|26.35|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|UMR [2035]|UMR OPTIONS [203501]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|561.00||||561.00|18.41|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|561.00||||561.00|22.28|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|561.00||||561.00|22.37|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|FIRST HEALTH [1375]|QUALCHOICE [137513]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|FMH BENEFIT SERVICES [1390]|FMH [139000]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|561.00||||561.00|25.95|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MULTIPLAN [1680]|IHC HS [168011]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MULTIPLAN [1680]|HMA [168003]|561.00||||561.00|27.08|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|561.00||||561.00|269|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|HEALTHNET [1495]|HEALTHNET [149500]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|TRUSTMARK [2030]|STARMARK [203000]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|561.00||||561.00|19.56|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|AETNA [1015]|AETNA ACO WILCO [101532]|561.00||||561.00|28.54|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|561.00||||561.00|12.04|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|561.00||||561.00|18.89|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|561.00||||561.00|19.86|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|561.00||||561.00|19.56|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|561.00||||561.00|18.95|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|GEHA [1415]|GEHA [141500]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|561.00||||561.00|336.6|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|561.00||||561.00|280.5|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|561.00||||561.00|196.91|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|561.00||||561.00|281.06|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|561.00||||561.00|238.99|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|561.00||||561.00|22.28|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|561.00||||561.00|18.05|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|561.00||||561.00|19.86|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|561.00||||561.00|504.9|561|12.04 30180158|EAP|0301 - LABORATORY-CHEMISTRY|HC CYCLOSPORINE (SANDIMMUNE)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|561.00||||561.00||| 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368.00||||368.00|14.61|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|368.00||||368.00|156.77|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368.00||||368.00|16.39|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368.00||||368.00|129.17|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368.00||||368.00|184|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368.00||||368.00|220.8|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368.00||||368.00|13.94|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368.00||||368.00|14.61|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368.00||||368.00|13.89|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|368.00||||368.00|8.85|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|TRUSTMARK [2030]|STARMARK [203000]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|HEALTHNET [1495]|HEALTHNET [149500]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MULTIPLAN [1680]|IHC HS [168011]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MULTIPLAN [1680]|HMA [168003]|368.00||||368.00|19.92|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|368.00||||368.00|19.09|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|FMH BENEFIT SERVICES [1390]|FMH [139000]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|FIRST HEALTH [1375]|QUALCHOICE [137513]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|368.00||||368.00|16.44|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368.00||||368.00|16.39|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368.00||||368.00|13.55|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|UMR [2035]|UMR OPTIONS [203501]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368.00||||368.00|19.39|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|AETNA [1015]|AETNA ACO WILCO [101532]|368.00||||368.00|20.98|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368.00||||368.00|77.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368.00||||368.00|14.38|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368.00||||368.00|368|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368.00||||368.00|176.46|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368.00||||368.00|239.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|368.00||||368.00|184.37|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|||368.00||||368.00|110.4|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368.00||||368.00|14.38|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368.00||||368.00|13.28|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368.00||||368.00|13.23|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|CHAMPVA [1240]|CHAMP VA [124000]|368.00||||368.00|276|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|368.00||||368.00|19.09|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|CORESOURCE [1315]|CORESOURCE [131500]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|368.00||||368.00|14.95|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|GEHA [1415]|GEHA [141500]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368.00||||368.00|331.2|368|8.85 30180162|EAP|0301 - LABORATORY-CHEMISTRY|HC DIGOXIN (LANOXIN)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|368.00||||368.00||| 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|GEHA [1415]|GEHA [141500]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|520.00||||520.00|15.25|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|520.00||||520.00|19.47|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|520.00||||520.00|390|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|520.00||||520.00|14.67|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|||520.00||||520.00|156|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|520.00||||520.00|338|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|520.00||||520.00|249.34|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|520.00||||520.00|520|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|520.00||||520.00|109.2|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|UMR [2035]|UMR OPTIONS [203501]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|520.00||||520.00|13.81|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|520.00||||520.00|16.72|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|520.00||||520.00|16.78|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|520.00||||520.00|19.47|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|520.00||||520.00|19.77|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MULTIPLAN [1680]|HMA [168003]|520.00||||520.00|20.31|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MULTIPLAN [1680]|IHC HS [168011]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|TRUSTMARK [2030]|STARMARK [203000]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|520.00||||520.00|21.4|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|520.00||||520.00|9.03|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|520.00||||520.00|13.49|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|520.00||||520.00|14.17|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|520.00||||520.00|14.89|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|520.00||||520.00|14.67|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|520.00||||520.00|14.22|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|520.00||||520.00|312|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|520.00||||520.00|260|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|520.00||||520.00|16.72|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|520.00||||520.00|260.52|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|520.00||||520.00|221.52|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|520.00||||520.00|182.52|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|520.00||||520.00|13.54|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|520.00||||520.00|14.89|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|520.00||||520.00|468|520|9.03 30180164|EAP|0301 - LABORATORY-CHEMISTRY|HC DIPROPYLACETIC ACID(VALPROIC) TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|520.00||||520.00||| 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|174.00||||174.00|14.89|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|174.00||||174.00|61.07|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|174.00||||174.00|87.17|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|174.00||||174.00|74.12|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|174.00||||174.00|87|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|174.00||||174.00|104.4|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|174.00||||174.00|14.89|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|174.00||||174.00|9.03|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|TRUSTMARK [2030]|STARMARK [203000]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|HEALTHNET [1495]|HEALTHNET [149500]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MULTIPLAN [1680]|HMA [168003]|174.00||||174.00|20.31|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|174.00||||174.00|19.47|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MULTIPLAN [1680]|IHC HS [168011]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|174.00||||174.00|16.72|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|AETNA [1015]|AETNA ACO WILCO [101532]|174.00||||174.00|21.4|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|174.00||||174.00|13.81|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|UMR [2035]|UMR OPTIONS [203501]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|174.00||||174.00|19.77|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|174.00||||174.00|36.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|174.00||||174.00|174|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|174.00||||174.00|83.43|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|174.00||||174.00|14.22|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|174.00||||174.00|16.72|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|174.00||||174.00|113.1|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|||174.00||||174.00|52.2|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|174.00||||174.00|13.54|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|CHAMPVA [1240]|CHAMP VA [124000]|174.00||||174.00|130.5|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|174.00||||174.00|19.47|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|CORESOURCE [1315]|CORESOURCE [131500]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|GEHA [1415]|GEHA [141500]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|174.00||||174.00|156.6|174|9.03 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|174.00||||174.00||| 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|174.00||||174.00||| 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|174.00||||174.00||| 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|174.00||||174.00||| 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|174.00||||174.00||| 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|174.00||||174.00||| 30180165|EAP|0301 - LABORATORY-CHEMISTRY|HC VALPROIC ACID FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|174.00||||174.00||| 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|GEHA [1415]|GEHA [141500]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|356.00||||356.00|18.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|CORESOURCE [1315]|CORESOURCE [131500]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|356.00||||356.00|23.49|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356.00||||356.00|16.29|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|||356.00||||356.00|106.8|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356.00||||356.00|231.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356.00||||356.00|170.7|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356.00||||356.00|356|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356.00||||356.00|74.76|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356.00||||356.00|23.86|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|UMR [2035]|UMR OPTIONS [203501]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356.00||||356.00|16.67|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356.00||||356.00|20.17|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|356.00||||356.00|20.24|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MULTIPLAN [1680]|HMA [168003]|356.00||||356.00|24.51|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|356.00||||356.00|23.49|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MULTIPLAN [1680]|IHC HS [168011]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|HEALTHNET [1495]|HEALTHNET [149500]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|TRUSTMARK [2030]|STARMARK [203000]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|AETNA [1015]|AETNA ACO WILCO [101532]|356.00||||356.00|25.82|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356.00||||356.00|17.7|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|356.00||||356.00|10.89|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356.00||||356.00|17.1|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356.00||||356.00|17.97|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|CHAMPVA [1240]|CHAMP VA [124000]|356.00||||356.00|267|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356.00||||356.00|17.7|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356.00||||356.00|17.16|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356.00||||356.00|213.6|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356.00||||356.00|178|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|356.00||||356.00|151.66|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356.00||||356.00|20.17|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|356.00||||356.00|178.36|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356.00||||356.00|124.96|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356.00||||356.00|16.34|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356.00||||356.00|17.97|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356.00||||356.00|320.4|356|10.89 30180168|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHOSUXIMIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|356.00||||356.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|303.00||||303.00|16.96|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|303.00||||303.00|106.35|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|303.00||||303.00|151.8|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|303.00||||303.00|129.08|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|303.00||||303.00|181.8|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|303.00||||303.00|14.37|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|303.00||||303.00|9.16|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|AETNA [1015]|AETNA ACO WILCO [101532]|303.00||||303.00|21.71|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|TRUSTMARK [2030]|STARMARK [203000]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|HEALTHNET [1495]|HEALTHNET [149500]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MULTIPLAN [1680]|IHC HS [168011]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|303.00||||303.00|17.01|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|303.00||||303.00|16.96|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|UMR [2035]|UMR OPTIONS [203501]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|303.00||||303.00|63.63|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|303.00||||303.00|303|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|303.00||||303.00|14.88|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|303.00||||303.00|151.5|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|303.00||||303.00|145.29|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|303.00||||303.00|196.95|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|||303.00||||303.00|90.9|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|303.00||||303.00|14.88|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|303.00||||303.00|13.69|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|CHAMPVA [1240]|CHAMP VA [124000]|303.00||||303.00|227.25|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|CORESOURCE [1315]|CORESOURCE [131500]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|303.00||||303.00|15.47|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|GEHA [1415]|GEHA [141500]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|303.00||||303.00|272.7|303|9.16 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MULTIPLAN [1680]|HMA [168003]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|303.00||||303.00||| 30180169|EAP|0301 - LABORATORY-CHEMISTRY|HC EVEROLIMUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|303.00||||303.00||| 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|GEHA [1415]|GEHA [141500]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|485.00||||485.00|18.45|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|485.00||||485.00|23.55|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|CHAMPVA [1240]|CHAMP VA [124000]|485.00||||485.00|363.75|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|485.00||||485.00|16.33|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|485.00||||485.00|17.75|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|||485.00||||485.00|145.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|485.00||||485.00|315.25|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|485.00||||485.00|232.56|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|485.00||||485.00|485|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|485.00||||485.00|101.85|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|485.00||||485.00|23.91|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|UMR [2035]|UMR OPTIONS [203501]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|485.00||||485.00|16.71|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|485.00||||485.00|20.22|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|485.00||||485.00|20.3|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|485.00||||485.00|23.55|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MULTIPLAN [1680]|HMA [168003]|485.00||||485.00|24.57|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MULTIPLAN [1680]|IHC HS [168011]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|HEALTHNET [1495]|HEALTHNET [149500]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|TRUSTMARK [2030]|STARMARK [203000]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|AETNA [1015]|AETNA ACO WILCO [101532]|485.00||||485.00|25.88|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|485.00||||485.00|10.92|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|485.00||||485.00|17.15|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|485.00||||485.00|18.02|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|485.00||||485.00|17.75|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|485.00||||485.00|17.2|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|485.00||||485.00|291|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|485.00||||485.00|242.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|CORESOURCE [1315]|CORESOURCE [131500]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|485.00||||485.00|206.61|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|485.00||||485.00|242.99|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|485.00||||485.00|20.22|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|485.00||||485.00|170.24|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|485.00||||485.00|16.38|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|485.00||||485.00|18.02|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|485.00||||485.00|436.5|485|10.92 30180170|EAP|0301 - LABORATORY-CHEMISTRY|HC GENTAMICIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|485.00||||485.00||| 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273.00||||273.00|17.36|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273.00||||273.00|95.82|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|273.00||||273.00|136.77|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273.00||||273.00|17.98|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273.00||||273.00|136.5|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273.00||||273.00|163.8|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273.00||||273.00|16.57|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273.00||||273.00|17.09|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273.00||||273.00|16.51|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|273.00||||273.00|9.71|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|AETNA [1015]|AETNA ACO WILCO [101532]|273.00||||273.00|23.02|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|TRUSTMARK [2030]|STARMARK [203000]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|HEALTHNET [1495]|HEALTHNET [149500]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|273.00||||273.00|22.69|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MULTIPLAN [1680]|HMA [168003]|273.00||||273.00|23.67|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MULTIPLAN [1680]|IHC HS [168011]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|FMH BENEFIT SERVICES [1390]|FMH [139000]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|FIRST HEALTH [1375]|QUALCHOICE [137513]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|273.00||||273.00|19.54|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273.00||||273.00|17.98|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273.00||||273.00|16.1|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|UMR [2035]|UMR OPTIONS [203501]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273.00||||273.00|23.04|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273.00||||273.00|57.33|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273.00||||273.00|17.36|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273.00||||273.00|273|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273.00||||273.00|130.9|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|273.00||||273.00|116.3|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273.00||||273.00|177.45|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|||273.00||||273.00|81.9|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273.00||||273.00|17.09|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273.00||||273.00|15.78|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273.00||||273.00|15.73|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|CHAMPVA [1240]|CHAMP VA [124000]|273.00||||273.00|204.75|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|273.00||||273.00|22.69|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|CORESOURCE [1315]|CORESOURCE [131500]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|273.00||||273.00|17.76|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|GEHA [1415]|GEHA [141500]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273.00||||273.00|245.7|273|9.71 30180173|EAP|0301 - LABORATORY-CHEMISTRY|HC HALOPERIDOL (HALDOL)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|273.00||||273.00||| 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|326.00||||326.00|14.93|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|CORESOURCE [1315]|CORESOURCE [131500]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|326.00||||326.00|19.05|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|326.00||||326.00|13.21|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|326.00||||326.00|14.36|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|||326.00||||326.00|97.8|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|326.00||||326.00|211.9|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|326.00||||326.00|326|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|326.00||||326.00|68.46|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|326.00||||326.00|19.35|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|UMR [2035]|UMR OPTIONS [203501]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|326.00||||326.00|13.52|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|326.00||||326.00|16.36|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|326.00||||326.00|16.42|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|FIRST HEALTH [1375]|QUALCHOICE [137513]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|FMH BENEFIT SERVICES [1390]|FMH [139000]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MULTIPLAN [1680]|HMA [168003]|326.00||||326.00|19.88|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|326.00||||326.00|19.05|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MULTIPLAN [1680]|IHC HS [168011]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|326.00||||326.00|156.32|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|HEALTHNET [1495]|HEALTHNET [149500]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|TRUSTMARK [2030]|STARMARK [203000]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|AETNA [1015]|AETNA ACO WILCO [101532]|326.00||||326.00|20.96|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|326.00||||326.00|8.84|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|326.00||||326.00|13.87|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|326.00||||326.00|14.58|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|CHAMPVA [1240]|CHAMP VA [124000]|326.00||||326.00|244.5|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|326.00||||326.00|14.36|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|326.00||||326.00|13.91|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|GEHA [1415]|GEHA [141500]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|326.00||||326.00|195.6|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|326.00||||326.00|163|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|326.00||||326.00|163.33|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|326.00||||326.00|138.88|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|326.00||||326.00|16.36|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|326.00||||326.00|114.43|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|326.00||||326.00|13.25|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|326.00||||326.00|14.58|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|326.00||||326.00|293.4|326|8.84 30180175|EAP|0301 - LABORATORY-CHEMISTRY|HC LAMOTRIGINE (LAMICTAL)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|326.00||||326.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|248.00||||248.00|124.25|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248.00||||248.00|18.14|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248.00||||248.00|87.05|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248.00||||248.00|148.8|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248.00||||248.00|15.38|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|248.00||||248.00|9.79|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|AETNA [1015]|AETNA ACO WILCO [101532]|248.00||||248.00|23.22|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|TRUSTMARK [2030]|STARMARK [203000]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|HEALTHNET [1495]|HEALTHNET [149500]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MULTIPLAN [1680]|IHC HS [168011]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|248.00||||248.00|18.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248.00||||248.00|18.14|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|UMR [2035]|UMR OPTIONS [203501]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248.00||||248.00|52.08|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248.00||||248.00|15.92|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248.00||||248.00|248|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248.00||||248.00|118.92|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248.00||||248.00|161.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248.00||||248.00|124|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|248.00||||248.00|105.65|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|||248.00||||248.00|74.4|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248.00||||248.00|15.92|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248.00||||248.00|14.65|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|CHAMPVA [1240]|CHAMP VA [124000]|248.00||||248.00|186|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|CORESOURCE [1315]|CORESOURCE [131500]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|248.00||||248.00|16.55|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|GEHA [1415]|GEHA [141500]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248.00||||248.00|223.2|248|9.79 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|MULTIPLAN [1680]|HMA [168003]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248.00||||248.00||| 30180176|EAP|0301 - LABORATORY-CHEMISTRY|HC LIDOCAINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|248.00||||248.00||| 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|GEHA [1415]|GEHA [141500]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64.00||||64.00|14.93|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|CORESOURCE [1315]|CORESOURCE [131500]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64.00||||64.00|19.05|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|CHAMPVA [1240]|CHAMP VA [124000]|64.00||||64.00|48|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64.00||||64.00|14.36|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|||64.00||||64.00|19.2|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64.00||||64.00|41.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.00||||64.00|30.69|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64.00||||64.00|64|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64.00||||64.00|13.44|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|UMR [2035]|UMR OPTIONS [203501]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.00||||64.00|13.52|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.00||||64.00|16.36|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64.00||||64.00|16.42|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MULTIPLAN [1680]|IHC HS [168011]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64.00||||64.00|19.35|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MULTIPLAN [1680]|HMA [168003]|64.00||||64.00|19.88|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64.00||||64.00|19.05|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|HEALTHNET [1495]|HEALTHNET [149500]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|TRUSTMARK [2030]|STARMARK [203000]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|AETNA [1015]|AETNA ACO WILCO [101532]|64.00||||64.00|20.96|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64.00||||64.00|13.21|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64.00||||64.00|8.84|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64.00||||64.00|13.87|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64.00||||64.00|14.58|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64.00||||64.00|14.36|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.00||||64.00|13.91|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64.00||||64.00|38.4|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.00||||64.00|32|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64.00||||64.00|22.46|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64.00||||64.00|27.26|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64.00||||64.00|16.36|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64.00||||64.00|32.06|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.00||||64.00|13.25|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64.00||||64.00|14.58|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64.00||||64.00|57.6|64|8.84 30180177|EAP|0301 - LABORATORY-CHEMISTRY|HC LEVETIRACE (KEPPRA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64.00||||64.00||| 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|353.00||||353.00|7.27|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|353.00||||353.00|150.38|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|353.00||||353.00|123.9|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|353.00||||353.00|8.16|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|353.00||||353.00|176.85|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|353.00||||353.00|176.5|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|353.00||||353.00|211.8|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|353.00||||353.00|7.16|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|353.00||||353.00|6.91|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|353.00||||353.00|4.41|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|AETNA [1015]|AETNA ACO WILCO [101532]|353.00||||353.00|10.45|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|TRUSTMARK [2030]|STARMARK [203000]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|HEALTHNET [1495]|HEALTHNET [149500]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|353.00||||353.00|9.5|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MULTIPLAN [1680]|IHC HS [168011]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MULTIPLAN [1680]|HMA [168003]|353.00||||353.00|9.92|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|353.00||||353.00|8.19|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|353.00||||353.00|8.16|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|353.00||||353.00|6.74|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|UMR [2035]|UMR OPTIONS [203501]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|353.00||||353.00|9.65|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|353.00||||353.00|7.27|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|353.00||||353.00|74.13|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|353.00||||353.00|6.94|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|353.00||||353.00|353|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|353.00||||353.00|169.26|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|353.00||||353.00|229.45|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|||353.00||||353.00|105.9|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|353.00||||353.00|7.16|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|353.00||||353.00|6.61|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|353.00||||353.00|6.58|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|CHAMPVA [1240]|CHAMP VA [124000]|353.00||||353.00|264.75|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|353.00||||353.00|9.5|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|CORESOURCE [1315]|CORESOURCE [131500]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|353.00||||353.00|7.44|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|GEHA [1415]|GEHA [141500]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|353.00||||353.00|317.7|353|4.41 30180178|EAP|0301 - LABORATORY-CHEMISTRY|HC LITHIUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|353.00||||353.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|240.00||||240.00|20.33|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|GEHA [1415]|GEHA [141500]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|CORESOURCE [1315]|CORESOURCE [131500]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|240.00||||240.00|148.8|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|240.00||||240.00|17.99|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|240.00||||240.00|18.05|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|||240.00||||240.00|72|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|240.00||||240.00|156|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|240.00||||240.00|240|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|240.00||||240.00|50.4|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|240.00||||240.00|149.04|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|UMR [2035]|UMR OPTIONS [203501]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|240.00||||240.00|18.41|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|240.00||||240.00|22.28|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|240.00||||240.00|22.37|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|240.00||||240.00|18.05|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MULTIPLAN [1680]|IHC HS [168011]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|240.00||||240.00|25.95|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MULTIPLAN [1680]|HMA [168003]|240.00||||240.00|27.08|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|HEALTHNET [1495]|HEALTHNET [149500]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|240.00||||240.00|18.05|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|AETNA [1015]|AETNA ACO WILCO [101532]|240.00||||240.00|28.54|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|240.00||||240.00|115.08|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|240.00||||240.00|19.56|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|TRUSTMARK [2030]|STARMARK [203000]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|240.00||||240.00|12.04|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|240.00||||240.00|18.89|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|240.00||||240.00|18.05|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|CHAMPVA [1240]|CHAMP VA [124000]|240.00||||240.00|180|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|240.00||||240.00|19.56|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|240.00||||240.00|22.28|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|240.00||||240.00|120.24|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|240.00||||240.00|84.24|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|240.00||||240.00|102.24|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|240.00||||240.00|18.95|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|240.00||||240.00|144|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|240.00||||240.00|120|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|240.00||||240.00|18.05|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|240.00||||240.00|18.05|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|240.00||||240.00|216|240|12.04 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|240.00||||240.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|240.00||||240.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|240.00||||240.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|240.00||||240.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|240.00||||240.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|240.00||||240.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|240.00||||240.00||| 30180180|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCRN QUAN MYCOPHENOLATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|240.00||||240.00||| 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|285.00||||285.00|14.58|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|285.00||||285.00|16.36|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|285.00||||285.00|100.04|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|285.00||||285.00|142.79|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|285.00||||285.00|142.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|285.00||||285.00|171|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|285.00||||285.00|13.91|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|285.00||||285.00|14.36|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|285.00||||285.00|14.58|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|285.00||||285.00|13.87|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|285.00||||285.00|8.84|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|AETNA [1015]|AETNA ACO WILCO [101532]|285.00||||285.00|20.96|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|TRUSTMARK [2030]|STARMARK [203000]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|HEALTHNET [1495]|HEALTHNET [149500]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MULTIPLAN [1680]|HMA [168003]|285.00||||285.00|19.88|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MULTIPLAN [1680]|IHC HS [168011]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|285.00||||285.00|19.05|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|285.00||||285.00|16.42|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|285.00||||285.00|16.36|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|285.00||||285.00|13.52|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|UMR [2035]|UMR OPTIONS [203501]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|285.00||||285.00|19.35|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|285.00||||285.00|59.85|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|285.00||||285.00|285|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|285.00||||285.00|136.66|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|285.00||||285.00|185.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|285.00||||285.00|121.41|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|||285.00||||285.00|85.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|285.00||||285.00|14.36|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|285.00||||285.00|13.25|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|285.00||||285.00|13.21|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|CHAMPVA [1240]|CHAMP VA [124000]|285.00||||285.00|213.75|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|285.00||||285.00|19.05|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|CORESOURCE [1315]|CORESOURCE [131500]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|285.00||||285.00|14.93|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|GEHA [1415]|GEHA [141500]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|285.00||||285.00|256.5|285|8.84 30180183|EAP|0301 - LABORATORY-CHEMISTRY|HC OXCARBAZEPINE (TRILETAL) QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|285.00||||285.00||| 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|GEHA [1415]|GEHA [141500]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|291.00||||291.00|17.22|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|291.00||||291.00|22|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|CHAMPVA [1240]|CHAMP VA [124000]|291.00||||291.00|218.25|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|291.00||||291.00|16.57|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|||291.00||||291.00|87.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|291.00||||291.00|189.15|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|291.00||||291.00|139.53|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|291.00||||291.00|291|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|291.00||||291.00|61.11|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|UMR [2035]|UMR OPTIONS [203501]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|291.00||||291.00|15.61|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|291.00||||291.00|18.95|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|291.00||||291.00|22.34|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|291.00||||291.00|22|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MULTIPLAN [1680]|IHC HS [168011]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MULTIPLAN [1680]|HMA [168003]|291.00||||291.00|22.95|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|HEALTHNET [1495]|HEALTHNET [149500]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|TRUSTMARK [2030]|STARMARK [203000]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|AETNA [1015]|AETNA ACO WILCO [101532]|291.00||||291.00|21.76|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|291.00||||291.00|9.18|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|291.00||||291.00|15.25|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|291.00||||291.00|16.01|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|291.00||||291.00|16.83|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|CORESOURCE [1315]|CORESOURCE [131500]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|291.00||||291.00|16.57|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|291.00||||291.00|16.07|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|291.00||||291.00|174.6|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|291.00||||291.00|145.5|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|291.00||||291.00|123.97|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|291.00||||291.00|145.79|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|291.00||||291.00|102.14|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|291.00||||291.00|15.3|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|291.00||||291.00|16.83|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|291.00||||291.00|261.9|291|9.18 30180184|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENOBARBITAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|291.00||||291.00||| 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|501.00||||501.00|14.58|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|501.00||||501.00|16.36|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|501.00||||501.00|175.85|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|501.00||||501.00|213.43|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|501.00||||501.00|250.5|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|501.00||||501.00|300.6|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|501.00||||501.00|14.36|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|501.00||||501.00|13.87|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|501.00||||501.00|8.84|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|TRUSTMARK [2030]|STARMARK [203000]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|HEALTHNET [1495]|HEALTHNET [149500]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MULTIPLAN [1680]|IHC HS [168011]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MULTIPLAN [1680]|HMA [168003]|501.00||||501.00|19.88|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|501.00||||501.00|19.05|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|501.00||||501.00|16.42|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|501.00||||501.00|16.36|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|AETNA [1015]|AETNA ACO WILCO [101532]|501.00||||501.00|20.96|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|501.00||||501.00|13.52|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|UMR [2035]|UMR OPTIONS [203501]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|501.00||||501.00|19.35|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|501.00||||501.00|105.21|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|501.00||||501.00|14.58|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|501.00||||501.00|13.91|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|501.00||||501.00|501|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|501.00||||501.00|240.23|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|501.00||||501.00|325.65|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|||501.00||||501.00|150.3|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|501.00||||501.00|14.36|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|501.00||||501.00|251|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|501.00||||501.00|13.25|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|501.00||||501.00|13.21|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|CHAMPVA [1240]|CHAMP VA [124000]|501.00||||501.00|375.75|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|501.00||||501.00|19.05|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|CORESOURCE [1315]|CORESOURCE [131500]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|501.00||||501.00|14.93|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|GEHA [1415]|GEHA [141500]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|501.00||||501.00|450.9|501|8.84 30180185|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|501.00||||501.00||| 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242.00||||242.00|15.49|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|CORESOURCE [1315]|CORESOURCE [131500]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242.00||||242.00|19.78|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|CHAMPVA [1240]|CHAMP VA [124000]|242.00||||242.00|181.5|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.00||||242.00|13.71|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|||242.00||||242.00|72.6|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.00||||242.00|157.3|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.00||||242.00|242|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.00||||242.00|50.82|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.00||||242.00|20.09|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|UMR [2035]|UMR OPTIONS [203501]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.00||||242.00|14.04|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.00||||242.00|16.99|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242.00||||242.00|17.04|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242.00||||242.00|19.78|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MULTIPLAN [1680]|IHC HS [168011]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MULTIPLAN [1680]|HMA [168003]|242.00||||242.00|20.64|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.00||||242.00|116.04|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|HEALTHNET [1495]|HEALTHNET [149500]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|TRUSTMARK [2030]|STARMARK [203000]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.00||||242.00|14.9|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|AETNA [1015]|AETNA ACO WILCO [101532]|242.00||||242.00|21.75|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242.00||||242.00|9.17|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.00||||242.00|14.4|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.00||||242.00|15.14|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.00||||242.00|14.9|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.00||||242.00|14.45|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|GEHA [1415]|GEHA [141500]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.00||||242.00|145.2|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.00||||242.00|121|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242.00||||242.00|121.24|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.00||||242.00|84.94|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242.00||||242.00|103.09|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.00||||242.00|16.99|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.00||||242.00|13.76|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.00||||242.00|15.14|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.00||||242.00|217.8|242|9.17 30180186|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYTOIN FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242.00||||242.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|288.00||||288.00|144.29|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|288.00||||288.00|20.48|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|288.00||||288.00|122.69|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|288.00||||288.00|144|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|288.00||||288.00|172.8|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|288.00||||288.00|17.35|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|288.00||||288.00|11.06|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|AETNA [1015]|AETNA ACO WILCO [101532]|288.00||||288.00|26.23|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|TRUSTMARK [2030]|STARMARK [203000]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|HEALTHNET [1495]|HEALTHNET [149500]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MULTIPLAN [1680]|IHC HS [168011]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|288.00||||288.00|20.55|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|288.00||||288.00|20.48|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|UMR [2035]|UMR OPTIONS [203501]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|288.00||||288.00|60.48|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|288.00||||288.00|17.97|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|288.00||||288.00|288|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|288.00||||288.00|138.1|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|288.00||||288.00|187.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|288.00||||288.00|101.09|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|||288.00||||288.00|86.4|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|288.00||||288.00|17.97|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|288.00||||288.00|16.53|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|CHAMPVA [1240]|CHAMP VA [124000]|288.00||||288.00|216|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|CORESOURCE [1315]|CORESOURCE [131500]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|288.00||||288.00|18.68|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|GEHA [1415]|GEHA [141500]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|288.00||||288.00|259.2|288|11.06 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MULTIPLAN [1680]|HMA [168003]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|288.00||||288.00||| 30180188|EAP|0301 - LABORATORY-CHEMISTRY|HC PRIMIDONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|288.00||||288.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|GEHA [1415]|GEHA [141500]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|274.00||||274.00|18.86|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|CHAMPVA [1240]|CHAMP VA [124000]|274.00||||274.00|205.5|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|274.00||||274.00|18.15|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|||274.00||||274.00|82.2|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|274.00||||274.00|178.1|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|274.00||||274.00|131.38|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|274.00||||274.00|274|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|274.00||||274.00|57.54|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|UMR [2035]|UMR OPTIONS [203501]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|274.00||||274.00|20.68|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|274.00||||274.00|20.76|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MULTIPLAN [1680]|IHC HS [168011]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|HEALTHNET [1495]|HEALTHNET [149500]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|TRUSTMARK [2030]|STARMARK [203000]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|AETNA [1015]|AETNA ACO WILCO [101532]|274.00||||274.00|26.47|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|274.00||||274.00|11.17|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|274.00||||274.00|16.7|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|274.00||||274.00|17.54|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|274.00||||274.00|18.15|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|CORESOURCE [1315]|CORESOURCE [131500]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|274.00||||274.00|164.4|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|274.00||||274.00|137|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|274.00||||274.00|96.17|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|274.00||||274.00|137.27|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|274.00||||274.00|20.68|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|274.00||||274.00|116.72|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|274.00||||274.00|246.6|274|11.17 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MULTIPLAN [1680]|HMA [168003]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|274.00||||274.00||| 30180192|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCAINAMIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|274.00||||274.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206.00||||206.00|18.03|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|206.00||||206.00|103.21|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|206.00||||206.00|87.76|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206.00||||206.00|103|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206.00||||206.00|123.6|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206.00||||206.00|15.81|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206.00||||206.00|15.27|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|206.00||||206.00|9.73|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|AETNA [1015]|AETNA ACO WILCO [101532]|206.00||||206.00|23.07|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|TRUSTMARK [2030]|STARMARK [203000]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|HEALTHNET [1495]|HEALTHNET [149500]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MULTIPLAN [1680]|IHC HS [168011]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|206.00||||206.00|18.07|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206.00||||206.00|18.03|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|UMR [2035]|UMR OPTIONS [203501]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206.00||||206.00|43.26|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206.00||||206.00|206|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206.00||||206.00|98.78|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206.00||||206.00|72.31|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206.00||||206.00|133.9|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|||206.00||||206.00|61.8|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206.00||||206.00|15.81|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206.00||||206.00|14.54|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|CHAMPVA [1240]|CHAMP VA [124000]|206.00||||206.00|154.5|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|CORESOURCE [1315]|CORESOURCE [131500]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|206.00||||206.00|16.43|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|GEHA [1415]|GEHA [141500]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206.00||||206.00|185.4|206|9.73 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MULTIPLAN [1680]|HMA [168003]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206.00||||206.00||| 30180194|EAP|0301 - LABORATORY-CHEMISTRY|HC QUINIDINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|206.00||||206.00||| 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|GEHA [1415]|GEHA [141500]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|297.00||||297.00|15.47|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|CORESOURCE [1315]|CORESOURCE [131500]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|297.00||||297.00|19.74|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297.00||||297.00|13.69|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|||297.00||||297.00|89.1|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297.00||||297.00|193.05|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297.00||||297.00|142.41|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297.00||||297.00|297|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297.00||||297.00|62.37|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297.00||||297.00|20.05|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|UMR [2035]|UMR OPTIONS [203501]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297.00||||297.00|14|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297.00||||297.00|16.96|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|297.00||||297.00|17.01|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MULTIPLAN [1680]|IHC HS [168011]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|297.00||||297.00|19.74|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MULTIPLAN [1680]|HMA [168003]|297.00||||297.00|20.6|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|HEALTHNET [1495]|HEALTHNET [149500]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|TRUSTMARK [2030]|STARMARK [203000]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|AETNA [1015]|AETNA ACO WILCO [101532]|297.00||||297.00|21.71|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297.00||||297.00|14.88|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|297.00||||297.00|9.16|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297.00||||297.00|14.37|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297.00||||297.00|15.1|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|CHAMPVA [1240]|CHAMP VA [124000]|297.00||||297.00|222.75|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297.00||||297.00|14.88|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297.00||||297.00|14.42|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297.00||||297.00|178.2|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297.00||||297.00|148.5|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297.00||||297.00|104.25|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|297.00||||297.00|148.8|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|297.00||||297.00|126.52|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297.00||||297.00|16.96|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297.00||||297.00|13.73|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297.00||||297.00|15.1|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297.00||||297.00|267.3|297|9.16 30180195|EAP|0301 - LABORATORY-CHEMISTRY|HC ASSAY SIROLIMUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|297.00||||297.00||| 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|691.00||||691.00|15.1|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|691.00||||691.00|294.37|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|691.00||||691.00|16.96|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|691.00||||691.00|346.19|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|691.00||||691.00|242.54|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|691.00||||691.00|414.6|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|691.00||||691.00|14.42|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|691.00||||691.00|15.1|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|691.00||||691.00|14.37|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|691.00||||691.00|9.16|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|AETNA [1015]|AETNA ACO WILCO [101532]|691.00||||691.00|21.71|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|TRUSTMARK [2030]|STARMARK [203000]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|HEALTHNET [1495]|HEALTHNET [149500]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MULTIPLAN [1680]|HMA [168003]|691.00||||691.00|20.6|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|691.00||||691.00|19.74|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|691.00||||691.00|17.01|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|691.00||||691.00|16.96|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|691.00||||691.00|14|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MULTIPLAN [1680]|IHC HS [168011]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|UMR [2035]|UMR OPTIONS [203501]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|691.00||||691.00|20.05|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|691.00||||691.00|145.11|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|691.00||||691.00|691|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|691.00||||691.00|14.88|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|691.00||||691.00|345.5|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|691.00||||691.00|331.33|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|691.00||||691.00|449.15|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|||691.00||||691.00|207.3|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|691.00||||691.00|14.88|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|691.00||||691.00|13.73|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|691.00||||691.00|13.69|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|CHAMPVA [1240]|CHAMP VA [124000]|691.00||||691.00|518.25|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|691.00||||691.00|19.74|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|CORESOURCE [1315]|CORESOURCE [131500]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|691.00||||691.00|15.47|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|GEHA [1415]|GEHA [141500]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|691.00||||691.00|621.9|691|9.16 30180197|EAP|0301 - LABORATORY-CHEMISTRY|HC TACROLIMUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|691.00||||691.00||| 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|GEHA [1415]|GEHA [141500]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|607.00||||607.00|15.92|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|607.00||||607.00|20.33|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|CHAMPVA [1240]|CHAMP VA [124000]|607.00||||607.00|455.25|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|607.00||||607.00|14.09|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|607.00||||607.00|15.32|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|||607.00||||607.00|182.1|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|607.00||||607.00|394.55|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|607.00||||607.00|291.06|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|607.00||||607.00|607|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|607.00||||607.00|127.47|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|607.00||||607.00|20.64|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|UMR [2035]|UMR OPTIONS [203501]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|607.00||||607.00|14.42|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|607.00||||607.00|17.46|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|607.00||||607.00|17.51|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|607.00||||607.00|20.33|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MULTIPLAN [1680]|IHC HS [168011]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MULTIPLAN [1680]|HMA [168003]|607.00||||607.00|21.21|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|HEALTHNET [1495]|HEALTHNET [149500]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|TRUSTMARK [2030]|STARMARK [203000]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|AETNA [1015]|AETNA ACO WILCO [101532]|607.00||||607.00|22.34|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|607.00||||607.00|9.43|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|607.00||||607.00|14.8|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|607.00||||607.00|15.55|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|CORESOURCE [1315]|CORESOURCE [131500]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|607.00||||607.00|15.32|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|607.00||||607.00|14.85|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|607.00||||607.00|364.2|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|607.00||||607.00|303.5|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|607.00||||607.00|213.06|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|607.00||||607.00|17.46|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|607.00||||607.00|304.11|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|607.00||||607.00|258.58|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|607.00||||607.00|14.14|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|607.00||||607.00|15.55|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|607.00||||607.00|546.3|607|9.43 30180198|EAP|0301 - LABORATORY-CHEMISTRY|HC THEOPHYLLINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|607.00||||607.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|583.00||||583.00|248.36|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|583.00||||583.00|204.63|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|583.00||||583.00|292.08|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|583.00||||583.00|291.5|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|583.00||||583.00|349.8|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|583.00||||583.00|17.47|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|583.00||||583.00|16.87|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|583.00||||583.00|10.75|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|AETNA [1015]|AETNA ACO WILCO [101532]|583.00||||583.00|25.49|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|TRUSTMARK [2030]|STARMARK [203000]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|HEALTHNET [1495]|HEALTHNET [149500]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MULTIPLAN [1680]|IHC HS [168011]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|583.00||||583.00|19.98|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|583.00||||583.00|19.91|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|UMR [2035]|UMR OPTIONS [203501]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|583.00||||583.00|122.43|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|583.00||||583.00|583|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|583.00||||583.00|279.55|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|583.00||||583.00|19.91|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|583.00||||583.00|378.95|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|||583.00||||583.00|174.9|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|583.00||||583.00|17.47|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|583.00||||583.00|16.07|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|CHAMPVA [1240]|CHAMP VA [124000]|583.00||||583.00|437.25|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|CORESOURCE [1315]|CORESOURCE [131500]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|583.00||||583.00|18.16|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|GEHA [1415]|GEHA [141500]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|583.00||||583.00|524.7|583|10.75 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MULTIPLAN [1680]|HMA [168003]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|583.00||||583.00||| 30180200|EAP|0301 - LABORATORY-CHEMISTRY|HC TOBRAMYCIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|583.00||||583.00||| 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|TRUSTMARK [2030]|STARMARK [203000]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|AETNA [1015]|AETNA ACO WILCO [101532]|186.00||||186.00|18.83|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|186.00||||186.00|7.94|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186.00||||186.00|12.46|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186.00||||186.00|13.11|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186.00||||186.00|12.91|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186.00||||186.00|12.52|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|HEALTHNET [1495]|HEALTHNET [149500]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186.00||||186.00|111.6|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186.00||||186.00|93|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|186.00||||186.00|79.24|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|186.00||||186.00|93.19|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186.00||||186.00|14.72|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186.00||||186.00|65.29|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186.00||||186.00|13.11|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|CORESOURCE [1315]|CORESOURCE [131500]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186.00||||186.00|120.9|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|GEHA [1415]|GEHA [141500]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186.00||||186.00|89.19|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186.00||||186.00|12.91|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|186.00||||186.00|17.14|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186.00||||186.00|12.16|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186.00||||186.00|186|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|UMR [2035]|UMR OPTIONS [203501]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MULTIPLAN [1680]|IHC HS [168011]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|186.00||||186.00|13.42|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186.00||||186.00|17.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|CHAMPVA [1240]|CHAMP VA [124000]|186.00||||186.00|139.5|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186.00||||186.00|14.72|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MULTIPLAN [1680]|HMA [168003]|186.00||||186.00|17.88|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|186.00||||186.00|14.76|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|186.00||||186.00|17.14|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186.00||||186.00|39.06|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186.00||||186.00|11.87|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|||186.00||||186.00|55.8|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186.00||||186.00|167.4|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186.00||||186.00|11.92|186|7.94 30180201|EAP|0301 - LABORATORY-CHEMISTRY|HC TOPIRAMATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|186.00||||186.00||| 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|249.00||||249.00|119.4|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|249.00||||249.00|14.22|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|249.00||||249.00|14.17|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|FIRST HEALTH [1375]|QUALCHOICE [137513]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|249.00||||249.00|106.07|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|249.00||||249.00|124.75|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|249.00||||249.00|16.78|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MULTIPLAN [1680]|IHC HS [168011]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|AETNA [1015]|AETNA ACO WILCO [101532]|249.00||||249.00|21.4|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|CHAMPVA [1240]|CHAMP VA [124000]|249.00||||249.00|186.75|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|249.00||||249.00|14.67|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|249.00||||249.00|249|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|||249.00||||249.00|74.7|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|249.00||||249.00|87.4|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|249.00||||249.00|15.25|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|249.00||||249.00|9.03|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|TRUSTMARK [2030]|STARMARK [203000]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|HEALTHNET [1495]|HEALTHNET [149500]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|FMH BENEFIT SERVICES [1390]|FMH [139000]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|249.00||||249.00|52.29|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|CORESOURCE [1315]|CORESOURCE [131500]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|249.00||||249.00|13.81|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|UMR [2035]|UMR OPTIONS [203501]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|249.00||||249.00|161.85|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|249.00||||249.00|19.77|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|249.00||||249.00|16.72|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|249.00||||249.00|16.72|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MULTIPLAN [1680]|HMA [168003]|249.00||||249.00|20.31|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|249.00||||249.00|14.67|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|249.00||||249.00|13.49|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|249.00||||249.00|124.5|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|249.00||||249.00|149.4|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|249.00||||249.00|19.47|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|GEHA [1415]|GEHA [141500]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|249.00||||249.00|224.1|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|249.00||||249.00|14.89|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|249.00||||249.00|14.89|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|249.00||||249.00|19.47|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|249.00||||249.00|13.54|249|9.03 30180202|EAP|0301 - LABORATORY-CHEMISTRY|HC VANCOMYCIN PEAK/TROUGH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|249.00||||249.00||| 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|450.00||||450.00|14.36|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|450.00||||450.00|225|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|450.00||||450.00|8.84|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|450.00||||450.00|14.58|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|450.00||||450.00|157.95|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|450.00||||450.00|13.91|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|450.00||||450.00|13.87|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|GEHA [1415]|GEHA [141500]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|450.00||||450.00|16.36|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|450.00||||450.00|191.7|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|450.00||||450.00|14.93|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|CHAMPVA [1240]|CHAMP VA [124000]|450.00||||450.00|337.5|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|450.00||||450.00|16.36|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|CORESOURCE [1315]|CORESOURCE [131500]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|450.00||||450.00|292.5|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|450.00||||450.00|215.78|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|UMR [2035]|UMR OPTIONS [203501]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|||450.00||||450.00|135|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|450.00||||450.00|13.52|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|450.00||||450.00|13.21|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|450.00||||450.00|94.5|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|450.00||||450.00|14.58|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MULTIPLAN [1680]|IHC HS [168011]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|450.00||||450.00|270|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|450.00||||450.00|19.35|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|450.00||||450.00|450|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|AETNA [1015]|AETNA ACO WILCO [101532]|450.00||||450.00|20.96|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|450.00||||450.00|19.05|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|450.00||||450.00|14.36|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|MULTIPLAN [1680]|HMA [168003]|450.00||||450.00|19.88|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|450.00||||450.00|16.42|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|450.00||||450.00|225.45|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|HEALTHNET [1495]|HEALTHNET [149500]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|TRUSTMARK [2030]|STARMARK [203000]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|450.00||||450.00|19.05|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|450.00||||450.00|13.25|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|450.00||||450.00|405|450|8.84 30180203|EAP|0301 - LABORATORY-CHEMISTRY|HC ZONISAMIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|450.00||||450.00||| 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281.00||||281.00|20.5|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MULTIPLAN [1680]|HMA [168003]|281.00||||281.00|27.96|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|281.00||||281.00|140.78|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281.00||||281.00|98.63|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281.00||||281.00|168.6|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|281.00||||281.00|119.71|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281.00||||281.00|19.57|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281.00||||281.00|20.5|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281.00||||281.00|20.19|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|TRUSTMARK [2030]|STARMARK [203000]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|281.00||||281.00|11.18|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281.00||||281.00|134.74|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MULTIPLAN [1680]|IHC HS [168011]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281.00||||281.00|281|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281.00||||281.00|27.21|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281.00||||281.00|140.5|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|UMR [2035]|UMR OPTIONS [203501]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|281.00||||281.00|23.08|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281.00||||281.00|19.01|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281.00||||281.00|19.5|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|HEALTHNET [1495]|HEALTHNET [149500]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281.00||||281.00|182.65|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|||281.00||||281.00|84.3|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|281.00||||281.00|20.98|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|CHAMPVA [1240]|CHAMP VA [124000]|281.00||||281.00|210.75|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|281.00||||281.00|26.8|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|FMH BENEFIT SERVICES [1390]|FMH [139000]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|CORESOURCE [1315]|CORESOURCE [131500]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|GEHA [1415]|GEHA [141500]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|FIRST HEALTH [1375]|QUALCHOICE [137513]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281.00||||281.00|252.9|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281.00||||281.00|20.19|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281.00||||281.00|18.57|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|281.00||||281.00|26.8|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|AETNA [1015]|AETNA ACO WILCO [101532]|281.00||||281.00|26.51|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281.00||||281.00|18.64|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281.00||||281.00|59.01|281|11.18 30180299|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED QUANTITATIVE ASSAY DRUG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|281.00||||281.00||| 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.00||||37.00|22.2|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.00||||37.00|13.86|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.00||||37.00|18.54|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.00||||37.00|12.99|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.00||||37.00|13.46|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.00||||37.00|13.18|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.00||||37.00|13.86|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.00||||37.00|15.76|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.00||||37.00|13.65|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.00||||37.00|18.5|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.00||||37.00|13.23|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|GEHA [1415]|GEHA [141500]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.00||||37.00|17.74|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|CORESOURCE [1315]|CORESOURCE [131500]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|||37.00||||37.00|11.1|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.00||||37.00|12.56|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|CHAMPVA [1240]|CHAMP VA [124000]|37.00||||37.00|27.75|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.00||||37.00|37|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.00||||37.00|13.65|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.00||||37.00|18.4|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.00||||37.00|24.05|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|HEALTHNET [1495]|HEALTHNET [149500]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.00||||37.00|18.11|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|TRUSTMARK [2030]|STARMARK [203000]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MULTIPLAN [1680]|HMA [168003]|37.00||||37.00|18.9|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.00||||37.00|14.19|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|MULTIPLAN [1680]|IHC HS [168011]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.00||||37.00|18.11|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.00||||37.00|12.85|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|AETNA [1015]|AETNA ACO WILCO [101532]|37.00||||37.00|17.92|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.00||||37.00|13.46|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.00||||37.00|7.77|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.00||||37.00|7.56|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.00||||37.00|15.61|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|UMR [2035]|UMR OPTIONS [203501]|37.00||||37.00|33.3|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.00||||37.00|12.6|37|7.56 30180305|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN MULTIPLE URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.00||||37.00||| 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1763.00||||1763.00|68.35|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MULTIPLAN [1680]|IHC HS [168011]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1763.00||||1763.00|1057.8|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|CHAMPVA [1240]|CHAMP VA [124000]|1763.00||||1763.00|1322.25|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1763.00||||1763.00|71.83|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MULTIPLAN [1680]|HMA [168003]|1763.00||||1763.00|93.21|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1763.00||||1763.00|881.5|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1763.00||||1763.00|68.35|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1763.00||||1763.00|76.97|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1763.00||||1763.00|89.33|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1763.00||||1763.00|751.04|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|AETNA [1015]|AETNA ACO WILCO [101532]|1763.00||||1763.00|91.96|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1763.00||||1763.00|65.03|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1763.00||||1763.00|38.79|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1763.00||||1763.00|90.72|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1763.00||||1763.00|63.38|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1763.00||||1763.00|71.83|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|HEALTHNET [1495]|HEALTHNET [149500]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1763.00||||1763.00|370.23|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1763.00||||1763.00|1145.95|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1763.00||||1763.00|61.93|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|UMR [2035]|UMR OPTIONS [203501]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|TRUSTMARK [2030]|STARMARK [203000]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1763.00||||1763.00|67.32|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1763.00||||1763.00|69.97|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|CORESOURCE [1315]|CORESOURCE [131500]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1763.00||||1763.00|845.36|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1763.00||||1763.00|883.26|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1763.00||||1763.00|618.81|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1763.00||||1763.00|89.33|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1763.00||||1763.00|67.32|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1763.00||||1763.00|1763|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1763.00||||1763.00|62.14|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|GEHA [1415]|GEHA [141500]|1763.00||||1763.00|1586.7|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|||1763.00||||1763.00|528.9|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1763.00||||1763.00|65.25|1763|38.79 30180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG TEST PRESUMP INSTR CHEM ANALYZ PER DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1763.00||||1763.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|GEHA [1415]|GEHA [141500]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.00||||123.00|76.38|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|CORESOURCE [1315]|CORESOURCE [131500]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|CHAMPVA [1240]|CHAMP VA [124000]|123.00||||123.00|92.25|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.00||||123.00|31.98|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|||123.00||||123.00|36.9|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.00||||123.00|58.98|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.00||||123.00|25.83|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.00||||123.00|43.17|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.00||||123.00|79.95|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|TRUSTMARK [2030]|STARMARK [203000]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.00||||123.00|123|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|HEALTHNET [1495]|HEALTHNET [149500]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MULTIPLAN [1680]|IHC HS [168011]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|AETNA [1015]|AETNA ACO WILCO [101532]|123.00||||123.00|0.01|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123.00||||123.00|76.26|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|UMR [2035]|UMR OPTIONS [203501]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.00||||123.00|31.98|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.00||||123.00|61.5|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.00||||123.00|52.89|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.00||||123.00|73.8|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.00||||123.00|52.89|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123.00||||123.00|76.26|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123.00||||123.00|52.4|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.00||||123.00|110.7|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123.00||||123.00|61.62|123|0.01 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MULTIPLAN [1680]|HMA [168003]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123.00||||123.00||| 30180361|EAP|0301 - LABORATORY-CHEMISTRY|HC DIHYDROCODEINONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.00||||123.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|357.00||||357.00|40.27|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|357.00||||357.00|214.2|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|357.00||||357.00|125.31|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|357.00||||357.00|40.4|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|357.00||||357.00|152.08|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|HEALTHNET [1495]|HEALTHNET [149500]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|357.00||||357.00|35.34|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|AETNA [1015]|AETNA ACO WILCO [101532]|357.00||||357.00|51.54|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|357.00||||357.00|357|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|357.00||||357.00|178.5|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MULTIPLAN [1680]|IHC HS [168011]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|357.00||||357.00|40.27|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|UMR [2035]|UMR OPTIONS [203501]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|357.00||||357.00|34.13|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|||357.00||||357.00|107.1|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|357.00||||357.00|74.97|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|TRUSTMARK [2030]|STARMARK [203000]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|357.00||||357.00|171.18|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|CORESOURCE [1315]|CORESOURCE [131500]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|357.00||||357.00|32.5|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|357.00||||357.00|21.74|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|357.00||||357.00|178.86|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|357.00||||357.00|232.05|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|357.00||||357.00|35.34|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|CHAMPVA [1240]|CHAMP VA [124000]|357.00||||357.00|267.75|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|GEHA [1415]|GEHA [141500]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|357.00||||357.00|36.73|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|357.00||||357.00|321.3|357|21.74 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MULTIPLAN [1680]|HMA [168003]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|357.00||||357.00||| 30180400|EAP|0301 - LABORATORY-CHEMISTRY|HC ACTH STIM PANEL ADRENAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|357.00||||357.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|674.00||||674.00|163.11|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|674.00||||674.00|144.34|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|CORESOURCE [1315]|CORESOURCE [131500]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|674.00||||674.00|156.93|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|674.00||||674.00|438.1|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|||674.00||||674.00|202.2|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|UMR [2035]|UMR OPTIONS [203501]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|674.00||||674.00|287.12|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|674.00||||674.00|179.42|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|TRUSTMARK [2030]|STARMARK [203000]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MULTIPLAN [1680]|IHC HS [168011]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|674.00||||674.00|674|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|HEALTHNET [1495]|HEALTHNET [149500]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|674.00||||674.00|323.18|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|674.00||||674.00|178.81|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|674.00||||674.00|337|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|674.00||||674.00|96.56|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|674.00||||674.00|151.56|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|AETNA [1015]|AETNA ACO WILCO [101532]|674.00||||674.00|228.91|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|674.00||||674.00|337.67|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|674.00||||674.00|404.4|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|CHAMPVA [1240]|CHAMP VA [124000]|674.00||||674.00|505.5|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|674.00||||674.00|236.57|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|674.00||||674.00|178.81|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|674.00||||674.00|141.54|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|674.00||||674.00|156.93|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|GEHA [1415]|GEHA [141500]|674.00||||674.00|606.6|674|96.56 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MULTIPLAN [1680]|HMA [168003]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|674.00||||674.00||| 30181207|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR-ABL1-MINOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|674.00||||674.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|HEALTHNET [1495]|HEALTHNET [149500]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7470.00||||7470.00|4482|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7470.00||||7470.00|3182.22|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7470.00||||7470.00|3735|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7470.00||||7470.00|3742.47|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|TRUSTMARK [2030]|STARMARK [203000]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|AETNA [1015]|AETNA ACO WILCO [101532]|7470.00||||7470.00|791.71|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|CORESOURCE [1315]|CORESOURCE [131500]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7470.00||||7470.00|556.6|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|UMR [2035]|UMR OPTIONS [203501]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|FIRST HEALTH [1375]|QUALCHOICE [137513]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7470.00||||7470.00|2621.97|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7470.00||||7470.00|1568.7|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7470.00||||7470.00|4855.5|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7470.00||||7470.00|333.96|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MULTIPLAN [1680]|IHC HS [168011]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7470.00||||7470.00|7470|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|CHAMPVA [1240]|CHAMP VA [124000]|7470.00||||7470.00|5602.5|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7470.00||||7470.00|3581.87|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|FMH BENEFIT SERVICES [1390]|FMH [139000]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|||7470.00||||7470.00|2241|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7470.00||||7470.00|556.6|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|GEHA [1415]|GEHA [141500]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7470.00||||7470.00|6723|7470|333.96 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MULTIPLAN [1680]|HMA [168003]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7470.00||||7470.00||| 30181220|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE COM VARIANTS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7470.00||||7470.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|CORESOURCE [1315]|CORESOURCE [131500]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|CHAMPVA [1240]|CHAMP VA [124000]|921.00||||921.00|690.75|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|921.00||||921.00|197.31|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|921.00||||921.00|214.51|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|||921.00||||921.00|276.3|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|UMR [2035]|UMR OPTIONS [203501]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|921.00||||921.00|193.41|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|921.00||||921.00|245.25|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|921.00||||921.00|598.65|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|AETNA [1015]|AETNA ACO WILCO [101532]|921.00||||921.00|312.92|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MULTIPLAN [1680]|IHC HS [168011]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|GEHA [1415]|GEHA [141500]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|HEALTHNET [1495]|HEALTHNET [149500]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|TRUSTMARK [2030]|STARMARK [203000]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|921.00||||921.00|921|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|921.00||||921.00|441.62|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|921.00||||921.00|244.43|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|921.00||||921.00|207.18|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|921.00||||921.00|131.99|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|921.00||||921.00|323.27|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|921.00||||921.00|392.35|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|921.00||||921.00|244.43|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|921.00||||921.00|214.51|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|921.00||||921.00|461.42|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|921.00||||921.00|828.9|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|921.00||||921.00|460.5|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|921.00||||921.00|222.96|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|921.00||||921.00|552.6|921|131.99 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MULTIPLAN [1680]|HMA [168003]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|921.00||||921.00||| 30181261|EAP|0301 - LABORATORY-CHEMISTRY|HC B CELL PCR FRAGMENT ANALYSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|921.00||||921.00||| 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|HEALTHNET [1495]|HEALTHNET [149500]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1102.00||||1102.00|70.79|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1102.00||||1102.00|469.45|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1102.00||||1102.00|551|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1102.00||||1102.00|552.1|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1102.00||||1102.00|661.2|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1102.00||||1102.00|68.61|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1102.00||||1102.00|71.87|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1102.00||||1102.00|68.38|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1102.00||||1102.00|93.93|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|AETNA [1015]|AETNA ACO WILCO [101532]|1102.00||||1102.00|92.94|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1102.00||||1102.00|716.3|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MULTIPLAN [1680]|HMA [168003]|1102.00||||1102.00|98.01|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1102.00||||1102.00|231.42|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1102.00||||1102.00|39.2|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1102.00||||1102.00|66.65|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|UMR [2035]|UMR OPTIONS [203501]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1102.00||||1102.00|71.87|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1102.00||||1102.00|95.4|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1102.00||||1102.00|80.94|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MULTIPLAN [1680]|IHC HS [168011]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1102.00||||1102.00|1102|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|CHAMPVA [1240]|CHAMP VA [124000]|1102.00||||1102.00|826.5|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1102.00||||1102.00|65.12|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|||1102.00||||1102.00|330.6|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|CORESOURCE [1315]|CORESOURCE [131500]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1102.00||||1102.00|93.93|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1102.00||||1102.00|386.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|TRUSTMARK [2030]|STARMARK [203000]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1102.00||||1102.00|73.58|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1102.00||||1102.00|70.79|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|GEHA [1415]|GEHA [141500]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1102.00||||1102.00|528.41|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1102.00||||1102.00|65.34|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1102.00||||1102.00|991.8|1102|39.2 30181291|EAP|0301 - LABORATORY-CHEMISTRY|HC MTHFR GENE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1102.00||||1102.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|CORESOURCE [1315]|CORESOURCE [131500]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|881.00||||881.00|336.58|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|881.00||||881.00|380.33|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|CHAMPVA [1240]|CHAMP VA [124000]|881.00||||881.00|660.75|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|GEHA [1415]|GEHA [141500]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|881.00||||881.00|365.92|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|881.00||||881.00|881|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|881.00||||881.00|375.31|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|881.00||||881.00|440.5|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|881.00||||881.00|572.65|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MULTIPLAN [1680]|IHC HS [168011]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|HEALTHNET [1495]|HEALTHNET [149500]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|881.00||||881.00|418.36|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|AETNA [1015]|AETNA ACO WILCO [101532]|881.00||||881.00|480.39|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|FMH BENEFIT SERVICES [1390]|FMH [139000]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|881.00||||881.00|337.73|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|||881.00||||881.00|264.3|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|UMR [2035]|UMR OPTIONS [203501]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|881.00||||881.00|422.44|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|TRUSTMARK [2030]|STARMARK [203000]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|FIRST HEALTH [1375]|QUALCHOICE [137513]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|881.00||||881.00|353.42|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|881.00||||881.00|337.73|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|881.00||||881.00|365.92|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|881.00||||881.00|441.38|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|881.00||||881.00|202.64|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|881.00||||881.00|792.9|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|881.00||||881.00|309.23|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|881.00||||881.00|185.01|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|881.00||||881.00|528.6|881|185.01 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MULTIPLAN [1680]|HMA [168003]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|881.00||||881.00||| 30181296|EAP|0301 - LABORATORY-CHEMISTRY|HC MSH2 MUTATION ONE EXON HNPCC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|881.00||||881.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1755.00||||1755.00|139.28|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1755.00||||1755.00|616.01|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1755.00||||1755.00|879.26|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1755.00||||1755.00|257.92|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1755.00||||1755.00|877.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1755.00||||1755.00|747.63|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1755.00||||1755.00|226.35|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1755.00||||1755.00|1053|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MULTIPLAN [1680]|IHC HS [168011]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|TRUSTMARK [2030]|STARMARK [203000]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|HEALTHNET [1495]|HEALTHNET [149500]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|FMH BENEFIT SERVICES [1390]|FMH [139000]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1755.00||||1755.00|258.79|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|UMR [2035]|UMR OPTIONS [203501]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|FIRST HEALTH [1375]|QUALCHOICE [137513]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1755.00||||1755.00|368.55|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1755.00||||1755.00|1755|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1755.00||||1755.00|257.92|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1755.00||||1755.00|218.62|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|CHAMPVA [1240]|CHAMP VA [124000]|1755.00||||1755.00|1316.25|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1755.00||||1755.00|841.52|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|||1755.00||||1755.00|526.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1755.00||||1755.00|208.2|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1755.00||||1755.00|226.35|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|CORESOURCE [1315]|CORESOURCE [131500]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1755.00||||1755.00|235.26|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1755.00||||1755.00|1140.75|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|GEHA [1415]|GEHA [141500]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1755.00||||1755.00|1579.5|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|AETNA [1015]|AETNA ACO WILCO [101532]|1755.00||||1755.00|330.19|1755|139.28 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MULTIPLAN [1680]|HMA [168003]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1755.00||||1755.00||| 30181340|EAP|0301 - LABORATORY-CHEMISTRY|HC TRB T CELL AG RECEPTOR BETA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1755.00||||1755.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374.00||||374.00|80.53|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|CHAMPVA [1240]|CHAMP VA [124000]|374.00||||374.00|280.5|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|374.00||||374.00|83.7|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|GEHA [1415]|GEHA [141500]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374.00||||374.00|74.08|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|||374.00||||374.00|112.2|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374.00||||374.00|179.33|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|UMR [2035]|UMR OPTIONS [203501]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374.00||||374.00|374|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|374.00||||374.00|92.07|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374.00||||374.00|243.1|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|AETNA [1015]|AETNA ACO WILCO [101532]|374.00||||374.00|114.97|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|HEALTHNET [1495]|HEALTHNET [149500]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MULTIPLAN [1680]|IHC HS [168011]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374.00||||374.00|89.81|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|TRUSTMARK [2030]|STARMARK [203000]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374.00||||374.00|187|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|374.00||||374.00|48.5|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374.00||||374.00|77.78|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|CORESOURCE [1315]|CORESOURCE [131500]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|374.00||||374.00|159.32|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374.00||||374.00|131.27|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|374.00||||374.00|187.37|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374.00||||374.00|89.81|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374.00||||374.00|80.53|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374.00||||374.00|78.54|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374.00||||374.00|224.4|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374.00||||374.00|336.6|374|48.5 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MULTIPLAN [1680]|HMA [168003]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374.00||||374.00||| 30181374|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS I TYPING LOW ONE ANTIGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374.00||||374.00||| 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5085.00||||5085.00|859.56|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5085.00||||5085.00|3305.25|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5085.00||||5085.00|609.87|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5085.00||||5085.00|1067.85|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5085.00||||5085.00|872.95|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MULTIPLAN [1680]|IHC HS [168011]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5085.00||||5085.00|5085|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|CHAMPVA [1240]|CHAMP VA [124000]|5085.00||||5085.00|3813.75|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MULTIPLAN [1680]|HMA [168003]|5085.00||||5085.00|896.87|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|||5085.00||||5085.00|1525.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|UMR [2035]|UMR OPTIONS [203501]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5085.00||||5085.00|859.56|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|HEALTHNET [1495]|HEALTHNET [149500]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|CORESOURCE [1315]|CORESOURCE [131500]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|GEHA [1415]|GEHA [141500]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5085.00||||5085.00|2438.26|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5085.00||||5085.00|2166.21|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5085.00||||5085.00|2542.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5085.00||||5085.00|1784.84|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5085.00||||5085.00|2547.59|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5085.00||||5085.00|657.7|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5085.00||||5085.00|3051|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5085.00||||5085.00|627.81|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5085.00||||5085.00|597.91|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5085.00||||5085.00|657.7|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5085.00||||5085.00|358.75|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|TRUSTMARK [2030]|STARMARK [203000]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|AETNA [1015]|AETNA ACO WILCO [101532]|5085.00||||5085.00|850.47|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5085.00||||5085.00|4576.5|5085|358.75 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5085.00||||5085.00||| 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5085.00||||5085.00||| 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5085.00||||5085.00||| 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5085.00||||5085.00||| 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5085.00||||5085.00||| 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5085.00||||5085.00||| 30181445|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5085.00||||5085.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|GEHA [1415]|GEHA [141500]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11871.00||||11871.00|4361.4|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|CORESOURCE [1315]|CORESOURCE [131500]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|CHAMPVA [1240]|CHAMP VA [124000]|11871.00||||11871.00|8903.25|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11871.00||||11871.00|3859.74|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11871.00||||11871.00|4196.18|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11871.00||||11871.00|7716.15|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11871.00||||11871.00|11871|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|UMR [2035]|UMR OPTIONS [203501]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11871.00||||11871.00|4797.55|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|FMH BENEFIT SERVICES [1390]|FMH [139000]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MULTIPLAN [1680]|IHC HS [168011]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|FIRST HEALTH [1375]|QUALCHOICE [137513]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|HEALTHNET [1495]|HEALTHNET [149500]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11871.00||||11871.00|5692.14|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|AETNA [1015]|AETNA ACO WILCO [101532]|11871.00||||11871.00|5508.96|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|||11871.00||||11871.00|3561.3|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|TRUSTMARK [2030]|STARMARK [203000]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11871.00||||11871.00|3873|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11871.00||||11871.00|2492.91|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11871.00||||11871.00|2323.8|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11871.00||||11871.00|4052.84|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11871.00||||11871.00|7122.6|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11871.00||||11871.00|5947.37|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11871.00||||11871.00|5935.5|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11871.00||||11871.00|3873|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11871.00||||11871.00|4166.72|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11871.00||||11871.00|5057.05|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11871.00||||11871.00|4196.18|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11871.00||||11871.00|10683.9|11871|2323.8 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MULTIPLAN [1680]|HMA [168003]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11871.00||||11871.00||| 30181519|EAP|0301 - LABORATORY-CHEMISTRY|HC ONCOLOGY BREAST MRNA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11871.00||||11871.00||| 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.00||||17.00|4.97|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.00||||17.00|8.5|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.00||||17.00|8.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.00||||17.00|5.58|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.00||||17.00|5.97|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.00||||17.00|4.75|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.00||||17.00|4.9|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.00||||17.00|4.97|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.00||||17.00|4.74|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.00||||17.00|3.01|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|TRUSTMARK [2030]|STARMARK [203000]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|HEALTHNET [1495]|HEALTHNET [149500]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MULTIPLAN [1680]|HMA [168003]|17.00||||17.00|6.78|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.00||||17.00|6.5|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MULTIPLAN [1680]|IHC HS [168011]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.00||||17.00|5.58|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.00||||17.00|5.6|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.00||||17.00|4.61|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|UMR [2035]|UMR OPTIONS [203501]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.00||||17.00|6.6|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.00||||17.00|3.57|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.00||||17.00|17|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.00||||17.00|8.15|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.00||||17.00|11.05|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.00||||17.00|10.2|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|AETNA [1015]|AETNA ACO WILCO [101532]|17.00||||17.00|7.15|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|||17.00||||17.00|5.1|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.00||||17.00|7.24|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.00||||17.00|4.9|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.00||||17.00|4.51|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|CORESOURCE [1315]|CORESOURCE [131500]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|GEHA [1415]|GEHA [141500]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|CHAMPVA [1240]|CHAMP VA [124000]|17.00||||17.00|12.75|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.00||||17.00|6.5|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.00||||17.00|5.09|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.00||||17.00|15.3|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.00||||17.00|4.52|17|3.01 30182009|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETONE/KETONES SERUM QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.00||||17.00||| 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|GEHA [1415]|GEHA [141500]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|209.00||||209.00|9.2|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|CHAMPVA [1240]|CHAMP VA [124000]|209.00||||209.00|156.75|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209.00||||209.00|8.14|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209.00||||209.00|8.85|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|||209.00||||209.00|62.7|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209.00||||209.00|100.22|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209.00||||209.00|209|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209.00||||209.00|11.93|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|209.00||||209.00|10.12|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|UMR [2035]|UMR OPTIONS [203501]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209.00||||209.00|10.09|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MULTIPLAN [1680]|HMA [168003]|209.00||||209.00|12.26|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MULTIPLAN [1680]|IHC HS [168011]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|209.00||||209.00|11.75|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|HEALTHNET [1495]|HEALTHNET [149500]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|AETNA [1015]|AETNA ACO WILCO [101532]|209.00||||209.00|12.91|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209.00||||209.00|8.33|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|TRUSTMARK [2030]|STARMARK [203000]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209.00||||209.00|135.85|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209.00||||209.00|43.89|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|209.00||||209.00|5.45|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209.00||||209.00|8.55|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209.00||||209.00|8.99|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209.00||||209.00|8.85|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209.00||||209.00|73.36|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209.00||||209.00|104.5|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|209.00||||209.00|11.75|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|CORESOURCE [1315]|CORESOURCE [131500]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209.00||||209.00|8.99|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209.00||||209.00|8.17|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209.00||||209.00|188.1|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|209.00||||209.00|89.03|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209.00||||209.00|125.4|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209.00||||209.00|10.09|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209.00||||209.00|8.58|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|209.00||||209.00|104.71|209|5.45 30182010|EAP|0301 - LABORATORY-CHEMISTRY|HC KETONE BODY(S) QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|209.00||||209.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|204.00||||204.00|13.31|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|204.00||||204.00|86.9|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|204.00||||204.00|102|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|204.00||||204.00|71.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|204.00||||204.00|102.2|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|204.00||||204.00|13.79|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|204.00||||204.00|122.4|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|204.00||||204.00|12.86|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|204.00||||204.00|7.45|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|TRUSTMARK [2030]|STARMARK [203000]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|AETNA [1015]|AETNA ACO WILCO [101532]|204.00||||204.00|17.65|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|204.00||||204.00|13.79|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|204.00||||204.00|15.22|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|UMR [2035]|UMR OPTIONS [203501]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MULTIPLAN [1680]|IHC HS [168011]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|204.00||||204.00|42.84|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|204.00||||204.00|204|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|HEALTHNET [1495]|HEALTHNET [149500]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|204.00||||204.00|97.82|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|204.00||||204.00|132.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|||204.00||||204.00|61.2|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|204.00||||204.00|13.31|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|GEHA [1415]|GEHA [141500]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|CORESOURCE [1315]|CORESOURCE [131500]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|204.00||||204.00|13.83|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|CHAMPVA [1240]|CHAMP VA [124000]|204.00||||204.00|153|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|204.00||||204.00|12.24|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|204.00||||204.00|183.6|204|7.45 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MULTIPLAN [1680]|HMA [168003]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|204.00||||204.00||| 30182013|EAP|0301 - LABORATORY-CHEMISTRY|HC ACETYLCHOLINESTERASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|204.00||||204.00||| 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|GEHA [1415]|GEHA [141500]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|640.00||||640.00|43.49|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|640.00||||640.00|55.52|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|CHAMPVA [1240]|CHAMP VA [124000]|640.00||||640.00|480|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|640.00||||640.00|38.49|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|640.00||||640.00|41.84|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|640.00||||640.00|416|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|640.00||||640.00|306.88|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|640.00||||640.00|640|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|UMR [2035]|UMR OPTIONS [203501]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|640.00||||640.00|47.83|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|640.00||||640.00|47.68|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|CORESOURCE [1315]|CORESOURCE [131500]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MULTIPLAN [1680]|IHC HS [168011]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|640.00||||640.00|55.52|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|FIRST HEALTH [1375]|QUALCHOICE [137513]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MULTIPLAN [1680]|HMA [168003]|640.00||||640.00|57.93|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|HEALTHNET [1495]|HEALTHNET [149500]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|640.00||||640.00|39.39|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|AETNA [1015]|AETNA ACO WILCO [101532]|640.00||||640.00|61.04|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|TRUSTMARK [2030]|STARMARK [203000]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|||640.00||||640.00|192|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|640.00||||640.00|56.39|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|640.00||||640.00|134.4|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|640.00||||640.00|25.75|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|640.00||||640.00|40.41|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|640.00||||640.00|42.48|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|640.00||||640.00|384|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|640.00||||640.00|47.68|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|640.00||||640.00|42.48|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|640.00||||640.00|38.62|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|640.00||||640.00|320|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|640.00||||640.00|320.64|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|640.00||||640.00|272.64|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|640.00||||640.00|224.64|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|640.00||||640.00|40.55|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|640.00||||640.00|41.84|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|FMH BENEFIT SERVICES [1390]|FMH [139000]|640.00||||640.00|576|640|25.75 30182024|EAP|0301 - LABORATORY-CHEMISTRY|HC ADRENOCORTICOTROPIC (ACTH)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|640.00||||640.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|452.00||||452.00|271.2|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|452.00||||452.00|226|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|452.00||||452.00|192.55|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|452.00||||452.00|158.65|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|452.00||||452.00|31.85|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|452.00||||452.00|226.45|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|452.00||||452.00|27.95|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|452.00||||452.00|27|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|TRUSTMARK [2030]|STARMARK [203000]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|HEALTHNET [1495]|HEALTHNET [149500]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MULTIPLAN [1680]|IHC HS [168011]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|FMH BENEFIT SERVICES [1390]|FMH [139000]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|452.00||||452.00|31.96|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|UMR [2035]|UMR OPTIONS [203501]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|452.00||||452.00|94.92|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|452.00||||452.00|17.2|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|452.00||||452.00|452|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|452.00||||452.00|216.73|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|452.00||||452.00|293.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|AETNA [1015]|AETNA ACO WILCO [101532]|452.00||||452.00|40.78|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|||452.00||||452.00|135.6|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|452.00||||452.00|27.95|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|CORESOURCE [1315]|CORESOURCE [131500]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|GEHA [1415]|GEHA [141500]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|452.00||||452.00|29.05|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|CHAMPVA [1240]|CHAMP VA [124000]|452.00||||452.00|339|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|452.00||||452.00|25.71|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|452.00||||452.00|31.85|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|FIRST HEALTH [1375]|QUALCHOICE [137513]|452.00||||452.00|406.8|452|17.2 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MULTIPLAN [1680]|HMA [168003]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|452.00||||452.00||| 30182030|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB ADENOSINE CYCLIC (AMP)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|452.00||||452.00||| 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|||203.00||||203.00|60.9|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|GEHA [1415]|GEHA [141500]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|203.00||||203.00|5.57|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|CHAMPVA [1240]|CHAMP VA [124000]|203.00||||203.00|152.25|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203.00||||203.00|4.93|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203.00||||203.00|5.36|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203.00||||203.00|97.34|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203.00||||203.00|203|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203.00||||203.00|42.63|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203.00||||203.00|7.23|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|UMR [2035]|UMR OPTIONS [203501]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203.00||||203.00|6.11|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|203.00||||203.00|7.12|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MULTIPLAN [1680]|IHC HS [168011]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MULTIPLAN [1680]|HMA [168003]|203.00||||203.00|7.43|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|HEALTHNET [1495]|HEALTHNET [149500]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|AETNA [1015]|AETNA ACO WILCO [101532]|203.00||||203.00|7.83|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|TRUSTMARK [2030]|STARMARK [203000]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203.00||||203.00|5.05|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203.00||||203.00|131.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|203.00||||203.00|3.3|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203.00||||203.00|5.17|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203.00||||203.00|5.45|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203.00||||203.00|5.36|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203.00||||203.00|71.25|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|203.00||||203.00|86.48|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|CORESOURCE [1315]|CORESOURCE [131500]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|203.00||||203.00|7.12|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|203.00||||203.00|6.13|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203.00||||203.00|101.5|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|203.00||||203.00|101.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203.00||||203.00|6.11|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203.00||||203.00|4.95|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203.00||||203.00|121.8|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203.00||||203.00|5.2|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203.00||||203.00|182.7|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203.00||||203.00|5.45|203|3.3 30182040|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN SERUM QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|203.00||||203.00||| 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|189.00||||189.00|66.34|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|189.00||||189.00|94.5|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|189.00||||189.00|80.51|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|189.00||||189.00|94.69|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|189.00||||189.00|113.4|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|189.00||||189.00|8.17|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|189.00||||189.00|8.43|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|189.00||||189.00|8.56|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|189.00||||189.00|4.67|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|TRUSTMARK [2030]|STARMARK [203000]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MULTIPLAN [1680]|IHC HS [168011]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|189.00||||189.00|9.64|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|189.00||||189.00|7.94|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|UMR [2035]|UMR OPTIONS [203501]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|189.00||||189.00|11.36|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|189.00||||189.00|39.69|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|AETNA [1015]|AETNA ACO WILCO [101532]|189.00||||189.00|11.07|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|189.00||||189.00|8.14|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|189.00||||189.00|189|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|189.00||||189.00|90.63|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|HEALTHNET [1495]|HEALTHNET [149500]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|189.00||||189.00|122.85|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|||189.00||||189.00|56.7|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|189.00||||189.00|8.43|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|CHAMPVA [1240]|CHAMP VA [124000]|189.00||||189.00|141.75|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|189.00||||189.00|11.18|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|189.00||||189.00|8.56|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|GEHA [1415]|GEHA [141500]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|CORESOURCE [1315]|CORESOURCE [131500]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|189.00||||189.00|8.76|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|189.00||||189.00|7.75|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|189.00||||189.00|7.78|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|189.00||||189.00|11.18|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|189.00||||189.00|170.1|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|MULTIPLAN [1680]|HMA [168003]|189.00||||189.00|11.67|189|4.67 30182042|EAP|0301 - LABORATORY-CHEMISTRY|HC ALBUMIN OTHER SOURCE QN EA SPECIMEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|189.00||||189.00||| 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|GEHA [1415]|GEHA [141500]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|219.00||||219.00|6.51|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|CORESOURCE [1315]|CORESOURCE [131500]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|CHAMPVA [1240]|CHAMP VA [124000]|219.00||||219.00|164.25|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219.00||||219.00|5.76|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219.00||||219.00|6.26|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|||219.00||||219.00|65.7|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219.00||||219.00|142.35|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219.00||||219.00|219|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|UMR [2035]|UMR OPTIONS [203501]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|219.00||||219.00|7.16|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MULTIPLAN [1680]|IHC HS [168011]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MULTIPLAN [1680]|HMA [168003]|219.00||||219.00|8.67|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|219.00||||219.00|8.31|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|HEALTHNET [1495]|HEALTHNET [149500]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219.00||||219.00|5.9|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|AETNA [1015]|AETNA ACO WILCO [101532]|219.00||||219.00|9.13|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219.00||||219.00|105.01|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|TRUSTMARK [2030]|STARMARK [203000]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219.00||||219.00|7.14|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|219.00||||219.00|3.85|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219.00||||219.00|6.05|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219.00||||219.00|6.36|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219.00||||219.00|131.4|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219.00||||219.00|7.14|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219.00||||219.00|6.36|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|219.00||||219.00|8.31|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219.00||||219.00|45.99|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219.00||||219.00|5.78|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219.00||||219.00|109.5|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|219.00||||219.00|109.72|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219.00||||219.00|76.87|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|219.00||||219.00|93.29|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219.00||||219.00|6.26|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219.00||||219.00|197.1|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219.00||||219.00|8.44|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219.00||||219.00|6.07|219|3.85 30182043|EAP|0301 - LABORATORY-CHEMISTRY|HC MICROALBUMIN URINE QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|219.00||||219.00||| 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281.00||||281.00|10.68|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281.00||||281.00|140.5|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281.00||||281.00|11.99|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|281.00||||281.00|119.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281.00||||281.00|98.63|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281.00||||281.00|10.2|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281.00||||281.00|10.52|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281.00||||281.00|10.68|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281.00||||281.00|10.16|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|281.00||||281.00|6.47|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|TRUSTMARK [2030]|STARMARK [203000]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|HEALTHNET [1495]|HEALTHNET [149500]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MULTIPLAN [1680]|HMA [168003]|281.00||||281.00|14.57|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|281.00||||281.00|13.96|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MULTIPLAN [1680]|IHC HS [168011]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281.00||||281.00|11.99|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|281.00||||281.00|12.03|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281.00||||281.00|9.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|UMR [2035]|UMR OPTIONS [203501]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281.00||||281.00|14.18|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281.00||||281.00|59.01|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281.00||||281.00|281|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281.00||||281.00|134.74|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281.00||||281.00|182.65|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|AETNA [1015]|AETNA ACO WILCO [101532]|281.00||||281.00|15.34|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|||281.00||||281.00|84.3|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281.00||||281.00|168.6|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|281.00||||281.00|140.78|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281.00||||281.00|10.52|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|CORESOURCE [1315]|CORESOURCE [131500]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|GEHA [1415]|GEHA [141500]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|CHAMPVA [1240]|CHAMP VA [124000]|281.00||||281.00|210.75|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|281.00||||281.00|13.96|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281.00||||281.00|9.68|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|281.00||||281.00|10.93|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281.00||||281.00|9.71|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281.00||||281.00|252.9|281|6.47 30182085|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOLASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|281.00||||281.00||| 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|604.00||||604.00|45.9|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|CHAMPVA [1240]|CHAMP VA [124000]|604.00||||604.00|453|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|CORESOURCE [1315]|CORESOURCE [131500]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|604.00||||604.00|40.62|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|604.00||||604.00|44.16|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|||604.00||||604.00|181.2|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|604.00||||604.00|289.62|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|604.00||||604.00|604|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|604.00||||604.00|126.84|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|604.00||||604.00|59.5|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|UMR [2035]|UMR OPTIONS [203501]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|604.00||||604.00|50.31|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MULTIPLAN [1680]|IHC HS [168011]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MULTIPLAN [1680]|HMA [168003]|604.00||||604.00|61.13|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|604.00||||604.00|58.58|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|604.00||||604.00|50.49|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|HEALTHNET [1495]|HEALTHNET [149500]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|AETNA [1015]|AETNA ACO WILCO [101532]|604.00||||604.00|64.41|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|604.00||||604.00|41.57|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|TRUSTMARK [2030]|STARMARK [203000]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|604.00||||604.00|392.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|604.00||||604.00|27.17|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|604.00||||604.00|42.65|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|604.00||||604.00|44.83|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|604.00||||604.00|44.16|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|GEHA [1415]|GEHA [141500]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|604.00||||604.00|58.58|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|604.00||||604.00|302.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|604.00||||604.00|543.6|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|604.00||||604.00|44.83|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|604.00||||604.00|40.75|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|604.00||||604.00|302|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|604.00||||604.00|212|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|604.00||||604.00|50.31|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|604.00||||604.00|362.4|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|604.00||||604.00|257.3|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|604.00||||604.00|42.79|604|27.17 30182088|EAP|0301 - LABORATORY-CHEMISTRY|HC ALDOSTERONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|604.00||||604.00||| 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|251.00||||251.00|125.5|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|251.00||||251.00|106.93|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|251.00||||251.00|88.1|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|251.00||||251.00|125.75|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|251.00||||251.00|16.59|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|251.00||||251.00|150.6|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|251.00||||251.00|14.11|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|251.00||||251.00|14.78|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|251.00||||251.00|8.96|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|TRUSTMARK [2030]|STARMARK [203000]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|251.00||||251.00|21.24|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MULTIPLAN [1680]|IHC HS [168011]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MULTIPLAN [1680]|HMA [168003]|251.00||||251.00|20.16|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|251.00||||251.00|16.59|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|251.00||||251.00|16.65|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|251.00||||251.00|13.71|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|UMR [2035]|UMR OPTIONS [203501]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|251.00||||251.00|19.62|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|251.00||||251.00|19.32|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|251.00||||251.00|52.71|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|251.00||||251.00|251|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|251.00||||251.00|14.06|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|251.00||||251.00|120.35|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|251.00||||251.00|163.15|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|251.00||||251.00|14.56|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|||251.00||||251.00|75.3|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|251.00||||251.00|14.56|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|251.00||||251.00|14.78|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|251.00||||251.00|13.44|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|251.00||||251.00|19.32|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|251.00||||251.00|15.13|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|251.00||||251.00|188.25|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|251.00||||251.00|13.39|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|GEHA [1415]|GEHA [141500]|251.00||||251.00|225.9|251|8.96 30182103|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|251.00||||251.00||| 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|GEHA [1415]|GEHA [141500]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|528.00||||528.00|16.28|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|528.00||||528.00|20.79|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|CHAMPVA [1240]|CHAMP VA [124000]|528.00||||528.00|396|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|528.00||||528.00|14.41|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|528.00||||528.00|15.66|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|528.00||||528.00|343.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|528.00||||528.00|528|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|UMR [2035]|UMR OPTIONS [203501]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|528.00||||528.00|14.75|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|528.00||||528.00|17.86|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MULTIPLAN [1680]|HMA [168003]|528.00||||528.00|21.69|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|528.00||||528.00|20.79|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MULTIPLAN [1680]|IHC HS [168011]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|HEALTHNET [1495]|HEALTHNET [149500]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|528.00||||528.00|17.91|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|AETNA [1015]|AETNA ACO WILCO [101532]|528.00||||528.00|22.86|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|528.00||||528.00|253.18|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|TRUSTMARK [2030]|STARMARK [203000]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|528.00||||528.00|21.11|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|||528.00||||528.00|158.4|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|528.00||||528.00|110.88|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|528.00||||528.00|9.64|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|528.00||||528.00|15.13|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|528.00||||528.00|15.91|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|528.00||||528.00|316.8|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|528.00||||528.00|224.93|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|528.00||||528.00|17.86|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|528.00||||528.00|185.33|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|CORESOURCE [1315]|CORESOURCE [131500]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|528.00||||528.00|15.91|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|528.00||||528.00|14.46|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|528.00||||528.00|264.53|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|528.00||||528.00|15.18|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|528.00||||528.00|15.66|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|528.00||||528.00|475.2|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|528.00||||528.00|264|528|9.64 30182104|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA-1-ANTITRYPSIN PHENOTYPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|528.00||||528.00||| 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|753.00||||753.00|451.8|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|753.00||||753.00|376.5|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|753.00||||753.00|264.3|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|753.00||||753.00|18.45|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|753.00||||753.00|377.25|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|753.00||||753.00|20.71|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|753.00||||753.00|17.61|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|753.00||||753.00|18.16|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|753.00||||753.00|18.45|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|753.00||||753.00|17.55|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|753.00||||753.00|11.18|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|TRUSTMARK [2030]|STARMARK [203000]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|HEALTHNET [1495]|HEALTHNET [149500]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MULTIPLAN [1680]|IHC HS [168011]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|753.00||||753.00|20.71|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|753.00||||753.00|20.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|753.00||||753.00|17.11|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|UMR [2035]|UMR OPTIONS [203501]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|753.00||||753.00|24.48|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|753.00||||753.00|158.13|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|753.00||||753.00|24.11|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MULTIPLAN [1680]|HMA [168003]|753.00||||753.00|25.16|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|753.00||||753.00|753|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|753.00||||753.00|361.06|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|753.00||||753.00|489.45|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|||753.00||||753.00|225.9|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|753.00||||753.00|320.78|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|753.00||||753.00|18.16|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|753.00||||753.00|24.11|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|753.00||||753.00|18.88|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|CORESOURCE [1315]|CORESOURCE [131500]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|GEHA [1415]|GEHA [141500]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|753.00||||753.00|26.51|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|CHAMPVA [1240]|CHAMP VA [124000]|753.00||||753.00|564.75|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|753.00||||753.00|16.71|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|753.00||||753.00|16.77|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|753.00||||753.00|677.7|753|11.18 30182105|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|753.00||||753.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|CHAMPVA [1240]|CHAMP VA [124000]|218.00||||218.00|163.5|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218.00||||218.00|16.94|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218.00||||218.00|18.42|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|||218.00||||218.00|65.4|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218.00||||218.00|141.7|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218.00||||218.00|104.53|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218.00||||218.00|218|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218.00||||218.00|45.78|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|UMR [2035]|UMR OPTIONS [203501]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|218.00||||218.00|21.06|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218.00||||218.00|20.71|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MULTIPLAN [1680]|IHC HS [168011]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|HEALTHNET [1495]|HEALTHNET [149500]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|AETNA [1015]|AETNA ACO WILCO [101532]|218.00||||218.00|26.51|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|TRUSTMARK [2030]|STARMARK [203000]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|218.00||||218.00|11.18|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218.00||||218.00|17.79|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218.00||||218.00|18.42|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|218.00||||218.00|92.87|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218.00||||218.00|109|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218.00||||218.00|20.71|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218.00||||218.00|76.52|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|218.00||||218.00|109.22|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218.00||||218.00|130.8|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|GEHA [1415]|GEHA [141500]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|CORESOURCE [1315]|CORESOURCE [131500]|218.00||||218.00|196.2|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|218.00||||218.00|19.15|218|11.18 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MULTIPLAN [1680]|HMA [168003]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218.00||||218.00||| 30182106|EAP|0301 - LABORATORY-CHEMISTRY|HC ALPHA FETOPROTEIN AMNIOTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218.00||||218.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1051.00||||1051.00|525.5|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1051.00||||1051.00|79.52|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1051.00||||1051.00|447.73|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1051.00||||1051.00|526.55|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1051.00||||1051.00|630.6|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1051.00||||1051.00|42.94|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|TRUSTMARK [2030]|STARMARK [203000]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|AETNA [1015]|AETNA ACO WILCO [101532]|1051.00||||1051.00|101.8|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|HEALTHNET [1495]|HEALTHNET [149500]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MULTIPLAN [1680]|IHC HS [168011]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|FIRST HEALTH [1375]|QUALCHOICE [137513]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1051.00||||1051.00|79.52|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1051.00||||1051.00|79.79|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|UMR [2035]|UMR OPTIONS [203501]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1051.00||||1051.00|67.4|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1051.00||||1051.00|220.71|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1051.00||||1051.00|69.79|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1051.00||||1051.00|1051|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1051.00||||1051.00|503.95|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1051.00||||1051.00|368.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1051.00||||1051.00|683.15|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|||1051.00||||1051.00|315.3|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1051.00||||1051.00|69.79|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1051.00||||1051.00|64.19|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|CHAMPVA [1240]|CHAMP VA [124000]|1051.00||||1051.00|788.25|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1051.00||||1051.00|72.54|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|CORESOURCE [1315]|CORESOURCE [131500]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|GEHA [1415]|GEHA [141500]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1051.00||||1051.00|945.9|1051|42.94 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|MULTIPLAN [1680]|HMA [168003]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1051.00||||1051.00||| 30182107|EAP|0301 - LABORATORY-CHEMISTRY|HC REF LAB AFP-L3 FXN ISOF W TOT AFP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1051.00||||1051.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|GEHA [1415]|GEHA [141500]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|260.00||||260.00|28.69|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|CHAMPVA [1240]|CHAMP VA [124000]|260.00||||260.00|195|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260.00||||260.00|25.39|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260.00||||260.00|27.6|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260.00||||260.00|169|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260.00||||260.00|260|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260.00||||260.00|54.6|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|260.00||||260.00|31.56|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260.00||||260.00|31.46|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|UMR [2035]|UMR OPTIONS [203501]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MULTIPLAN [1680]|IHC HS [168011]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260.00||||260.00|124.67|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|HEALTHNET [1495]|HEALTHNET [149500]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|AETNA [1015]|AETNA ACO WILCO [101532]|260.00||||260.00|40.26|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|||260.00||||260.00|78|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|TRUSTMARK [2030]|STARMARK [203000]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|260.00||||260.00|16.99|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260.00||||260.00|26.66|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|CORESOURCE [1315]|CORESOURCE [131500]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260.00||||260.00|27.6|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260.00||||260.00|156|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260.00||||260.00|91.26|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|260.00||||260.00|110.76|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260.00||||260.00|31.46|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|260.00||||260.00|130.26|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260.00||||260.00|130|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260.00||||260.00|234|260|16.99 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MULTIPLAN [1680]|HMA [168003]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260.00||||260.00||| 30182108|EAP|0301 - LABORATORY-CHEMISTRY|HC ALUMINUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260.00||||260.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|193.00||||193.00|96.5|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|193.00||||193.00|67.74|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|193.00||||193.00|82.22|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|193.00||||193.00|17.13|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|193.00||||193.00|115.8|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|193.00||||193.00|15.03|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|193.00||||193.00|14.52|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|TRUSTMARK [2030]|STARMARK [203000]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|AETNA [1015]|AETNA ACO WILCO [101532]|193.00||||193.00|21.92|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|HEALTHNET [1495]|HEALTHNET [149500]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MULTIPLAN [1680]|IHC HS [168011]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|193.00||||193.00|17.13|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|193.00||||193.00|17.18|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|UMR [2035]|UMR OPTIONS [203501]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|193.00||||193.00|40.53|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|193.00||||193.00|9.25|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|193.00||||193.00|193|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|193.00||||193.00|92.54|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|193.00||||193.00|125.45|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|||193.00||||193.00|57.9|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|193.00||||193.00|96.69|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|193.00||||193.00|15.03|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|193.00||||193.00|13.82|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|CHAMPVA [1240]|CHAMP VA [124000]|193.00||||193.00|144.75|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|193.00||||193.00|15.62|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|CORESOURCE [1315]|CORESOURCE [131500]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|GEHA [1415]|GEHA [141500]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|193.00||||193.00|173.7|193|9.25 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|MULTIPLAN [1680]|HMA [168003]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|193.00||||193.00||| 30182128|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QL SERUM MULTIPLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|193.00||||193.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|GEHA [1415]|GEHA [141500]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|CORESOURCE [1315]|CORESOURCE [131500]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|275.00||||275.00|25.88|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|CHAMPVA [1240]|CHAMP VA [124000]|275.00||||275.00|206.25|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|275.00||||275.00|22.9|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|275.00||||275.00|24.9|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|||275.00||||275.00|82.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|275.00||||275.00|131.86|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|275.00||||275.00|275|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|275.00||||275.00|57.75|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|UMR [2035]|UMR OPTIONS [203501]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|275.00||||275.00|28.47|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|275.00||||275.00|22.98|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MULTIPLAN [1680]|IHC HS [168011]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|275.00||||275.00|178.75|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|HEALTHNET [1495]|HEALTHNET [149500]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|AETNA [1015]|AETNA ACO WILCO [101532]|275.00||||275.00|32.68|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|TRUSTMARK [2030]|STARMARK [203000]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|275.00||||275.00|13.79|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|275.00||||275.00|24.04|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|275.00||||275.00|24.9|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|275.00||||275.00|165|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|275.00||||275.00|137.78|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|275.00||||275.00|96.53|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|275.00||||275.00|117.15|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|275.00||||275.00|22.98|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|275.00||||275.00|137.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|275.00||||275.00|247.5|275|13.79 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MULTIPLAN [1680]|HMA [168003]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|275.00||||275.00||| 30182131|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS QN SINGLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|275.00||||275.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|340.00||||340.00|170|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|340.00||||340.00|170.34|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|340.00||||340.00|20.31|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|340.00||||340.00|119.34|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|340.00||||340.00|204|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|340.00||||340.00|17.21|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|340.00||||340.00|10.97|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|TRUSTMARK [2030]|STARMARK [203000]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|AETNA [1015]|AETNA ACO WILCO [101532]|340.00||||340.00|26.01|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|HEALTHNET [1495]|HEALTHNET [149500]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MULTIPLAN [1680]|IHC HS [168011]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|340.00||||340.00|20.31|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|340.00||||340.00|20.37|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|UMR [2035]|UMR OPTIONS [203501]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|340.00||||340.00|71.4|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|340.00||||340.00|340|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|340.00||||340.00|163.03|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|340.00||||340.00|221|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|340.00||||340.00|17.82|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|340.00||||340.00|144.84|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|||340.00||||340.00|102|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|340.00||||340.00|17.82|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|340.00||||340.00|16.39|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|CHAMPVA [1240]|CHAMP VA [124000]|340.00||||340.00|255|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|340.00||||340.00|18.52|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|CORESOURCE [1315]|CORESOURCE [131500]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|GEHA [1415]|GEHA [141500]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|340.00||||340.00|306|340|10.97 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MULTIPLAN [1680]|HMA [168003]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|340.00||||340.00||| 30182135|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINOLEVULINIC ACID (ALA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|340.00||||340.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|GEHA [1415]|GEHA [141500]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|CORESOURCE [1315]|CORESOURCE [131500]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|343.00||||343.00|19|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|343.00||||343.00|212.66|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|CHAMPVA [1240]|CHAMP VA [124000]|343.00||||343.00|257.25|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|343.00||||343.00|16.82|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|343.00||||343.00|16.87|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|343.00||||343.00|18.28|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|343.00||||343.00|222.95|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|343.00||||343.00|164.47|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|343.00||||343.00|343|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|343.00||||343.00|213|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|343.00||||343.00|17.21|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|343.00||||343.00|20.9|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|343.00||||343.00|20.83|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|343.00||||343.00|16.87|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|UMR [2035]|UMR OPTIONS [203501]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|343.00||||343.00|72.03|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|343.00||||343.00|24.25|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MULTIPLAN [1680]|HMA [168003]|343.00||||343.00|25.31|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MULTIPLAN [1680]|IHC HS [168011]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|HEALTHNET [1495]|HEALTHNET [149500]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|343.00||||343.00|16.87|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|AETNA [1015]|AETNA ACO WILCO [101532]|343.00||||343.00|26.66|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|||343.00||||343.00|102.9|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|TRUSTMARK [2030]|STARMARK [203000]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|343.00||||343.00|11.24|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|343.00||||343.00|17.66|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|343.00||||343.00|16.87|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|343.00||||343.00|18.28|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|343.00||||343.00|17.71|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|343.00||||343.00|205.8|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|343.00||||343.00|120.39|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|343.00||||343.00|20.83|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|343.00||||343.00|171.84|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|343.00||||343.00|146.12|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|343.00||||343.00|171.5|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|343.00||||343.00|16.87|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|343.00||||343.00|16.87|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|343.00||||343.00|308.7|343|11.24 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|343.00||||343.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|343.00||||343.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|343.00||||343.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|343.00||||343.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|343.00||||343.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|343.00||||343.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|343.00||||343.00||| 30182139|EAP|0301 - LABORATORY-CHEMISTRY|HC AMINO ACIDS 6+ QN EACH SPECIMEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|343.00||||343.00||| 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|391.00||||391.00|195.5|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|391.00||||391.00|137.24|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|391.00||||391.00|17.99|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|391.00||||391.00|166.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|391.00||||391.00|195.89|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391.00||||391.00|15.3|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|391.00||||391.00|15.79|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|391.00||||391.00|16.03|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|391.00||||391.00|15.25|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|TRUSTMARK [2030]|STARMARK [203000]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|AETNA [1015]|AETNA ACO WILCO [101532]|391.00||||391.00|23.03|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|HEALTHNET [1495]|HEALTHNET [149500]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MULTIPLAN [1680]|HMA [168003]|391.00||||391.00|21.86|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|391.00||||391.00|20.95|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MULTIPLAN [1680]|IHC HS [168011]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|391.00||||391.00|17.99|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|391.00||||391.00|18.05|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|391.00||||391.00|14.86|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|UMR [2035]|UMR OPTIONS [203501]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|391.00||||391.00|9.71|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|391.00||||391.00|21.27|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|391.00||||391.00|82.11|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|391.00||||391.00|391|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.00||||391.00|187.48|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|391.00||||391.00|234.6|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|391.00||||391.00|254.15|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|||391.00||||391.00|117.3|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|391.00||||391.00|15.79|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|391.00||||391.00|16.03|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|391.00||||391.00|14.57|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|391.00||||391.00|14.52|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|CHAMPVA [1240]|CHAMP VA [124000]|391.00||||391.00|293.25|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|391.00||||391.00|20.95|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|391.00||||391.00|16.41|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|CORESOURCE [1315]|CORESOURCE [131500]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|GEHA [1415]|GEHA [141500]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|391.00||||391.00|351.9|391|9.71 30182140|EAP|0301 - LABORATORY-CHEMISTRY|HC AMMONIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|391.00||||391.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|GEHA [1415]|GEHA [141500]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|CORESOURCE [1315]|CORESOURCE [131500]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|145.00||||145.00|10.53|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|CHAMPVA [1240]|CHAMP VA [124000]|145.00||||145.00|108.75|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145.00||||145.00|9.32|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145.00||||145.00|10.13|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|||145.00||||145.00|43.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145.00||||145.00|69.53|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145.00||||145.00|145|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145.00||||145.00|30.45|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|UMR [2035]|UMR OPTIONS [203501]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|145.00||||145.00|11.58|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145.00||||145.00|9.35|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MULTIPLAN [1680]|IHC HS [168011]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|HEALTHNET [1495]|HEALTHNET [149500]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145.00||||145.00|94.25|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|AETNA [1015]|AETNA ACO WILCO [101532]|145.00||||145.00|13.29|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|TRUSTMARK [2030]|STARMARK [203000]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|145.00||||145.00|5.61|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145.00||||145.00|9.79|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145.00||||145.00|10.13|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145.00||||145.00|87|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145.00||||145.00|9.35|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|145.00||||145.00|61.77|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|145.00||||145.00|72.65|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145.00||||145.00|50.9|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145.00||||145.00|72.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145.00||||145.00|130.5|145|5.61 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MULTIPLAN [1680]|HMA [168003]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145.00||||145.00||| 30182143|EAP|0301 - LABORATORY-CHEMISTRY|HC AMNIOTIC FLUID SCAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145.00||||145.00||| 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|339.00||||339.00|7.13|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|339.00||||339.00|169.5|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|339.00||||339.00|8|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|339.00||||339.00|118.99|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|339.00||||339.00|169.84|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|339.00||||339.00|203.4|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|339.00||||339.00|6.8|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|339.00||||339.00|7.02|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|339.00||||339.00|7.13|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|339.00||||339.00|4.32|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|TRUSTMARK [2030]|STARMARK [203000]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|AETNA [1015]|AETNA ACO WILCO [101532]|339.00||||339.00|10.24|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|HEALTHNET [1495]|HEALTHNET [149500]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|339.00||||339.00|9.32|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MULTIPLAN [1680]|HMA [168003]|339.00||||339.00|9.72|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MULTIPLAN [1680]|IHC HS [168011]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|339.00||||339.00|8|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|339.00||||339.00|8.02|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|339.00||||339.00|6.61|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|UMR [2035]|UMR OPTIONS [203501]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|339.00||||339.00|6.78|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|339.00||||339.00|9.46|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|339.00||||339.00|71.19|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|339.00||||339.00|339|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|339.00||||339.00|162.55|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|339.00||||339.00|220.35|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|339.00||||339.00|144.41|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|||339.00||||339.00|101.7|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|339.00||||339.00|7.02|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|339.00||||339.00|6.48|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|339.00||||339.00|6.45|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|CHAMPVA [1240]|CHAMP VA [124000]|339.00||||339.00|254.25|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|339.00||||339.00|9.32|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|339.00||||339.00|7.3|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|CORESOURCE [1315]|CORESOURCE [131500]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|GEHA [1415]|GEHA [141500]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|339.00||||339.00|305.1|339|4.32 30182150|EAP|0301 - LABORATORY-CHEMISTRY|HC AMYLASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|339.00||||339.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|GEHA [1415]|GEHA [141500]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|507.00||||507.00|32.47|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|CHAMPVA [1240]|CHAMP VA [124000]|507.00||||507.00|380.25|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|507.00||||507.00|28.73|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|507.00||||507.00|31.24|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|||507.00||||507.00|152.1|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|507.00||||507.00|329.55|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|507.00||||507.00|507|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|507.00||||507.00|35.71|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|507.00||||507.00|35.6|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|UMR [2035]|UMR OPTIONS [203501]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|507.00||||507.00|106.47|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MULTIPLAN [1680]|IHC HS [168011]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|507.00||||507.00|243.11|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|HEALTHNET [1495]|HEALTHNET [149500]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|AETNA [1015]|AETNA ACO WILCO [101532]|507.00||||507.00|45.57|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|TRUSTMARK [2030]|STARMARK [203000]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|507.00||||507.00|19.22|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|507.00||||507.00|30.17|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|CORESOURCE [1315]|CORESOURCE [131500]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|507.00||||507.00|31.24|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|507.00||||507.00|304.2|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|507.00||||507.00|177.96|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|507.00||||507.00|35.6|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|507.00||||507.00|215.98|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|507.00||||507.00|254.01|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|507.00||||507.00|253.5|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|507.00||||507.00|456.3|507|19.22 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MULTIPLAN [1680]|HMA [168003]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|507.00||||507.00||| 30182154|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTANEDIOL GLUCURONIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|507.00||||507.00||| 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|487.00||||487.00|32.21|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|487.00||||487.00|243.5|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|487.00||||487.00|170.94|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|487.00||||487.00|36.14|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|487.00||||487.00|243.99|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|487.00||||487.00|30.74|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|487.00||||487.00|31.72|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|487.00||||487.00|32.21|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|487.00||||487.00|30.64|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|487.00||||487.00|19.52|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|TRUSTMARK [2030]|STARMARK [203000]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|HEALTHNET [1495]|HEALTHNET [149500]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|487.00||||487.00|42.09|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MULTIPLAN [1680]|IHC HS [168011]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MULTIPLAN [1680]|HMA [168003]|487.00||||487.00|43.92|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|487.00||||487.00|36.14|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|487.00||||487.00|36.26|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|AETNA [1015]|AETNA ACO WILCO [101532]|487.00||||487.00|46.27|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|487.00||||487.00|29.87|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|UMR [2035]|UMR OPTIONS [203501]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|487.00||||487.00|42.75|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|487.00||||487.00|102.27|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|487.00||||487.00|487|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|487.00||||487.00|233.52|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|487.00||||487.00|292.2|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|487.00||||487.00|316.55|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|||487.00||||487.00|146.1|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|487.00||||487.00|207.46|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|487.00||||487.00|31.72|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|487.00||||487.00|29.28|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|487.00||||487.00|29.18|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|CHAMPVA [1240]|CHAMP VA [124000]|487.00||||487.00|365.25|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|487.00||||487.00|42.09|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|487.00||||487.00|32.97|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|CORESOURCE [1315]|CORESOURCE [131500]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|GEHA [1415]|GEHA [141500]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|487.00||||487.00|438.3|487|19.52 30182157|EAP|0301 - LABORATORY-CHEMISTRY|HC ANDROSTENEDIONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|487.00||||487.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|GEHA [1415]|GEHA [141500]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|CORESOURCE [1315]|CORESOURCE [131500]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|260.00||||260.00|16.43|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|260.00||||260.00|161.2|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|CHAMPVA [1240]|CHAMP VA [124000]|260.00||||260.00|195|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260.00||||260.00|14.54|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260.00||||260.00|14.6|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260.00||||260.00|15.81|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|||260.00||||260.00|78|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260.00||||260.00|124.67|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260.00||||260.00|260|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260.00||||260.00|54.6|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260.00||||260.00|161.46|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|UMR [2035]|UMR OPTIONS [203501]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|260.00||||260.00|18.07|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260.00||||260.00|18.03|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|FIRST HEALTH [1375]|QUALCHOICE [137513]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260.00||||260.00|14.6|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|FMH BENEFIT SERVICES [1390]|FMH [139000]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|260.00||||260.00|20.99|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MULTIPLAN [1680]|IHC HS [168011]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260.00||||260.00|14.89|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MULTIPLAN [1680]|HMA [168003]|260.00||||260.00|21.9|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|HEALTHNET [1495]|HEALTHNET [149500]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260.00||||260.00|169|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260.00||||260.00|14.6|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|AETNA [1015]|AETNA ACO WILCO [101532]|260.00||||260.00|23.07|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|TRUSTMARK [2030]|STARMARK [203000]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|260.00||||260.00|9.73|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260.00||||260.00|15.27|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260.00||||260.00|14.6|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260.00||||260.00|15.81|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260.00||||260.00|15.33|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260.00||||260.00|156|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260.00||||260.00|91.26|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|260.00||||260.00|130.26|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260.00||||260.00|18.03|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|260.00||||260.00|110.76|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260.00||||260.00|130|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260.00||||260.00|14.6|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260.00||||260.00|14.6|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260.00||||260.00|234|260|9.73 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|260.00||||260.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260.00||||260.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260.00||||260.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260.00||||260.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|260.00||||260.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|260.00||||260.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260.00||||260.00||| 30182164|EAP|0301 - LABORATORY-CHEMISTRY|HC ANGIOTENSIN I ENZYME (ACE)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260.00||||260.00||| 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179.00||||179.00|23.2|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179.00||||179.00|89.5|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179.00||||179.00|62.83|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|179.00||||179.00|76.25|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|179.00||||179.00|89.68|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179.00||||179.00|107.4|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179.00||||179.00|22.14|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179.00||||179.00|23.2|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|179.00||||179.00|12.65|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|TRUSTMARK [2030]|STARMARK [203000]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|AETNA [1015]|AETNA ACO WILCO [101532]|179.00||||179.00|29.99|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|HEALTHNET [1495]|HEALTHNET [149500]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MULTIPLAN [1680]|IHC HS [168011]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|179.00||||179.00|30.32|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MULTIPLAN [1680]|HMA [168003]|179.00||||179.00|31.64|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|179.00||||179.00|26.11|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179.00||||179.00|21.51|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|UMR [2035]|UMR OPTIONS [203501]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179.00||||179.00|22.07|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179.00||||179.00|30.79|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179.00||||179.00|37.59|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179.00||||179.00|22.84|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179.00||||179.00|179|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179.00||||179.00|85.83|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179.00||||179.00|116.35|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|||179.00||||179.00|53.7|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179.00||||179.00|22.84|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179.00||||179.00|21.09|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179.00||||179.00|21.02|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|CHAMPVA [1240]|CHAMP VA [124000]|179.00||||179.00|134.25|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|179.00||||179.00|30.32|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|179.00||||179.00|23.74|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|CORESOURCE [1315]|CORESOURCE [131500]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|GEHA [1415]|GEHA [141500]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179.00||||179.00|161.1|179|12.65 30182172|EAP|0301 - LABORATORY-CHEMISTRY|HC APOLIPOPROTEIN EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|179.00||||179.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|GEHA [1415]|GEHA [141500]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|213.00||||213.00|21.36|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|213.00||||213.00|132.06|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|CHAMPVA [1240]|CHAMP VA [124000]|213.00||||213.00|159.75|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213.00||||213.00|18.91|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213.00||||213.00|18.97|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213.00||||213.00|20.55|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213.00||||213.00|138.45|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213.00||||213.00|213|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213.00||||213.00|132.27|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|UMR [2035]|UMR OPTIONS [203501]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213.00||||213.00|19.35|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|213.00||||213.00|23.5|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213.00||||213.00|23.42|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213.00||||213.00|18.97|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213.00||||213.00|44.73|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MULTIPLAN [1680]|IHC HS [168011]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|213.00||||213.00|27.27|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MULTIPLAN [1680]|HMA [168003]|213.00||||213.00|28.46|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|HEALTHNET [1495]|HEALTHNET [149500]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213.00||||213.00|18.97|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|AETNA [1015]|AETNA ACO WILCO [101532]|213.00||||213.00|29.98|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213.00||||213.00|102.13|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|||213.00||||213.00|63.9|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|TRUSTMARK [2030]|STARMARK [203000]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|213.00||||213.00|12.65|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213.00||||213.00|19.85|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213.00||||213.00|18.97|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|CORESOURCE [1315]|CORESOURCE [131500]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213.00||||213.00|20.55|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213.00||||213.00|19.92|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213.00||||213.00|127.8|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213.00||||213.00|74.76|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|213.00||||213.00|106.71|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|213.00||||213.00|90.74|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213.00||||213.00|23.42|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213.00||||213.00|106.5|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213.00||||213.00|18.97|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213.00||||213.00|18.97|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213.00||||213.00|191.7|213|12.65 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|213.00||||213.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|213.00||||213.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213.00||||213.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213.00||||213.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213.00||||213.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|213.00||||213.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213.00||||213.00||| 30182175|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN ARSENIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213.00||||213.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|361.00||||361.00|180.5|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|361.00||||361.00|12.2|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|361.00||||361.00|126.71|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|361.00||||361.00|153.79|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|361.00||||361.00|10.72|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|361.00||||361.00|10.36|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|361.00||||361.00|6.59|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|TRUSTMARK [2030]|STARMARK [203000]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|AETNA [1015]|AETNA ACO WILCO [101532]|361.00||||361.00|15.61|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|HEALTHNET [1495]|HEALTHNET [149500]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MULTIPLAN [1680]|IHC HS [168011]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|FMH BENEFIT SERVICES [1390]|FMH [139000]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|FIRST HEALTH [1375]|QUALCHOICE [137513]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|361.00||||361.00|12.2|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|361.00||||361.00|12.25|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|UMR [2035]|UMR OPTIONS [203501]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|361.00||||361.00|75.81|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|361.00||||361.00|361|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|361.00||||361.00|173.1|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|361.00||||361.00|216.6|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|361.00||||361.00|234.65|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|||361.00||||361.00|108.3|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|361.00||||361.00|180.86|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|361.00||||361.00|10.72|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|361.00||||361.00|9.86|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|CHAMPVA [1240]|CHAMP VA [124000]|361.00||||361.00|270.75|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|361.00||||361.00|11.14|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|CORESOURCE [1315]|CORESOURCE [131500]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|GEHA [1415]|GEHA [141500]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|361.00||||361.00|324.9|361|6.59 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MULTIPLAN [1680]|HMA [168003]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|361.00||||361.00||| 30182180|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN C (ASCORBIC ACID)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|361.00||||361.00||| 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|GEHA [1415]|GEHA [141500]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|CORESOURCE [1315]|CORESOURCE [131500]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|262.00||||262.00|18.22|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|CHAMPVA [1240]|CHAMP VA [124000]|262.00||||262.00|196.5|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|262.00||||262.00|16.12|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|262.00||||262.00|17.53|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|||262.00||||262.00|78.6|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|262.00||||262.00|170.3|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|262.00||||262.00|125.63|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|262.00||||262.00|262|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|262.00||||262.00|55.02|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|262.00||||262.00|23.62|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|UMR [2035]|UMR OPTIONS [203501]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|262.00||||262.00|20.04|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|262.00||||262.00|19.97|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|262.00||||262.00|16.5|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MULTIPLAN [1680]|IHC HS [168011]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MULTIPLAN [1680]|HMA [168003]|262.00||||262.00|24.27|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|262.00||||262.00|23.26|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|HEALTHNET [1495]|HEALTHNET [149500]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|AETNA [1015]|AETNA ACO WILCO [101532]|262.00||||262.00|25.56|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|TRUSTMARK [2030]|STARMARK [203000]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|262.00||||262.00|10.78|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|262.00||||262.00|16.93|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|262.00||||262.00|23.26|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|262.00||||262.00|17.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|262.00||||262.00|17.53|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|262.00||||262.00|16.99|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|262.00||||262.00|157.2|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|262.00||||262.00|91.96|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|262.00||||262.00|111.61|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|262.00||||262.00|19.97|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|262.00||||262.00|131.26|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|262.00||||262.00|131|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|262.00||||262.00|16.18|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|262.00||||262.00|17.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|262.00||||262.00|235.8|262|10.78 30182232|EAP|0301 - LABORATORY-CHEMISTRY|HC BETA-2 MICROGLOBULIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|262.00||||262.00||| 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|630.00||||630.00|5.52|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|630.00||||630.00|315|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|630.00||||630.00|221.13|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|630.00||||630.00|268.38|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|630.00||||630.00|6.19|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|630.00||||630.00|378|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|630.00||||630.00|5.27|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|630.00||||630.00|5.52|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|630.00||||630.00|3.34|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|TRUSTMARK [2030]|STARMARK [203000]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|630.00||||630.00|7.22|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MULTIPLAN [1680]|HMA [168003]|630.00||||630.00|7.53|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MULTIPLAN [1680]|IHC HS [168011]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|630.00||||630.00|6.19|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|630.00||||630.00|6.22|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|630.00||||630.00|5.12|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|630.00||||630.00|7.92|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|UMR [2035]|UMR OPTIONS [203501]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|630.00||||630.00|5.25|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|630.00||||630.00|7.33|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|630.00||||630.00|132.3|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|630.00||||630.00|5.44|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|630.00||||630.00|630|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|630.00||||630.00|302.09|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|630.00||||630.00|315.63|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|630.00||||630.00|409.5|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|||630.00||||630.00|189|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|630.00||||630.00|5.44|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|630.00||||630.00|5.02|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|630.00||||630.00|5|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|630.00||||630.00|472.5|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|630.00||||630.00|7.22|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|630.00||||630.00|5.65|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|GEHA [1415]|GEHA [141500]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|630.00||||630.00|567|630|3.34 30182247|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|630.00||||630.00||| 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|GEHA [1415]|GEHA [141500]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123.00||||123.00|5.65|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123.00||||123.00|7.22|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|CHAMPVA [1240]|CHAMP VA [124000]|123.00||||123.00|92.25|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.00||||123.00|5|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.00||||123.00|5.44|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.00||||123.00|79.95|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.00||||123.00|123|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.00||||123.00|25.83|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.00||||123.00|7.33|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.00||||123.00|5.12|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123.00||||123.00|6.22|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.00||||123.00|6.19|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|UMR [2035]|UMR OPTIONS [203501]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123.00||||123.00|7.22|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MULTIPLAN [1680]|IHC HS [168011]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MULTIPLAN [1680]|HMA [168003]|123.00||||123.00|7.53|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.00||||123.00|58.98|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|HEALTHNET [1495]|HEALTHNET [149500]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|AETNA [1015]|AETNA ACO WILCO [101532]|123.00||||123.00|7.92|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|||123.00||||123.00|36.9|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|TRUSTMARK [2030]|STARMARK [203000]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123.00||||123.00|3.34|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.00||||123.00|5.25|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.00||||123.00|5.52|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.00||||123.00|5.44|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.00||||123.00|5.27|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.00||||123.00|73.8|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|CORESOURCE [1315]|CORESOURCE [131500]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123.00||||123.00|52.4|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123.00||||123.00|61.62|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.00||||123.00|6.19|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.00||||123.00|43.17|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.00||||123.00|61.5|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.00||||123.00|5.02|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.00||||123.00|5.52|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.00||||123.00|110.7|123|3.34 30182248|EAP|0301 - LABORATORY-CHEMISTRY|HC BILIRUBIN DIRECT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123.00||||123.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.00||||132.00|66|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132.00||||132.00|20.83|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132.00||||132.00|56.23|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132.00||||132.00|46.33|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132.00||||132.00|79.2|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132.00||||132.00|18.28|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132.00||||132.00|17.66|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132.00||||132.00|11.24|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|TRUSTMARK [2030]|STARMARK [203000]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|HEALTHNET [1495]|HEALTHNET [149500]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MULTIPLAN [1680]|IHC HS [168011]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132.00||||132.00|20.83|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132.00||||132.00|20.9|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|AETNA [1015]|AETNA ACO WILCO [101532]|132.00||||132.00|26.66|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|UMR [2035]|UMR OPTIONS [203501]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132.00||||132.00|27.72|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132.00||||132.00|132|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.00||||132.00|63.29|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132.00||||132.00|85.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|||132.00||||132.00|39.6|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132.00||||132.00|66.13|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132.00||||132.00|18.28|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132.00||||132.00|16.82|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|CHAMPVA [1240]|CHAMP VA [124000]|132.00||||132.00|99|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132.00||||132.00|19|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|CORESOURCE [1315]|CORESOURCE [131500]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|GEHA [1415]|GEHA [141500]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132.00||||132.00|118.8|132|11.24 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|MULTIPLAN [1680]|HMA [168003]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132.00||||132.00||| 30182261|EAP|0301 - LABORATORY-CHEMISTRY|HC BIOTINIDASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132.00||||132.00||| 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|GEHA [1415]|GEHA [141500]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|CORESOURCE [1315]|CORESOURCE [131500]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|89.00||||89.00|4.94|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|CHAMPVA [1240]|CHAMP VA [124000]|89.00||||89.00|66.75|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89.00||||89.00|4.37|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89.00||||89.00|4.75|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|||89.00||||89.00|26.7|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89.00||||89.00|42.68|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89.00||||89.00|89|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89.00||||89.00|18.69|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89.00||||89.00|6.39|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|UMR [2035]|UMR OPTIONS [203501]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89.00||||89.00|4.47|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|89.00||||89.00|5.44|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|FIRST HEALTH [1375]|QUALCHOICE [137513]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|FMH BENEFIT SERVICES [1390]|FMH [139000]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|89.00||||89.00|6.3|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MULTIPLAN [1680]|HMA [168003]|89.00||||89.00|6.57|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MULTIPLAN [1680]|IHC HS [168011]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|HEALTHNET [1495]|HEALTHNET [149500]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89.00||||89.00|57.85|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|AETNA [1015]|AETNA ACO WILCO [101532]|89.00||||89.00|6.23|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|TRUSTMARK [2030]|STARMARK [203000]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|89.00||||89.00|2.63|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89.00||||89.00|4.58|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|89.00||||89.00|6.3|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89.00||||89.00|4.82|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89.00||||89.00|4.75|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89.00||||89.00|4.6|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89.00||||89.00|53.4|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89.00||||89.00|31.24|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|89.00||||89.00|37.91|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|89.00||||89.00|44.59|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89.00||||89.00|44.5|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89.00||||89.00|4.38|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89.00||||89.00|4.82|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89.00||||89.00|80.1|89|2.63 30182270|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD STOOL GUAIAC 1-3|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|89.00||||89.00||| 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114.00||||114.00|5.85|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114.00||||114.00|57|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|114.00||||114.00|57.11|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|114.00||||114.00|48.56|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114.00||||114.00|68.4|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114.00||||114.00|5.59|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114.00||||114.00|5.85|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114.00||||114.00|5.57|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|114.00||||114.00|3.19|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|TRUSTMARK [2030]|STARMARK [203000]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|AETNA [1015]|AETNA ACO WILCO [101532]|114.00||||114.00|7.57|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|HEALTHNET [1495]|HEALTHNET [149500]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|114.00||||114.00|7.65|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MULTIPLAN [1680]|IHC HS [168011]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MULTIPLAN [1680]|HMA [168003]|114.00||||114.00|7.98|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|114.00||||114.00|6.59|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114.00||||114.00|5.43|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|UMR [2035]|UMR OPTIONS [203501]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114.00||||114.00|7.77|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114.00||||114.00|23.94|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114.00||||114.00|5.76|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114.00||||114.00|114|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114.00||||114.00|54.66|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114.00||||114.00|74.1|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114.00||||114.00|40.01|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|||114.00||||114.00|34.2|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114.00||||114.00|5.76|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114.00||||114.00|5.32|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114.00||||114.00|5.3|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|CHAMPVA [1240]|CHAMP VA [124000]|114.00||||114.00|85.5|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|114.00||||114.00|7.65|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|114.00||||114.00|5.99|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|CORESOURCE [1315]|CORESOURCE [131500]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|GEHA [1415]|GEHA [141500]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114.00||||114.00|102.6|114|3.19 30182271|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLOOD OTHER SOURCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|114.00||||114.00||| 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|GEHA [1415]|GEHA [141500]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|CORESOURCE [1315]|CORESOURCE [131500]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|102.00||||102.00|4.77|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|102.00||||102.00|6.08|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|CHAMPVA [1240]|CHAMP VA [124000]|102.00||||102.00|76.5|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102.00||||102.00|4.22|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102.00||||102.00|4.59|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102.00||||102.00|66.3|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102.00||||102.00|48.91|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102.00||||102.00|102|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102.00||||102.00|6.18|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102.00||||102.00|4.31|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|102.00||||102.00|5.25|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|FIRST HEALTH [1375]|QUALCHOICE [137513]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|FMH BENEFIT SERVICES [1390]|FMH [139000]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|UMR [2035]|UMR OPTIONS [203501]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102.00||||102.00|21.42|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MULTIPLAN [1680]|HMA [168003]|102.00||||102.00|6.35|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|102.00||||102.00|6.08|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MULTIPLAN [1680]|IHC HS [168011]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|HEALTHNET [1495]|HEALTHNET [149500]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|AETNA [1015]|AETNA ACO WILCO [101532]|102.00||||102.00|6.01|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|||102.00||||102.00|30.6|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|TRUSTMARK [2030]|STARMARK [203000]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|102.00||||102.00|2.54|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102.00||||102.00|4.43|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102.00||||102.00|4.65|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102.00||||102.00|4.59|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102.00||||102.00|4.44|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102.00||||102.00|61.2|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102.00||||102.00|35.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|102.00||||102.00|51.1|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|102.00||||102.00|43.45|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102.00||||102.00|51|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102.00||||102.00|4.23|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102.00||||102.00|4.65|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102.00||||102.00|91.8|102|2.54 30182272|EAP|0301 - LABORATORY-CHEMISTRY|HC OCCULT BLD FECES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|102.00||||102.00||| 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|278.00||||278.00|17.51|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|278.00||||278.00|139|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|278.00||||278.00|19.64|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|278.00||||278.00|139.28|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|278.00||||278.00|118.43|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|278.00||||278.00|97.58|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|278.00||||278.00|16.72|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|278.00||||278.00|17.24|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|278.00||||278.00|17.51|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|278.00||||278.00|16.65|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|TRUSTMARK [2030]|STARMARK [203000]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|AETNA [1015]|AETNA ACO WILCO [101532]|278.00||||278.00|25.13|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|AETNA [1015]|COVENTRY HEALTHCARE [101502]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|HEALTHNET [1495]|HEALTHNET [149500]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MULTIPLAN [1680]|HMA [168003]|278.00||||278.00|23.88|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MULTIPLAN [1680]|IHC HS [168011]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|278.00||||278.00|22.89|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|FMH BENEFIT SERVICES [1390]|FMH [139000]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|FIRST HEALTH [1375]|QUALCHOICE [137513]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|278.00||||278.00|19.64|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|278.00||||278.00|19.71|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|278.00||||278.00|16.24|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|UMR [2035]|UMR OPTIONS [203501]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|278.00||||278.00|10.6|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|278.00||||278.00|23.24|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|278.00||||278.00|58.38|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|278.00||||278.00|278|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|278.00||||278.00|133.3|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|278.00||||278.00|166.8|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|278.00||||278.00|180.7|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|||278.00||||278.00|83.4|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|278.00||||278.00|17.24|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|278.00||||278.00|15.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|278.00||||278.00|15.86|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|CHAMPVA [1240]|CHAMP VA [124000]|278.00||||278.00|208.5|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|278.00||||278.00|22.89|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|278.00||||278.00|17.92|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|CORESOURCE [1315]|CORESOURCE [131500]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|GEHA [1415]|GEHA [141500]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|278.00||||278.00|250.2|278|10.6 30182274|EAP|0301 - LABORATORY-CHEMISTRY|HC BLOOD OCCULT FECAL HGB DETER IA QL FECES 1-3|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|278.00||||278.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|GEHA [1415]|GEHA [141500]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|CORESOURCE [1315]|CORESOURCE [131500]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|351.00||||351.00|26.62|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|CHAMPVA [1240]|CHAMP VA [124000]|351.00||||351.00|263.25|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351.00||||351.00|23.55|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351.00||||351.00|25.61|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|||351.00||||351.00|105.3|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351.00||||351.00|168.3|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351.00||||351.00|351|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351.00||||351.00|73.71|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|UMR [2035]|UMR OPTIONS [203501]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|351.00||||351.00|29.28|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351.00||||351.00|28.58|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MULTIPLAN [1680]|IHC HS [168011]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|HEALTHNET [1495]|HEALTHNET [149500]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|AETNA [1015]|AETNA ACO WILCO [101532]|351.00||||351.00|36.58|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351.00||||351.00|228.15|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|TRUSTMARK [2030]|STARMARK [203000]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|351.00||||351.00|15.43|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351.00||||351.00|24.73|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351.00||||351.00|25.61|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351.00||||351.00|210.6|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|351.00||||351.00|175.85|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351.00||||351.00|123.2|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|351.00||||351.00|149.53|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351.00||||351.00|28.58|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351.00||||351.00|175.5|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351.00||||351.00|315.9|351|15.43 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MULTIPLAN [1680]|HMA [168003]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351.00||||351.00||| 30182300|EAP|0301 - LABORATORY-CHEMISTRY|HC CADMIUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351.00||||351.00||| 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|427.00||||427.00|32.56|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|427.00||||427.00|213.5|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|427.00||||427.00|149.88|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|427.00||||427.00|36.55|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|427.00||||427.00|213.93|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|427.00||||427.00|256.2|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|427.00||||427.00|31.08|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|427.00||||427.00|32.07|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|427.00||||427.00|32.56|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|427.00||||427.00|19.73|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|TRUSTMARK [2030]|STARMARK [203000]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|AETNA [1015]|AETNA ACO WILCO [101532]|427.00||||427.00|46.78|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|HEALTHNET [1495]|HEALTHNET [149500]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MULTIPLAN [1680]|HMA [168003]|427.00||||427.00|44.4|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MULTIPLAN [1680]|IHC HS [168011]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|427.00||||427.00|42.55|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|FMH BENEFIT SERVICES [1390]|FMH [139000]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|FIRST HEALTH [1375]|QUALCHOICE [137513]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|427.00||||427.00|36.55|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|427.00||||427.00|36.67|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|427.00||||427.00|30.19|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|UMR [2035]|UMR OPTIONS [203501]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|427.00||||427.00|43.22|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|427.00||||427.00|89.67|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|427.00||||427.00|30.97|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|427.00||||427.00|427|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|427.00||||427.00|204.75|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|427.00||||427.00|277.55|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|427.00||||427.00|181.9|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|||427.00||||427.00|128.1|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|427.00||||427.00|32.07|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|427.00||||427.00|29.6|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|427.00||||427.00|29.5|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|CHAMPVA [1240]|CHAMP VA [124000]|427.00||||427.00|320.25|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|427.00||||427.00|42.55|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|427.00||||427.00|33.33|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|CORESOURCE [1315]|CORESOURCE [131500]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|GEHA [1415]|GEHA [141500]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|427.00||||427.00|384.3|427|19.73 30182306|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D 25-HYDROXY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|427.00||||427.00||| 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|GEHA [1415]|GEHA [141500]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|371.00||||371.00|30.16|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|371.00||||371.00|38.51|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|CHAMPVA [1240]|CHAMP VA [124000]|371.00||||371.00|278.25|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371.00||||371.00|26.69|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371.00||||371.00|29.02|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|||371.00||||371.00|111.3|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371.00||||371.00|241.15|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371.00||||371.00|371|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371.00||||371.00|39.11|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371.00||||371.00|27.33|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|371.00||||371.00|33.18|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371.00||||371.00|33.08|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|UMR [2035]|UMR OPTIONS [203501]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371.00||||371.00|77.91|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MULTIPLAN [1680]|IHC HS [168011]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|371.00||||371.00|38.51|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MULTIPLAN [1680]|HMA [168003]|371.00||||371.00|40.19|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371.00||||371.00|177.89|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|HEALTHNET [1495]|HEALTHNET [149500]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|AETNA [1015]|AETNA ACO WILCO [101532]|371.00||||371.00|42.35|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|TRUSTMARK [2030]|STARMARK [203000]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|371.00||||371.00|17.86|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371.00||||371.00|28.03|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371.00||||371.00|29.47|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|CORESOURCE [1315]|CORESOURCE [131500]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371.00||||371.00|29.02|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371.00||||371.00|28.13|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371.00||||371.00|222.6|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371.00||||371.00|33.08|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|371.00||||371.00|158.05|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|371.00||||371.00|185.87|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371.00||||371.00|130.22|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371.00||||371.00|185.5|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371.00||||371.00|26.79|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371.00||||371.00|29.47|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371.00||||371.00|333.9|371|17.86 30182308|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCITONIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|371.00||||371.00||| 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|175.00||||175.00|5.68|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|175.00||||175.00|87.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|175.00||||175.00|6.37|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|175.00||||175.00|74.55|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|175.00||||175.00|61.43|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|175.00||||175.00|5.42|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|175.00||||175.00|5.59|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|175.00||||175.00|5.68|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|175.00||||175.00|5.4|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|175.00||||175.00|3.44|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|TRUSTMARK [2030]|STARMARK [203000]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|175.00||||175.00|8.15|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MULTIPLAN [1680]|IHC HS [168011]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MULTIPLAN [1680]|HMA [168003]|175.00||||175.00|7.74|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|175.00||||175.00|7.42|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|175.00||||175.00|6.37|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|175.00||||175.00|6.39|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|175.00||||175.00|5.26|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|UMR [2035]|UMR OPTIONS [203501]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|175.00||||175.00|7.53|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|175.00||||175.00|36.75|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|175.00||||175.00|175|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|175.00||||175.00|83.91|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|175.00||||175.00|105|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|175.00||||175.00|113.75|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|||175.00||||175.00|52.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|175.00||||175.00|87.68|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|175.00||||175.00|5.59|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|175.00||||175.00|5.16|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|175.00||||175.00|5.15|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|175.00||||175.00|131.25|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|175.00||||175.00|7.42|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|175.00||||175.00|5.81|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|GEHA [1415]|GEHA [141500]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|175.00||||175.00|157.5|175|3.44 30182310|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|175.00||||175.00||| 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|GEHA [1415]|GEHA [141500]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|CORESOURCE [1315]|CORESOURCE [131500]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|260.00||||260.00|15.4|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|260.00||||260.00|19.67|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|CHAMPVA [1240]|CHAMP VA [124000]|260.00||||260.00|195|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260.00||||260.00|13.64|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260.00||||260.00|14.82|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|||260.00||||260.00|78|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260.00||||260.00|124.67|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260.00||||260.00|260|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260.00||||260.00|54.6|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260.00||||260.00|19.97|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|UMR [2035]|UMR OPTIONS [203501]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|260.00||||260.00|16.94|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260.00||||260.00|16.88|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260.00||||260.00|13.95|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|FIRST HEALTH [1375]|QUALCHOICE [137513]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|FMH BENEFIT SERVICES [1390]|FMH [139000]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|260.00||||260.00|19.67|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MULTIPLAN [1680]|IHC HS [168011]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MULTIPLAN [1680]|HMA [168003]|260.00||||260.00|20.52|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|HEALTHNET [1495]|HEALTHNET [149500]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260.00||||260.00|169|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|AETNA [1015]|AETNA ACO WILCO [101532]|260.00||||260.00|21.62|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|TRUSTMARK [2030]|STARMARK [203000]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|260.00||||260.00|9.12|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260.00||||260.00|14.32|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260.00||||260.00|15.05|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260.00||||260.00|14.82|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260.00||||260.00|14.36|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260.00||||260.00|156|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|260.00||||260.00|110.76|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260.00||||260.00|16.88|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260.00||||260.00|91.26|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|260.00||||260.00|130.26|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260.00||||260.00|130|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260.00||||260.00|13.68|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260.00||||260.00|15.05|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260.00||||260.00|234|260|9.12 30182330|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM IONIZED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|260.00||||260.00||| 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|129.00||||129.00|6.63|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|129.00||||129.00|64.5|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|129.00||||129.00|54.95|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|129.00||||129.00|45.28|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|129.00||||129.00|7.44|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|129.00||||129.00|64.63|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|129.00||||129.00|77.4|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|129.00||||129.00|6.33|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|129.00||||129.00|6.63|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|129.00||||129.00|4.02|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|TRUSTMARK [2030]|STARMARK [203000]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|AETNA [1015]|AETNA ACO WILCO [101532]|129.00||||129.00|9.53|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|HEALTHNET [1495]|HEALTHNET [149500]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|129.00||||129.00|8.67|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MULTIPLAN [1680]|IHC HS [168011]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MULTIPLAN [1680]|HMA [168003]|129.00||||129.00|9.05|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|129.00||||129.00|7.44|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|129.00||||129.00|7.47|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|129.00||||129.00|6.15|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|UMR [2035]|UMR OPTIONS [203501]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|129.00||||129.00|6.31|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|129.00||||129.00|8.8|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|129.00||||129.00|27.09|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|129.00||||129.00|6.54|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|129.00||||129.00|129|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|129.00||||129.00|61.86|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|129.00||||129.00|83.85|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|||129.00||||129.00|38.7|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|129.00||||129.00|6.54|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|129.00||||129.00|6.03|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|129.00||||129.00|6.01|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|CHAMPVA [1240]|CHAMP VA [124000]|129.00||||129.00|96.75|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|129.00||||129.00|8.67|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|129.00||||129.00|6.8|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|CORESOURCE [1315]|CORESOURCE [131500]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|GEHA [1415]|GEHA [141500]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|129.00||||129.00|116.1|129|4.02 30182340|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCIUM 24 HR URINE QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|129.00||||129.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|14.29|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|AETNA [1015]|AETNA ACO WILCO [101532]|183.00||||183.00|18.29|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|183.00||||183.00|7.72|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|14.35|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|12.13|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|12.55|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183.00||||183.00|109.8|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|77.96|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|14.29|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|91.68|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|64.23|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|183|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|CHAMPVA [1240]|CHAMP VA [124000]|183.00||||183.00|137.25|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|||183.00||||183.00|54.9|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|13.04|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|11.55|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|12.55|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|GEHA [1415]|GEHA [141500]|183.00||||183.00|164.7|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183.00||||183.00|87.75|183|7.72 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MULTIPLAN [1680]|HMA [168003]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00||| 30182355|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS (STONE) ANALYSIS QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183.00||||183.00||| 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00|18.55|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|13.98|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|15.99|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00|13.55|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|CHAMPVA [1240]|CHAMP VA [124000]|183.00||||183.00|137.25|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00|13.16|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00|14.19|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00|18.83|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|GEHA [1415]|GEHA [141500]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00|14.19|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183.00||||183.00|109.8|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|64.23|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|15.92|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|183|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|12.86|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|13.5|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|13.98|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|15.92|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|AETNA [1015]|AETNA ACO WILCO [101532]|183.00||||183.00|20.38|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183.00||||183.00|12.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|14.53|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00|18.55|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|FIRST HEALTH [1375]|QUALCHOICE [137513]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|||183.00||||183.00|54.9|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|183.00||||183.00|8.6|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|77.96|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183.00||||183.00|87.75|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|91.68|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|MULTIPLAN [1680]|HMA [168003]|183.00||||183.00|19.35|183|8.6 30182365|EAP|0301 - LABORATORY-CHEMISTRY|HC CALCULUS ANALYSIS INFRARED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|TRUSTMARK [2030]|STARMARK [203000]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|HEALTHNET [1495]|HEALTHNET [149500]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|318.00||||318.00|22.29|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MULTIPLAN [1680]|IHC HS [168011]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|318.00||||318.00|18.9|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|318.00||||318.00|12.04|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|318.00||||318.00|22.29|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|AETNA [1015]|AETNA ACO WILCO [101532]|318.00||||318.00|28.54|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|318.00||||318.00|159.32|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|318.00||||318.00|135.47|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|318.00||||318.00|19.57|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|318.00||||318.00|20.34|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|CORESOURCE [1315]|CORESOURCE [131500]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|GEHA [1415]|GEHA [141500]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|318.00||||318.00|190.8|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|318.00||||318.00|19.57|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|318.00||||318.00|18|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|318.00||||318.00|152.48|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|CHAMPVA [1240]|CHAMP VA [124000]|318.00||||318.00|238.5|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|318.00||||318.00|66.78|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|||318.00||||318.00|95.4|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|318.00||||318.00|22.38|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|318.00||||318.00|206.7|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|UMR [2035]|UMR OPTIONS [203501]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|318.00||||318.00|318|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|318.00||||318.00|111.62|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|318.00||||318.00|286.2|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|318.00||||318.00|159|318|12.04 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MULTIPLAN [1680]|HMA [168003]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|318.00||||318.00||| 30182373|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOHYDRATE DEFICIENT TRANSFERRIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|318.00||||318.00||| 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110.00||||110.00|38.61|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110.00||||110.00|5.11|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|TRUSTMARK [2030]|STARMARK [203000]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|110.00||||110.00|55.11|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110.00||||110.00|5.29|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110.00||||110.00|6.03|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110.00||||110.00|55|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110.00||||110.00|5.37|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|110.00||||110.00|7.02|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|110.00||||110.00|3.26|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MULTIPLAN [1680]|HMA [168003]|110.00||||110.00|7.32|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110.00||||110.00|6.03|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|AETNA [1015]|AETNA ACO WILCO [101532]|110.00||||110.00|7.73|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|110.00||||110.00|6.05|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110.00||||110.00|5.12|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110.00||||110.00|23.1|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|FMH BENEFIT SERVICES [1390]|FMH [139000]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MULTIPLAN [1680]|IHC HS [168011]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110.00||||110.00|5.37|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110.00||||110.00|110|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|FIRST HEALTH [1375]|QUALCHOICE [137513]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110.00||||110.00|71.5|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|110.00||||110.00|7.02|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110.00||||110.00|5.29|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|110.00||||110.00|5.5|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110.00||||110.00|4.86|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|GEHA [1415]|GEHA [141500]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|HEALTHNET [1495]|HEALTHNET [149500]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110.00||||110.00|52.75|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|110.00||||110.00|46.86|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110.00||||110.00|66|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110.00||||110.00|7.12|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|CORESOURCE [1315]|CORESOURCE [131500]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|110.00||||110.00|4.88|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110.00||||110.00|4.98|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|||110.00||||110.00|33|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|CHAMPVA [1240]|CHAMP VA [124000]|110.00||||110.00|82.5|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|UMR [2035]|UMR OPTIONS [203501]|110.00||||110.00|99|110|3.26 30182374|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBON DIOXIDE (BICARB) BL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|110.00||||110.00||| 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|168.00||||168.00|13.55|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|168.00||||168.00|8.21|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|TRUSTMARK [2030]|STARMARK [203000]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MULTIPLAN [1680]|HMA [168003]|168.00||||168.00|18.48|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|AETNA [1015]|AETNA ACO WILCO [101532]|168.00||||168.00|19.48|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|168.00||||168.00|84.17|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|168.00||||168.00|13.35|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|168.00||||168.00|58.97|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|168.00||||168.00|15.21|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|168.00||||168.00|71.57|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|168.00||||168.00|12.94|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|168.00||||168.00|100.8|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|HEALTHNET [1495]|HEALTHNET [149500]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|168.00||||168.00|13.55|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|168.00||||168.00|84|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|168.00||||168.00|17.71|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MULTIPLAN [1680]|IHC HS [168011]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|168.00||||168.00|12.89|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|GEHA [1415]|GEHA [141500]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|||168.00||||168.00|50.4|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|CORESOURCE [1315]|CORESOURCE [131500]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|168.00||||168.00|12.28|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|168.00||||168.00|80.56|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|168.00||||168.00|13.35|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|UMR [2035]|UMR OPTIONS [203501]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|168.00||||168.00|35.28|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|168.00||||168.00|17.99|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|168.00||||168.00|13.88|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|168.00||||168.00|109.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|168.00||||168.00|168|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|168.00||||168.00|15.21|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|168.00||||168.00|17.71|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|CHAMPVA [1240]|CHAMP VA [124000]|168.00||||168.00|126|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|168.00||||168.00|151.2|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|168.00||||168.00|12.32|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|168.00||||168.00|15.27|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|168.00||||168.00|12.57|168|8.21 30182375|EAP|0301 - LABORATORY-CHEMISTRY|HC CARBOXYHEMOGLOBIN QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|168.00||||168.00||| 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|343.00||||343.00|72.03|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|343.00||||343.00|20.86|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|343.00||||343.00|20.86|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|343.00||||343.00|20.54|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|343.00||||343.00|120.39|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|343.00||||343.00|171.84|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|343.00||||343.00|146.12|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|343.00||||343.00|171.5|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|343.00||||343.00|12.64|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|343.00||||343.00|164.47|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MULTIPLAN [1680]|IHC HS [168011]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|343.00||||343.00|205.8|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|HEALTHNET [1495]|HEALTHNET [149500]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|AETNA [1015]|AETNA ACO WILCO [101532]|343.00||||343.00|29.97|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|343.00||||343.00|23.41|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|343.00||||343.00|23.48|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|343.00||||343.00|27.26|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|343.00||||343.00|222.95|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|343.00||||343.00|27.68|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|TRUSTMARK [2030]|STARMARK [203000]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|343.00||||343.00|19.34|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|UMR [2035]|UMR OPTIONS [203501]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|343.00||||343.00|19.84|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|343.00||||343.00|20.54|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|CORESOURCE [1315]|CORESOURCE [131500]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MULTIPLAN [1680]|HMA [168003]|343.00||||343.00|28.44|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|CHAMPVA [1240]|CHAMP VA [124000]|343.00||||343.00|257.25|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|343.00||||343.00|18.9|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|343.00||||343.00|19.91|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|343.00||||343.00|23.41|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|343.00||||343.00|21.35|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|||343.00||||343.00|102.9|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|GEHA [1415]|GEHA [141500]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|343.00||||343.00|27.26|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|343.00||||343.00|343|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|343.00||||343.00|18.96|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|343.00||||343.00|308.7|343|12.64 30182378|EAP|0301 - LABORATORY-CHEMISTRY|HC AG CARCINOEMBRYONIC (CEA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|343.00||||343.00||| 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209.00||||209.00|135.85|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MULTIPLAN [1680]|IHC HS [168011]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|GEHA [1415]|GEHA [141500]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209.00||||209.00|16.82|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|CORESOURCE [1315]|CORESOURCE [131500]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|||209.00||||209.00|62.7|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209.00||||209.00|100.22|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209.00||||209.00|18.28|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209.00||||209.00|20.83|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|UMR [2035]|UMR OPTIONS [203501]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209.00||||209.00|43.89|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209.00||||209.00|24.63|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209.00||||209.00|17.21|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|209.00||||209.00|20.9|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209.00||||209.00|209|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|AETNA [1015]|AETNA ACO WILCO [101532]|209.00||||209.00|26.66|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209.00||||209.00|18.56|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MULTIPLAN [1680]|HMA [168003]|209.00||||209.00|25.31|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|HEALTHNET [1495]|HEALTHNET [149500]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|CHAMPVA [1240]|CHAMP VA [124000]|209.00||||209.00|156.75|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|209.00||||209.00|11.24|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|209.00||||209.00|19|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|209.00||||209.00|24.25|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|TRUSTMARK [2030]|STARMARK [203000]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|209.00||||209.00|89.03|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209.00||||209.00|20.83|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209.00||||209.00|18.28|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209.00||||209.00|17.71|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|209.00||||209.00|104.71|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209.00||||209.00|104.5|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209.00||||209.00|125.4|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209.00||||209.00|73.36|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209.00||||209.00|16.87|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209.00||||209.00|17.66|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|209.00||||209.00|24.25|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209.00||||209.00|188.1|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209.00||||209.00|18.56|209|11.24 30182379|EAP|0301 - LABORATORY-CHEMISTRY|HC CARNITINE (TOTAL & FREE) QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|209.00||||209.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106.00||||106.00|63.6|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|106.00||||106.00|53.11|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.00||||106.00|37.21|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.00||||106.00|11.39|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.00||||106.00|22.26|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.00||||106.00|9.99|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|HEALTHNET [1495]|HEALTHNET [149500]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.00||||106.00|106|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.00||||106.00|11.39|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MULTIPLAN [1680]|IHC HS [168011]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.00||||106.00|68.9|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|106.00||||106.00|45.16|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.00||||106.00|53|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|106.00||||106.00|11.42|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.00||||106.00|9.19|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|CHAMPVA [1240]|CHAMP VA [124000]|106.00||||106.00|79.5|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|TRUSTMARK [2030]|STARMARK [203000]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.00||||106.00|9.99|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|CORESOURCE [1315]|CORESOURCE [131500]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|GEHA [1415]|GEHA [141500]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|||106.00||||106.00|31.8|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|106.00||||106.00|10.38|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.00||||106.00|9.65|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|UMR [2035]|UMR OPTIONS [203501]|106.00||||106.00|95.4|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.00||||106.00|50.83|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|AETNA [1015]|AETNA ACO WILCO [101532]|106.00||||106.00|14.58|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|106.00||||106.00|6.15|106|6.15 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MULTIPLAN [1680]|HMA [168003]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.00||||106.00||| 30182380|EAP|0301 - LABORATORY-CHEMISTRY|HC CAROTENE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.00||||106.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|212.00||||212.00|74.41|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|212.00||||212.00|27.3|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|212.00||||212.00|127.2|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|212.00||||212.00|90.31|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|212.00||||212.00|106|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|212.00||||212.00|29.58|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|212.00||||212.00|106.21|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|212.00||||212.00|16.38|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|212.00||||212.00|28.56|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|CHAMPVA [1240]|CHAMP VA [124000]|212.00||||212.00|159|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|||212.00||||212.00|63.6|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|CORESOURCE [1315]|CORESOURCE [131500]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|212.00||||212.00|30.74|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|212.00||||212.00|27.2|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|212.00||||212.00|29.58|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|GEHA [1415]|GEHA [141500]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|212.00||||212.00|212|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|212.00||||212.00|44.52|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|UMR [2035]|UMR OPTIONS [203501]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|212.00||||212.00|33.82|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MULTIPLAN [1680]|IHC HS [168011]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|212.00||||212.00|27.3|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|212.00||||212.00|101.65|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|212.00||||212.00|137.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|HEALTHNET [1495]|HEALTHNET [149500]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|AETNA [1015]|AETNA ACO WILCO [101532]|212.00||||212.00|38.83|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|TRUSTMARK [2030]|STARMARK [203000]|212.00||||212.00|190.8|212|16.38 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MULTIPLAN [1680]|HMA [168003]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|212.00||||212.00||| 30182382|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|212.00||||212.00||| 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|604.00||||604.00|27.78|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|604.00||||604.00|27.78|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|604.00||||604.00|212|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|604.00||||604.00|302.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|604.00||||604.00|257.3|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|604.00||||604.00|26.51|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|604.00||||604.00|362.4|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|604.00||||604.00|302|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|604.00||||604.00|16.84|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|AETNA [1015]|AETNA ACO WILCO [101532]|604.00||||604.00|39.92|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|604.00||||604.00|36.3|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|HEALTHNET [1495]|HEALTHNET [149500]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MULTIPLAN [1680]|IHC HS [168011]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|TRUSTMARK [2030]|STARMARK [203000]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MULTIPLAN [1680]|HMA [168003]|604.00||||604.00|37.88|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|604.00||||604.00|604|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|604.00||||604.00|31.18|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|604.00||||604.00|31.29|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|604.00||||604.00|126.84|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|UMR [2035]|UMR OPTIONS [203501]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|604.00||||604.00|36.87|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|604.00||||604.00|25.76|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|604.00||||604.00|289.62|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|604.00||||604.00|28.44|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|604.00||||604.00|36.3|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|604.00||||604.00|31.18|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|604.00||||604.00|25.16|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|CHAMPVA [1240]|CHAMP VA [124000]|604.00||||604.00|453|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|604.00||||604.00|27.36|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|604.00||||604.00|27.36|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|604.00||||604.00|25.25|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|||604.00||||604.00|181.2|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|GEHA [1415]|GEHA [141500]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|CORESOURCE [1315]|CORESOURCE [131500]|604.00||||604.00|543.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|604.00||||604.00|26.42|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|604.00||||604.00|392.6|604|16.84 30182384|EAP|0301 - LABORATORY-CHEMISTRY|HC CATECHOLAMINES FRACTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|604.00||||604.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|217.00||||217.00|10.71|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|217.00||||217.00|12.1|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|217.00||||217.00|11.64|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|CORESOURCE [1315]|CORESOURCE [131500]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|217.00||||217.00|134.54|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|217.00||||217.00|10.74|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|CHAMPVA [1240]|CHAMP VA [124000]|217.00||||217.00|162.75|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|217.00||||217.00|10.74|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|217.00||||217.00|141.05|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|217.00||||217.00|104.05|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|217.00||||217.00|134.76|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|UMR [2035]|UMR OPTIONS [203501]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|217.00||||217.00|10.95|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|217.00||||217.00|13.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|217.00||||217.00|45.57|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|217.00||||217.00|217|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|217.00||||217.00|10.74|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|217.00||||217.00|13.26|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|217.00||||217.00|15.44|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|HEALTHNET [1495]|HEALTHNET [149500]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|||217.00||||217.00|65.1|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MULTIPLAN [1680]|IHC HS [168011]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MULTIPLAN [1680]|HMA [168003]|217.00||||217.00|16.11|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|AETNA [1015]|AETNA ACO WILCO [101532]|217.00||||217.00|16.97|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|217.00||||217.00|7.16|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|217.00||||217.00|10.74|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|217.00||||217.00|11.28|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|217.00||||217.00|108.72|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|217.00||||217.00|76.17|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|217.00||||217.00|130.2|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|217.00||||217.00|13.26|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|GEHA [1415]|GEHA [141500]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|217.00||||217.00|10.74|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|217.00||||217.00|92.44|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|217.00||||217.00|11.24|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|217.00||||217.00|10.74|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|217.00||||217.00|11.64|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|TRUSTMARK [2030]|STARMARK [203000]|217.00||||217.00|195.3|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|217.00||||217.00|108.5|217|7.16 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|217.00||||217.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|217.00||||217.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|217.00||||217.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|217.00||||217.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|217.00||||217.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|217.00||||217.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|217.00||||217.00||| 30182390|EAP|0301 - LABORATORY-CHEMISTRY|HC CERULOPLASMIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|217.00||||217.00||| 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215.00||||215.00|15.53|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215.00||||215.00|15.3|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|215.00||||215.00|91.59|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215.00||||215.00|14.83|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215.00||||215.00|129|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215.00||||215.00|17.43|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215.00||||215.00|14.78|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|215.00||||215.00|9.41|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MULTIPLAN [1680]|IHC HS [168011]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215.00||||215.00|75.47|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|AETNA [1015]|AETNA ACO WILCO [101532]|215.00||||215.00|22.32|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|215.00||||215.00|20.3|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|HEALTHNET [1495]|HEALTHNET [149500]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MULTIPLAN [1680]|HMA [168003]|215.00||||215.00|21.18|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|TRUSTMARK [2030]|STARMARK [203000]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215.00||||215.00|103.09|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215.00||||215.00|17.43|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|215.00||||215.00|17.49|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215.00||||215.00|45.15|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|UMR [2035]|UMR OPTIONS [203501]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215.00||||215.00|15.53|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215.00||||215.00|20.62|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215.00||||215.00|14.4|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215.00||||215.00|215|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|CORESOURCE [1315]|CORESOURCE [131500]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215.00||||215.00|15.3|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|215.00||||215.00|20.3|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|215.00||||215.00|107.72|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215.00||||215.00|14.07|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215.00||||215.00|14.12|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|CHAMPVA [1240]|CHAMP VA [124000]|215.00||||215.00|161.25|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|215.00||||215.00|15.9|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215.00||||215.00|107.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|GEHA [1415]|GEHA [141500]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|||215.00||||215.00|64.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215.00||||215.00|139.75|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215.00||||215.00|193.5|215|9.41 30182397|EAP|0301 - LABORATORY-CHEMISTRY|HC CHEMILUMINESCENT ASSAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|215.00||||215.00||| 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|CHAMPVA [1240]|CHAMP VA [124000]|101.00||||101.00|75.75|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|GEHA [1415]|GEHA [141500]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101.00||||101.00|4.98|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|101.00||||101.00|6.61|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MULTIPLAN [1680]|HMA [168003]|101.00||||101.00|6.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101.00||||101.00|101|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101.00||||101.00|21.21|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|UMR [2035]|UMR OPTIONS [203501]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101.00||||101.00|4.69|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101.00||||101.00|48.43|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|101.00||||101.00|5.7|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|FIRST HEALTH [1375]|QUALCHOICE [137513]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101.00||||101.00|6.72|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|FMH BENEFIT SERVICES [1390]|FMH [139000]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|101.00||||101.00|6.61|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|AETNA [1015]|AETNA ACO WILCO [101532]|101.00||||101.00|7.27|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101.00||||101.00|5.68|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|HEALTHNET [1495]|HEALTHNET [149500]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MULTIPLAN [1680]|IHC HS [168011]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|||101.00||||101.00|30.3|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101.00||||101.00|4.81|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101.00||||101.00|4.98|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|101.00||||101.00|50.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101.00||||101.00|65.65|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101.00||||101.00|5.68|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101.00||||101.00|35.45|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101.00||||101.00|4.83|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101.00||||101.00|50.5|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101.00||||101.00|5.06|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|101.00||||101.00|5.18|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|CORESOURCE [1315]|CORESOURCE [131500]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|101.00||||101.00|43.03|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101.00||||101.00|5.06|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101.00||||101.00|4.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101.00||||101.00|60.6|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|101.00||||101.00|3.07|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|TRUSTMARK [2030]|STARMARK [203000]|101.00||||101.00|90.9|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101.00||||101.00|4.58|101|3.07 30182435|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE BLOOD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|101.00||||101.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208.00||||208.00|6.24|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208.00||||208.00|5.75|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|208.00||||208.00|104.21|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208.00||||208.00|73.01|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208.00||||208.00|6.04|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208.00||||208.00|124.8|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|UMR [2035]|UMR OPTIONS [203501]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208.00||||208.00|104|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208.00||||208.00|5.75|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208.00||||208.00|5.75|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208.00||||208.00|5.75|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MULTIPLAN [1680]|IHC HS [168011]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|HEALTHNET [1495]|HEALTHNET [149500]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|AETNA [1015]|AETNA ACO WILCO [101532]|208.00||||208.00|8.18|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208.00||||208.00|5.75|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|208.00||||208.00|3.45|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MULTIPLAN [1680]|HMA [168003]|208.00||||208.00|8.63|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208.00||||208.00|208|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208.00||||208.00|6.21|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|208.00||||208.00|7.13|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208.00||||208.00|43.68|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|TRUSTMARK [2030]|STARMARK [203000]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208.00||||208.00|129.17|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208.00||||208.00|6.02|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208.00||||208.00|5.87|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|208.00||||208.00|8.27|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|CORESOURCE [1315]|CORESOURCE [131500]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|208.00||||208.00|6.49|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208.00||||208.00|135.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|208.00||||208.00|128.96|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|CHAMPVA [1240]|CHAMP VA [124000]|208.00||||208.00|156|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|208.00||||208.00|88.61|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208.00||||208.00|6.21|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208.00||||208.00|6.24|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208.00||||208.00|5.74|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|||208.00||||208.00|62.4|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|GEHA [1415]|GEHA [141500]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208.00||||208.00|99.74|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208.00||||208.00|5.75|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208.00||||208.00|187.2|208|3.45 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208.00||||208.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208.00||||208.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|208.00||||208.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208.00||||208.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208.00||||208.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208.00||||208.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|208.00||||208.00||| 30182436|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|208.00||||208.00||| 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.00||||49.00|5.42|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|CHAMPVA [1240]|CHAMP VA [124000]|49.00||||49.00|36.75|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|CORESOURCE [1315]|CORESOURCE [131500]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.00||||49.00|4.98|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.00||||49.00|6.03|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.00||||49.00|31.85|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.00||||49.00|7.3|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.00||||49.00|6.19|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.00||||49.00|49|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|UMR [2035]|UMR OPTIONS [203501]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.00||||49.00|7.19|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.00||||49.00|23.5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.00||||49.00|5.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|AETNA [1015]|AETNA ACO WILCO [101532]|49.00||||49.00|7.73|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MULTIPLAN [1680]|IHC HS [168011]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MULTIPLAN [1680]|HMA [168003]|49.00||||49.00|7.5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|HEALTHNET [1495]|HEALTHNET [149500]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|||49.00||||49.00|14.7|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.00||||49.00|3.26|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.00||||49.00|24.55|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.00||||49.00|29.4|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.00||||49.00|5.42|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.00||||49.00|20.87|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.00||||49.00|24.5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.00||||49.00|10.29|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.00||||49.00|5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.00||||49.00|7.19|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.00||||49.00|5.63|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|GEHA [1415]|GEHA [141500]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.00||||49.00|5.5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.00||||49.00|5.23|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.00||||49.00|6.03|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|TRUSTMARK [2030]|STARMARK [203000]|49.00||||49.00|44.1|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.00||||49.00|5.5|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.00||||49.00|5.25|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.00||||49.00|17.2|49|3.26 30182438|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORIDE OTHER SOURCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.00||||49.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78.00||||78.00|39|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78.00||||78.00|27.38|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|78.00||||78.00|39.08|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78.00||||78.00|46.8|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78.00||||78.00|6.51|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78.00||||78.00|6.29|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|78.00||||78.00|4|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|TRUSTMARK [2030]|STARMARK [203000]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MULTIPLAN [1680]|IHC HS [168011]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|HEALTHNET [1495]|HEALTHNET [149500]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|FMH BENEFIT SERVICES [1390]|FMH [139000]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|FIRST HEALTH [1375]|QUALCHOICE [137513]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78.00||||78.00|7.42|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|78.00||||78.00|7.44|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78.00||||78.00|16.38|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|UMR [2035]|UMR OPTIONS [203501]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78.00||||78.00|78|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78.00||||78.00|50.7|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78.00||||78.00|5.99|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|CHAMPVA [1240]|CHAMP VA [124000]|78.00||||78.00|58.5|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78.00||||78.00|6.51|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|78.00||||78.00|6.77|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78.00||||78.00|7.42|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|CORESOURCE [1315]|CORESOURCE [131500]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|GEHA [1415]|GEHA [141500]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|AETNA [1015]|AETNA ACO WILCO [101532]|78.00||||78.00|9.49|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|||78.00||||78.00|23.4|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|78.00||||78.00|33.23|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78.00||||78.00|37.4|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78.00||||78.00|70.2|78|4 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MULTIPLAN [1680]|HMA [168003]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78.00||||78.00||| 30182441|EAP|0301 - LABORATORY-CHEMISTRY|HC CHLORINATED HYDROCARBON SCRN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78.00||||78.00||| 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|GEHA [1415]|GEHA [141500]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|239.00||||239.00|4.9|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|239.00||||239.00|6.25|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|239.00||||239.00|179.25|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|||239.00||||239.00|71.7|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|239.00||||239.00|155.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|239.00||||239.00|114.6|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|239.00||||239.00|50.19|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|UMR [2035]|UMR OPTIONS [203501]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|239.00||||239.00|4.44|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|239.00||||239.00|5.38|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|239.00||||239.00|239|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|239.00||||239.00|5.37|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|239.00||||239.00|6.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MULTIPLAN [1680]|HMA [168003]|239.00||||239.00|6.53|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MULTIPLAN [1680]|IHC HS [168011]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|239.00||||239.00|6.25|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|239.00||||239.00|6.89|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|239.00||||239.00|2.9|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|239.00||||239.00|4.79|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|239.00||||239.00|4.33|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|239.00||||239.00|4.71|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|239.00||||239.00|4.57|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|239.00||||239.00|143.4|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|239.00||||239.00|101.81|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|239.00||||239.00|5.37|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|239.00||||239.00|83.89|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|239.00||||239.00|119.74|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|239.00||||239.00|4.55|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|239.00||||239.00|119.5|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|TRUSTMARK [2030]|STARMARK [203000]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|239.00||||239.00|4.71|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|239.00||||239.00|4.35|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|239.00||||239.00|4.79|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|239.00||||239.00|215.1|239|2.9 30182465|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLESTEROL SERUM/WHOLE BLOOD TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|239.00||||239.00||| 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|155.00||||155.00|8.66|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|155.00||||155.00|77.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|155.00||||155.00|54.41|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|155.00||||155.00|66.03|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|155.00||||155.00|77.66|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|155.00||||155.00|9.72|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|155.00||||155.00|93|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|155.00||||155.00|8.53|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|155.00||||155.00|8.66|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|155.00||||155.00|8.24|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|155.00||||155.00|5.25|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|155.00||||155.00|12.44|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|HEALTHNET [1495]|HEALTHNET [149500]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MULTIPLAN [1680]|HMA [168003]|155.00||||155.00|11.81|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MULTIPLAN [1680]|IHC HS [168011]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|155.00||||155.00|11.31|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|155.00||||155.00|9.72|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|155.00||||155.00|9.75|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|155.00||||155.00|8.03|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|TRUSTMARK [2030]|STARMARK [203000]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|UMR [2035]|UMR OPTIONS [203501]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|155.00||||155.00|11.49|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|155.00||||155.00|32.55|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|155.00||||155.00|8.53|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|155.00||||155.00|8.26|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|CHAMPVA [1240]|CHAMP VA [124000]|155.00||||155.00|116.25|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|155.00||||155.00|11.31|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|155.00||||155.00|8.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|155.00||||155.00|7.85|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|CORESOURCE [1315]|CORESOURCE [131500]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|GEHA [1415]|GEHA [141500]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|||155.00||||155.00|46.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|155.00||||155.00|100.75|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|155.00||||155.00|139.5|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|155.00||||155.00|74.32|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|155.00||||155.00|7.87|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|155.00||||155.00|155|155|5.25 30182480|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|155.00||||155.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|GEHA [1415]|GEHA [141500]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|CORESOURCE [1315]|CORESOURCE [131500]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|110.00||||110.00|11.05|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110.00||||110.00|9.77|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|||110.00||||110.00|33|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110.00||||110.00|71.5|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110.00||||110.00|110|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|110.00||||110.00|12.15|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110.00||||110.00|23.1|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|FIRST HEALTH [1375]|QUALCHOICE [137513]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110.00||||110.00|9.81|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110.00||||110.00|52.75|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|FMH BENEFIT SERVICES [1390]|FMH [139000]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|UMR [2035]|UMR OPTIONS [203501]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110.00||||110.00|10.63|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MULTIPLAN [1680]|IHC HS [168011]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|HEALTHNET [1495]|HEALTHNET [149500]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|AETNA [1015]|AETNA ACO WILCO [101532]|110.00||||110.00|13.96|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110.00||||110.00|66|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110.00||||110.00|38.61|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|110.00||||110.00|55.11|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|CHAMPVA [1240]|CHAMP VA [124000]|110.00||||110.00|82.5|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|110.00||||110.00|46.86|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110.00||||110.00|55|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110.00||||110.00|9.81|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110.00||||110.00|10.63|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|110.00||||110.00|5.89|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110.00||||110.00|10.26|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|TRUSTMARK [2030]|STARMARK [203000]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110.00||||110.00|99|110|5.89 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MULTIPLAN [1680]|HMA [168003]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110.00||||110.00||| 30182482|EAP|0301 - LABORATORY-CHEMISTRY|HC CHOLINESTERASE RBC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110.00||||110.00||| 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|887.00||||887.00|22.31|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|887.00||||887.00|25.04|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|887.00||||887.00|444.39|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|887.00||||887.00|377.86|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|887.00||||887.00|311.34|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|887.00||||887.00|532.2|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|887.00||||887.00|21.29|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|887.00||||887.00|21.97|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|887.00||||887.00|22.31|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|887.00||||887.00|21.22|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|TRUSTMARK [2030]|STARMARK [203000]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|HEALTHNET [1495]|HEALTHNET [149500]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MULTIPLAN [1680]|HMA [168003]|887.00||||887.00|30.42|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MULTIPLAN [1680]|IHC HS [168011]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|887.00||||887.00|29.15|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|887.00||||887.00|13.52|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|887.00||||887.00|25.04|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|887.00||||887.00|25.12|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|887.00||||887.00|20.69|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|UMR [2035]|UMR OPTIONS [203501]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|887.00||||887.00|29.61|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|887.00||||887.00|186.27|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|887.00||||887.00|887|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|887.00||||887.00|20.21|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|CHAMPVA [1240]|CHAMP VA [124000]|887.00||||887.00|665.25|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|887.00||||887.00|29.15|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|887.00||||887.00|22.84|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|887.00||||887.00|443.5|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|CORESOURCE [1315]|CORESOURCE [131500]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|GEHA [1415]|GEHA [141500]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|887.00||||887.00|21.97|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|887.00||||887.00|576.55|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|887.00||||887.00|20.28|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|||887.00||||887.00|266.1|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|887.00||||887.00|425.32|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|AETNA [1015]|AETNA ACO WILCO [101532]|887.00||||887.00|32.04|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|887.00||||887.00|798.3|887|13.52 30182495|EAP|0301 - LABORATORY-CHEMISTRY|HC CHROMIUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|887.00||||887.00||| 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|343.00||||343.00|31.31|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|GEHA [1415]|GEHA [141500]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|CORESOURCE [1315]|CORESOURCE [131500]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|343.00||||343.00|39.97|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|CHAMPVA [1240]|CHAMP VA [124000]|343.00||||343.00|257.25|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|||343.00||||343.00|102.9|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|343.00||||343.00|222.95|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|343.00||||343.00|164.47|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|343.00||||343.00|72.03|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|UMR [2035]|UMR OPTIONS [203501]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|343.00||||343.00|28.36|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|343.00||||343.00|34.43|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|343.00||||343.00|40.59|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|343.00||||343.00|34.33|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MULTIPLAN [1680]|IHC HS [168011]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|343.00||||343.00|39.97|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MULTIPLAN [1680]|HMA [168003]|343.00||||343.00|41.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|343.00||||343.00|30.12|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|HEALTHNET [1495]|HEALTHNET [149500]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|AETNA [1015]|AETNA ACO WILCO [101532]|343.00||||343.00|43.94|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|TRUSTMARK [2030]|STARMARK [203000]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|343.00||||343.00|18.53|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|343.00||||343.00|205.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|343.00||||343.00|171.84|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|343.00||||343.00|27.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|343.00||||343.00|146.12|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|343.00||||343.00|34.33|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|343.00||||343.00|120.39|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|343.00||||343.00|171.5|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|343.00||||343.00|29.19|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|343.00||||343.00|30.58|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|343.00||||343.00|30.58|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|343.00||||343.00|27.8|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|343.00||||343.00|29.09|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|343.00||||343.00|343|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|343.00||||343.00|308.7|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|343.00||||343.00|30.12|343|18.53 30182507|EAP|0301 - LABORATORY-CHEMISTRY|HC CITRATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|343.00||||343.00||| 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216.00||||216.00|20.55|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216.00||||216.00|108|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216.00||||216.00|23.07|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|216.00||||216.00|92.02|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216.00||||216.00|75.82|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216.00||||216.00|129.6|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216.00||||216.00|19.61|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216.00||||216.00|20.24|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|216.00||||216.00|12.46|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|TRUSTMARK [2030]|STARMARK [203000]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|AETNA [1015]|AETNA ACO WILCO [101532]|216.00||||216.00|29.53|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MULTIPLAN [1680]|IHC HS [168011]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MULTIPLAN [1680]|HMA [168003]|216.00||||216.00|28.02|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|FMH BENEFIT SERVICES [1390]|FMH [139000]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|FIRST HEALTH [1375]|QUALCHOICE [137513]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|216.00||||216.00|26.85|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216.00||||216.00|23.07|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|HEALTHNET [1495]|HEALTHNET [149500]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|216.00||||216.00|23.14|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216.00||||216.00|19.05|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216.00||||216.00|20.55|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|UMR [2035]|UMR OPTIONS [203501]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216.00||||216.00|27.27|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216.00||||216.00|45.36|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|||216.00||||216.00|64.8|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216.00||||216.00|20.24|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|CHAMPVA [1240]|CHAMP VA [124000]|216.00||||216.00|162|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|216.00||||216.00|108.22|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|216.00||||216.00|26.85|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216.00||||216.00|18.62|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|216.00||||216.00|21.04|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|CORESOURCE [1315]|CORESOURCE [131500]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|GEHA [1415]|GEHA [141500]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216.00||||216.00|194.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216.00||||216.00|19.55|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216.00||||216.00|103.57|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216.00||||216.00|216|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216.00||||216.00|140.4|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216.00||||216.00|18.68|216|12.46 30182523|EAP|0301 - LABORATORY-CHEMISTRY|HC COLLAGEN CROSS LINKS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|216.00||||216.00||| 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|498.00||||498.00|13.98|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|CORESOURCE [1315]|CORESOURCE [131500]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|498.00||||498.00|17.84|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|CHAMPVA [1240]|CHAMP VA [124000]|498.00||||498.00|373.5|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|498.00||||498.00|12.37|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|||498.00||||498.00|149.4|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|498.00||||498.00|323.7|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|498.00||||498.00|238.79|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|498.00||||498.00|498|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|498.00||||498.00|104.58|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|498.00||||498.00|18.12|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|UMR [2035]|UMR OPTIONS [203501]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|498.00||||498.00|12.66|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|498.00||||498.00|15.38|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|498.00||||498.00|15.32|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|FIRST HEALTH [1375]|QUALCHOICE [137513]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|FMH BENEFIT SERVICES [1390]|FMH [139000]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|498.00||||498.00|13.45|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|498.00||||498.00|17.84|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MULTIPLAN [1680]|IHC HS [168011]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MULTIPLAN [1680]|HMA [168003]|498.00||||498.00|18.62|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|HEALTHNET [1495]|HEALTHNET [149500]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|AETNA [1015]|AETNA ACO WILCO [101532]|498.00||||498.00|19.61|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|498.00||||498.00|13.65|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|498.00||||498.00|13.45|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|498.00||||498.00|13.03|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|498.00||||498.00|249.5|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|498.00||||498.00|15.32|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|498.00||||498.00|174.8|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|498.00||||498.00|212.15|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|498.00||||498.00|249|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|498.00||||498.00|298.8|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|GEHA [1415]|GEHA [141500]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|498.00||||498.00|13.65|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|498.00||||498.00|12.99|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|498.00||||498.00|8.27|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|TRUSTMARK [2030]|STARMARK [203000]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|498.00||||498.00|12.41|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|498.00||||498.00|448.2|498|8.27 30182525|EAP|0301 - LABORATORY-CHEMISTRY|HC COPPER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|498.00||||498.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368.00||||368.00|27.8|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|368.00||||368.00|156.77|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368.00||||368.00|129.17|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|368.00||||368.00|184.37|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368.00||||368.00|220.8|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368.00||||368.00|24.4|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368.00||||368.00|23.56|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|TRUSTMARK [2030]|STARMARK [203000]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|HEALTHNET [1495]|HEALTHNET [149500]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MULTIPLAN [1680]|IHC HS [168011]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|AETNA [1015]|AETNA ACO WILCO [101532]|368.00||||368.00|35.59|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|368.00||||368.00|15.01|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368.00||||368.00|27.8|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|368.00||||368.00|27.9|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|UMR [2035]|UMR OPTIONS [203501]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368.00||||368.00|77.28|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368.00||||368.00|368|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368.00||||368.00|22.44|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|CHAMPVA [1240]|CHAMP VA [124000]|368.00||||368.00|276|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368.00||||368.00|184|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|368.00||||368.00|25.36|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|CORESOURCE [1315]|CORESOURCE [131500]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|GEHA [1415]|GEHA [141500]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368.00||||368.00|24.4|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368.00||||368.00|239.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|||368.00||||368.00|110.4|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368.00||||368.00|176.46|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368.00||||368.00|331.2|368|15.01 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MULTIPLAN [1680]|HMA [168003]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|368.00||||368.00||| 30182528|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTICOSTERONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368.00||||368.00||| 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|GEHA [1415]|GEHA [141500]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|CORESOURCE [1315]|CORESOURCE [131500]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|287.00||||287.00|24.02|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|CHAMPVA [1240]|CHAMP VA [124000]|287.00||||287.00|215.25|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|287.00||||287.00|18.11|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|||287.00||||287.00|86.1|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|287.00||||287.00|186.55|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|287.00||||287.00|137.62|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|287.00||||287.00|60.27|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|UMR [2035]|UMR OPTIONS [203501]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|287.00||||287.00|17.04|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|287.00||||287.00|20.7|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|287.00||||287.00|287|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|287.00||||287.00|20.63|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|287.00||||287.00|24.4|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MULTIPLAN [1680]|IHC HS [168011]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|287.00||||287.00|24.02|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MULTIPLAN [1680]|HMA [168003]|287.00||||287.00|25.07|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|HEALTHNET [1495]|HEALTHNET [149500]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|AETNA [1015]|AETNA ACO WILCO [101532]|287.00||||287.00|26.41|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|TRUSTMARK [2030]|STARMARK [203000]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|287.00||||287.00|17.55|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|287.00||||287.00|172.2|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|287.00||||287.00|20.63|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|287.00||||287.00|100.74|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|287.00||||287.00|143.5|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|287.00||||287.00|16.65|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|287.00||||287.00|18.82|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|287.00||||287.00|18.38|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|287.00||||287.00|18.11|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|287.00||||287.00|122.26|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|287.00||||287.00|16.71|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|287.00||||287.00|18.38|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|287.00||||287.00|17.48|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|287.00||||287.00|11.14|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|287.00||||287.00|258.3|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|287.00||||287.00|143.79|287|11.14 30182530|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|287.00||||287.00||| 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|269.00||||269.00|17.93|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|269.00||||269.00|134.5|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|269.00||||269.00|134.77|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|269.00||||269.00|114.59|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|269.00||||269.00|94.42|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|269.00||||269.00|161.4|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|269.00||||269.00|17.66|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|269.00||||269.00|17.93|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|269.00||||269.00|10.87|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MULTIPLAN [1680]|IHC HS [168011]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MULTIPLAN [1680]|HMA [168003]|269.00||||269.00|24.45|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|269.00||||269.00|17.06|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|269.00||||269.00|20.12|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|269.00||||269.00|23.43|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|269.00||||269.00|20.2|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|269.00||||269.00|16.63|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|TRUSTMARK [2030]|STARMARK [203000]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|UMR [2035]|UMR OPTIONS [203501]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|269.00||||269.00|23.8|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|269.00||||269.00|56.49|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|269.00||||269.00|128.99|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|269.00||||269.00|17.66|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|269.00||||269.00|17.12|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|269.00||||269.00|201.75|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|269.00||||269.00|20.12|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|269.00||||269.00|23.43|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|269.00||||269.00|18.36|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|269.00||||269.00|16.25|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|GEHA [1415]|GEHA [141500]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|||269.00||||269.00|80.7|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|269.00||||269.00|174.85|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|269.00||||269.00|269|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|269.00||||269.00|16.3|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|269.00||||269.00|25.76|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|269.00||||269.00|242.1|269|10.87 30182533|EAP|0301 - LABORATORY-CHEMISTRY|HC CORTISOL TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|269.00||||269.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|494.00||||494.00|5.23|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|GEHA [1415]|GEHA [141500]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|CORESOURCE [1315]|CORESOURCE [131500]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494.00||||494.00|4.63|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|||494.00||||494.00|148.2|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494.00||||494.00|321.1|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|UMR [2035]|UMR OPTIONS [203501]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|494.00||||494.00|5.75|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494.00||||494.00|103.74|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494.00||||494.00|494|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494.00||||494.00|5.72|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494.00||||494.00|5.03|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MULTIPLAN [1680]|IHC HS [168011]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|HEALTHNET [1495]|HEALTHNET [149500]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|AETNA [1015]|AETNA ACO WILCO [101532]|494.00||||494.00|7.32|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494.00||||494.00|4.86|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494.00||||494.00|5.72|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|494.00||||494.00|247.49|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494.00||||494.00|296.4|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494.00||||494.00|247|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|CHAMPVA [1240]|CHAMP VA [124000]|494.00||||494.00|370.5|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|494.00||||494.00|210.44|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494.00||||494.00|173.39|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494.00||||494.00|5.03|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|494.00||||494.00|3.09|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494.00||||494.00|236.87|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|TRUSTMARK [2030]|STARMARK [203000]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494.00||||494.00|444.6|494|3.09 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MULTIPLAN [1680]|HMA [168003]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|494.00||||494.00||| 30182540|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494.00||||494.00||| 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|312.00||||312.00|26.5|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|312.00||||312.00|132.91|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|312.00||||312.00|109.51|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|312.00||||312.00|156.31|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|312.00||||312.00|187.2|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|312.00||||312.00|25.29|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|312.00||||312.00|26.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|312.00||||312.00|25.2|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|TRUSTMARK [2030]|STARMARK [203000]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MULTIPLAN [1680]|IHC HS [168011]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|AETNA [1015]|AETNA ACO WILCO [101532]|312.00||||312.00|34.26|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|312.00||||312.00|14.45|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|312.00||||312.00|29.83|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|312.00||||312.00|24.57|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|HEALTHNET [1495]|HEALTHNET [149500]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MULTIPLAN [1680]|HMA [168003]|312.00||||312.00|36.14|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|312.00||||312.00|34.63|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|UMR [2035]|UMR OPTIONS [203501]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|312.00||||312.00|35.17|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|312.00||||312.00|65.52|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|312.00||||312.00|312|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|312.00||||312.00|24|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|312.00||||312.00|156|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|CHAMPVA [1240]|CHAMP VA [124000]|312.00||||312.00|234|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|312.00||||312.00|34.63|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|CORESOURCE [1315]|CORESOURCE [131500]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|312.00||||312.00|27.12|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|312.00||||312.00|26.5|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|GEHA [1415]|GEHA [141500]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|312.00||||312.00|26.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|||312.00||||312.00|93.6|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|312.00||||312.00|202.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|312.00||||312.00|149.6|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|312.00||||312.00|24.09|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|312.00||||312.00|280.8|312|14.45 30182542|EAP|0301 - LABORATORY-CHEMISTRY|HC COL-CHR/MS NONDRUG ANALYT NES QL/QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|312.00||||312.00||| 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|GEHA [1415]|GEHA [141500]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|197.00||||197.00|7.33|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|197.00||||197.00|9.36|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|CHAMPVA [1240]|CHAMP VA [124000]|197.00||||197.00|147.75|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|197.00||||197.00|6.49|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|||197.00||||197.00|59.1|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|197.00||||197.00|128.05|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|197.00||||197.00|41.37|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|UMR [2035]|UMR OPTIONS [203501]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|197.00||||197.00|6.64|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|197.00||||197.00|8.07|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|FIRST HEALTH [1375]|QUALCHOICE [137513]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|197.00||||197.00|197|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|FMH BENEFIT SERVICES [1390]|FMH [139000]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|197.00||||197.00|9.5|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|197.00||||197.00|8.04|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|197.00||||197.00|94.46|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MULTIPLAN [1680]|IHC HS [168011]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MULTIPLAN [1680]|HMA [168003]|197.00||||197.00|9.77|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|197.00||||197.00|9.36|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|197.00||||197.00|7.05|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|HEALTHNET [1495]|HEALTHNET [149500]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|TRUSTMARK [2030]|STARMARK [203000]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|197.00||||197.00|118.2|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|197.00||||197.00|98.5|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|197.00||||197.00|69.15|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|197.00||||197.00|83.92|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|197.00||||197.00|8.04|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|197.00||||197.00|98.7|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|CORESOURCE [1315]|CORESOURCE [131500]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|197.00||||197.00|6.84|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|197.00||||197.00|7.05|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|197.00||||197.00|7.16|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|197.00||||197.00|6.51|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|197.00||||197.00|7.16|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|197.00||||197.00|6.81|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|197.00||||197.00|4.34|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|197.00||||197.00|177.3|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|AETNA [1015]|AETNA ACO WILCO [101532]|197.00||||197.00|10.28|197|4.34 30182550|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|197.00||||197.00||| 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154.00||||154.00|14.73|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|154.00||||154.00|77.15|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154.00||||154.00|54.05|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|154.00||||154.00|65.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154.00||||154.00|77|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154.00||||154.00|92.4|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154.00||||154.00|14.06|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154.00||||154.00|14.51|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154.00||||154.00|14.73|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154.00||||154.00|14.01|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|154.00||||154.00|8.93|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|HEALTHNET [1495]|HEALTHNET [149500]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|AETNA [1015]|AETNA ACO WILCO [101532]|154.00||||154.00|21.17|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|154.00||||154.00|19.25|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MULTIPLAN [1680]|IHC HS [168011]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MULTIPLAN [1680]|HMA [168003]|154.00||||154.00|20.09|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|TRUSTMARK [2030]|STARMARK [203000]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|FMH BENEFIT SERVICES [1390]|FMH [139000]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|FIRST HEALTH [1375]|QUALCHOICE [137513]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154.00||||154.00|16.53|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|154.00||||154.00|16.59|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154.00||||154.00|13.66|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|UMR [2035]|UMR OPTIONS [203501]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154.00||||154.00|19.55|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154.00||||154.00|32.34|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154.00||||154.00|73.84|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154.00||||154.00|14.51|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|CHAMPVA [1240]|CHAMP VA [124000]|154.00||||154.00|115.5|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154.00||||154.00|16.53|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|154.00||||154.00|19.25|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154.00||||154.00|13.35|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|CORESOURCE [1315]|CORESOURCE [131500]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|154.00||||154.00|15.08|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|GEHA [1415]|GEHA [141500]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|||154.00||||154.00|46.2|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154.00||||154.00|138.6|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154.00||||154.00|154|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154.00||||154.00|100.1|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154.00||||154.00|13.39|154|8.93 30182552|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE ISOENZYME|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|154.00||||154.00||| 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|239.00||||239.00|13.01|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|CORESOURCE [1315]|CORESOURCE [131500]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|239.00||||239.00|16.6|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|239.00||||239.00|11.52|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|239.00||||239.00|155.35|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|239.00||||239.00|14.31|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|239.00||||239.00|14.26|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|UMR [2035]|UMR OPTIONS [203501]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|239.00||||239.00|11.78|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|239.00||||239.00|50.19|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|239.00||||239.00|239|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MULTIPLAN [1680]|HMA [168003]|239.00||||239.00|17.33|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MULTIPLAN [1680]|IHC HS [168011]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|239.00||||239.00|114.6|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|||239.00||||239.00|71.7|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|239.00||||239.00|16.6|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|HEALTHNET [1495]|HEALTHNET [149500]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|TRUSTMARK [2030]|STARMARK [203000]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|239.00||||239.00|12.13|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|239.00||||239.00|101.81|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|239.00||||239.00|119.74|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|239.00||||239.00|119.5|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|239.00||||239.00|83.89|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|239.00||||239.00|14.26|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|239.00||||239.00|11.55|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|CHAMPVA [1240]|CHAMP VA [124000]|239.00||||239.00|179.25|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|GEHA [1415]|GEHA [141500]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|239.00||||239.00|12.52|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|239.00||||239.00|12.71|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|239.00||||239.00|12.71|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|239.00||||239.00|215.1|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|239.00||||239.00|7.7|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|239.00||||239.00|12.09|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|239.00||||239.00|16.86|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|239.00||||239.00|18.24|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|239.00||||239.00|143.4|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|239.00||||239.00|12.52|239|7.7 30182553|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATINE KINASE (CPK) MB ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|239.00||||239.00||| 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|229.00||||229.00|5.54|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|||229.00||||229.00|68.7|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|229.00||||229.00|5.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|CHAMPVA [1240]|CHAMP VA [124000]|229.00||||229.00|171.75|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|229.00||||229.00|7.36|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|CORESOURCE [1315]|CORESOURCE [131500]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|229.00||||229.00|5.76|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|GEHA [1415]|GEHA [141500]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|229.00||||229.00|5.63|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|229.00||||229.00|97.55|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|229.00||||229.00|6.33|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|229.00||||229.00|114.73|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|229.00||||229.00|137.4|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|229.00||||229.00|5.38|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|229.00||||229.00|5.54|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|229.00||||229.00|5.63|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|229.00||||229.00|5.36|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|229.00||||229.00|3.41|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|AETNA [1015]|AETNA ACO WILCO [101532]|229.00||||229.00|8.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|TRUSTMARK [2030]|STARMARK [203000]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|HEALTHNET [1495]|HEALTHNET [149500]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MULTIPLAN [1680]|IHC HS [168011]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MULTIPLAN [1680]|HMA [168003]|229.00||||229.00|7.68|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|229.00||||229.00|7.36|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|FMH BENEFIT SERVICES [1390]|FMH [139000]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|FIRST HEALTH [1375]|QUALCHOICE [137513]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|229.00||||229.00|6.33|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|229.00||||229.00|114.5|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|229.00||||229.00|80.38|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|229.00||||229.00|6.33|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|229.00||||229.00|5.22|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|UMR [2035]|UMR OPTIONS [203501]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|229.00||||229.00|7.48|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|229.00||||229.00|48.09|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|229.00||||229.00|5.12|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|229.00||||229.00|229|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|229.00||||229.00|206.1|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|229.00||||229.00|109.81|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|229.00||||229.00|148.85|229|3.41 30182565|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|229.00||||229.00|6.33|229|3.41 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|GEHA [1415]|GEHA [141500]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|225.00||||225.00|5.83|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|CORESOURCE [1315]|CORESOURCE [131500]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|225.00||||225.00|7.45|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|CHAMPVA [1240]|CHAMP VA [124000]|225.00||||225.00|168.75|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225.00||||225.00|5.61|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|||225.00||||225.00|67.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225.00||||225.00|146.25|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225.00||||225.00|107.89|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225.00||||225.00|225|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225.00||||225.00|47.25|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|UMR [2035]|UMR OPTIONS [203501]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225.00||||225.00|5.28|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|225.00||||225.00|6.41|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225.00||||225.00|6.39|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|225.00||||225.00|7.45|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225.00||||225.00|7.56|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MULTIPLAN [1680]|IHC HS [168011]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MULTIPLAN [1680]|HMA [168003]|225.00||||225.00|7.77|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|HEALTHNET [1495]|HEALTHNET [149500]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|TRUSTMARK [2030]|STARMARK [203000]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|AETNA [1015]|AETNA ACO WILCO [101532]|225.00||||225.00|8.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|225.00||||225.00|3.45|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225.00||||225.00|5.17|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225.00||||225.00|5.42|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225.00||||225.00|5.7|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225.00||||225.00|5.61|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225.00||||225.00|5.44|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225.00||||225.00|135|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225.00||||225.00|112.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225.00||||225.00|78.98|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225.00||||225.00|6.39|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|225.00||||225.00|112.73|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|225.00||||225.00|95.85|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225.00||||225.00|5.18|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225.00||||225.00|202.5|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225.00||||225.00|5.7|225|3.45 30182570|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE OTHER SOURCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|225.00||||225.00||| 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|498.00||||498.00|10.41|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|498.00||||498.00|11.67|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|498.00||||498.00|174.8|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|498.00||||498.00|212.15|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|498.00||||498.00|249.5|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|498.00||||498.00|249|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|498.00||||498.00|298.8|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|498.00||||498.00|10.25|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|498.00||||498.00|10.41|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|498.00||||498.00|9.9|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|AETNA [1015]|AETNA ACO WILCO [101532]|498.00||||498.00|14.95|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|TRUSTMARK [2030]|STARMARK [203000]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|HEALTHNET [1495]|HEALTHNET [149500]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|498.00||||498.00|13.6|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MULTIPLAN [1680]|HMA [168003]|498.00||||498.00|14.19|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MULTIPLAN [1680]|IHC HS [168011]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|498.00||||498.00|11.67|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|498.00||||498.00|11.72|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|498.00||||498.00|9.65|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|UMR [2035]|UMR OPTIONS [203501]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|498.00||||498.00|6.31|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|498.00||||498.00|13.81|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|498.00||||498.00|104.58|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|498.00||||498.00|9.93|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|498.00||||498.00|498|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|498.00||||498.00|238.79|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|498.00||||498.00|323.7|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|||498.00||||498.00|149.4|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|498.00||||498.00|10.25|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|498.00||||498.00|9.46|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|498.00||||498.00|9.43|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|CHAMPVA [1240]|CHAMP VA [124000]|498.00||||498.00|373.5|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|498.00||||498.00|13.6|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|CORESOURCE [1315]|CORESOURCE [131500]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|498.00||||498.00|10.65|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|GEHA [1415]|GEHA [141500]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|498.00||||498.00|448.2|498|6.31 30182575|EAP|0301 - LABORATORY-CHEMISTRY|HC CREATININE CLEARANCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|498.00||||498.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|100.00||||100.00|15.92|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|CORESOURCE [1315]|CORESOURCE [131500]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100.00||||100.00|14.09|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|||100.00||||100.00|30|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100.00||||100.00|65|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100.00||||100.00|100|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100.00||||100.00|21|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|UMR [2035]|UMR OPTIONS [203501]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|100.00||||100.00|17.51|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100.00||||100.00|14.14|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MULTIPLAN [1680]|IHC HS [168011]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|HEALTHNET [1495]|HEALTHNET [149500]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|TRUSTMARK [2030]|STARMARK [203000]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|AETNA [1015]|AETNA ACO WILCO [101532]|100.00||||100.00|20.12|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100.00||||100.00|47.95|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100.00||||100.00|15.32|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|100.00||||100.00|8.48|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100.00||||100.00|14.8|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|CHAMPVA [1240]|CHAMP VA [124000]|100.00||||100.00|75|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|GEHA [1415]|GEHA [141500]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100.00||||100.00|15.32|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100.00||||100.00|60|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100.00||||100.00|50|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100.00||||100.00|14.14|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|100.00||||100.00|50.1|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100.00||||100.00|35.1|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|100.00||||100.00|42.6|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100.00||||100.00|90|100|8.48 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MULTIPLAN [1680]|HMA [168003]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100.00||||100.00||| 30182585|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOFIBRINOGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100.00||||100.00||| 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106.00||||106.00|37.21|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106.00||||106.00|7.98|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|106.00||||106.00|53.11|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106.00||||106.00|63.6|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106.00||||106.00|6.79|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106.00||||106.00|7.01|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106.00||||106.00|7.12|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106.00||||106.00|6.77|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|106.00||||106.00|4.31|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|AETNA [1015]|AETNA ACO WILCO [101532]|106.00||||106.00|10.21|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|TRUSTMARK [2030]|STARMARK [203000]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MULTIPLAN [1680]|HMA [168003]|106.00||||106.00|9.71|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|106.00||||106.00|9.3|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MULTIPLAN [1680]|IHC HS [168011]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106.00||||106.00|7.98|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|HEALTHNET [1495]|HEALTHNET [149500]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|106.00||||106.00|8.01|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106.00||||106.00|6.6|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|UMR [2035]|UMR OPTIONS [203501]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106.00||||106.00|9.45|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106.00||||106.00|22.26|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106.00||||106.00|106|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106.00||||106.00|50.83|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106.00||||106.00|53|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106.00||||106.00|68.9|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|106.00||||106.00|45.16|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|||106.00||||106.00|31.8|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106.00||||106.00|7.01|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106.00||||106.00|7.12|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106.00||||106.00|6.47|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106.00||||106.00|6.44|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|CHAMPVA [1240]|CHAMP VA [124000]|106.00||||106.00|79.5|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|106.00||||106.00|9.3|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|CORESOURCE [1315]|CORESOURCE [131500]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|106.00||||106.00|7.29|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|GEHA [1415]|GEHA [141500]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106.00||||106.00|95.4|106|4.31 30182595|EAP|0301 - LABORATORY-CHEMISTRY|HC CRYOGLOBULINS QL/SEMI-QUANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|106.00||||106.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|GEHA [1415]|GEHA [141500]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|332.00||||332.00|21.85|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|CHAMPVA [1240]|CHAMP VA [124000]|332.00||||332.00|249|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|332.00||||332.00|21.02|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|||332.00||||332.00|99.6|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|332.00||||332.00|215.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|332.00||||332.00|159.19|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|332.00||||332.00|69.72|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|UMR [2035]|UMR OPTIONS [203501]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|332.00||||332.00|24.03|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|332.00||||332.00|23.95|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|332.00||||332.00|332|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MULTIPLAN [1680]|IHC HS [168011]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|HEALTHNET [1495]|HEALTHNET [149500]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|TRUSTMARK [2030]|STARMARK [203000]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|AETNA [1015]|AETNA ACO WILCO [101532]|332.00||||332.00|30.65|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|332.00||||332.00|12.93|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|332.00||||332.00|19.33|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|332.00||||332.00|20.3|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|CORESOURCE [1315]|CORESOURCE [131500]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|332.00||||332.00|21.02|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|332.00||||332.00|199.2|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|332.00||||332.00|166|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|332.00||||332.00|23.95|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|332.00||||332.00|116.53|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|332.00||||332.00|166.33|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|332.00||||332.00|141.43|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|332.00||||332.00|298.8|332|12.93 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MULTIPLAN [1680]|HMA [168003]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|332.00||||332.00||| 30182600|EAP|0301 - LABORATORY-CHEMISTRY|HC CYANIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|332.00||||332.00||| 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|303.00||||303.00|16.59|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|303.00||||303.00|129.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|303.00||||303.00|18.61|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|303.00||||303.00|151.8|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|303.00||||303.00|151.5|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|303.00||||303.00|181.8|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|303.00||||303.00|16.34|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|303.00||||303.00|16.59|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|303.00||||303.00|15.78|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|303.00||||303.00|10.05|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|AETNA [1015]|AETNA ACO WILCO [101532]|303.00||||303.00|23.82|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|TRUSTMARK [2030]|STARMARK [203000]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|HEALTHNET [1495]|HEALTHNET [149500]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MULTIPLAN [1680]|IHC HS [168011]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|303.00||||303.00|21.68|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|FMH BENEFIT SERVICES [1390]|FMH [139000]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|FIRST HEALTH [1375]|QUALCHOICE [137513]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|303.00||||303.00|18.61|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|303.00||||303.00|18.68|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|303.00||||303.00|15.38|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MULTIPLAN [1680]|HMA [168003]|303.00||||303.00|22.62|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|AETNA [1015]|COVENTRY HEALTHCARE [101502]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|UMR [2035]|UMR OPTIONS [203501]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|303.00||||303.00|22.02|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|303.00||||303.00|63.63|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|303.00||||303.00|15.83|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|303.00||||303.00|303|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|303.00||||303.00|145.29|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|303.00||||303.00|106.35|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|303.00||||303.00|196.95|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|||303.00||||303.00|90.9|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|303.00||||303.00|16.34|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|303.00||||303.00|15.08|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|303.00||||303.00|15.03|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|CHAMPVA [1240]|CHAMP VA [124000]|303.00||||303.00|227.25|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|303.00||||303.00|21.68|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|CORESOURCE [1315]|CORESOURCE [131500]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|303.00||||303.00|16.98|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|GEHA [1415]|GEHA [141500]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|303.00||||303.00|272.7|303|10.05 30182607|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B12|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|303.00||||303.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|GEHA [1415]|GEHA [141500]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|244.00||||244.00|16.12|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|CORESOURCE [1315]|CORESOURCE [131500]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|CHAMPVA [1240]|CHAMP VA [124000]|244.00||||244.00|183|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244.00||||244.00|14.27|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|||244.00||||244.00|73.2|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244.00||||244.00|158.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244.00||||244.00|244|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244.00||||244.00|51.24|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|UMR [2035]|UMR OPTIONS [203501]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|244.00||||244.00|17.73|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244.00||||244.00|17.68|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|FIRST HEALTH [1375]|QUALCHOICE [137513]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|FMH BENEFIT SERVICES [1390]|FMH [139000]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MULTIPLAN [1680]|IHC HS [168011]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244.00||||244.00|117|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|HEALTHNET [1495]|HEALTHNET [149500]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|TRUSTMARK [2030]|STARMARK [203000]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244.00||||244.00|15.51|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|AETNA [1015]|AETNA ACO WILCO [101532]|244.00||||244.00|22.64|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|244.00||||244.00|9.55|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244.00||||244.00|14.98|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244.00||||244.00|15.51|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244.00||||244.00|146.4|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244.00||||244.00|122|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244.00||||244.00|17.68|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244.00||||244.00|85.64|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|244.00||||244.00|103.94|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|244.00||||244.00|122.24|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244.00||||244.00|219.6|244|9.55 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MULTIPLAN [1680]|HMA [168003]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244.00||||244.00||| 30182608|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-12 BINDING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244.00||||244.00||| 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|222.00||||222.00|111.22|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222.00||||222.00|77.92|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|222.00||||222.00|94.57|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222.00||||222.00|111|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222.00||||222.00|133.2|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222.00||||222.00|19.45|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222.00||||222.00|20.07|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222.00||||222.00|20.37|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222.00||||222.00|19.38|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|222.00||||222.00|11.11|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|AETNA [1015]|AETNA ACO WILCO [101532]|222.00||||222.00|26.34|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|TRUSTMARK [2030]|STARMARK [203000]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|HEALTHNET [1495]|HEALTHNET [149500]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MULTIPLAN [1680]|IHC HS [168011]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MULTIPLAN [1680]|HMA [168003]|222.00||||222.00|27.78|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|222.00||||222.00|26.62|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|FMH BENEFIT SERVICES [1390]|FMH [139000]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|FIRST HEALTH [1375]|QUALCHOICE [137513]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|222.00||||222.00|22.95|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222.00||||222.00|18.89|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|UMR [2035]|UMR OPTIONS [203501]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222.00||||222.00|27.04|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222.00||||222.00|46.62|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222.00||||222.00|222|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222.00||||222.00|106.45|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222.00||||222.00|144.3|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|||222.00||||222.00|66.6|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222.00||||222.00|20.07|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222.00||||222.00|20.37|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222.00||||222.00|18.52|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222.00||||222.00|18.46|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|CHAMPVA [1240]|CHAMP VA [124000]|222.00||||222.00|166.5|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|222.00||||222.00|26.62|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|CORESOURCE [1315]|CORESOURCE [131500]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|222.00||||222.00|20.86|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|GEHA [1415]|GEHA [141500]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222.00||||222.00|199.8|222|11.11 30182610|EAP|0301 - LABORATORY-CHEMISTRY|HC CYSTATIN C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|222.00||||222.00||| 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|GEHA [1415]|GEHA [141500]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|579.00||||579.00|28.45|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|579.00||||579.00|36.33|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|CHAMPVA [1240]|CHAMP VA [124000]|579.00||||579.00|434.25|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|579.00||||579.00|27.37|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|||579.00||||579.00|173.7|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|579.00||||579.00|376.35|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|579.00||||579.00|277.63|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|579.00||||579.00|121.59|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|UMR [2035]|UMR OPTIONS [203501]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|579.00||||579.00|25.78|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|579.00||||579.00|31.3|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|579.00||||579.00|31.2|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|FIRST HEALTH [1375]|QUALCHOICE [137513]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|FMH BENEFIT SERVICES [1390]|FMH [139000]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|579.00||||579.00|36.33|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|579.00||||579.00|36.89|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|579.00||||579.00|579|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MULTIPLAN [1680]|HMA [168003]|579.00||||579.00|37.91|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MULTIPLAN [1680]|IHC HS [168011]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|HEALTHNET [1495]|HEALTHNET [149500]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|TRUSTMARK [2030]|STARMARK [203000]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|AETNA [1015]|AETNA ACO WILCO [101532]|579.00||||579.00|39.94|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|579.00||||579.00|16.85|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|579.00||||579.00|25.18|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|579.00||||579.00|26.44|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|579.00||||579.00|27.8|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|CORESOURCE [1315]|CORESOURCE [131500]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|579.00||||579.00|27.37|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|579.00||||579.00|26.53|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|579.00||||579.00|347.4|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|579.00||||579.00|289.5|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|579.00||||579.00|203.23|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|579.00||||579.00|290.08|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|579.00||||579.00|246.65|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|579.00||||579.00|31.2|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|579.00||||579.00|25.27|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|579.00||||579.00|521.1|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|579.00||||579.00|27.8|579|16.85 30182626|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|579.00||||579.00||| 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|438.00||||438.00|24.45|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|438.00||||438.00|27.45|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|438.00||||438.00|153.74|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|438.00||||438.00|219.44|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|438.00||||438.00|219|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|438.00||||438.00|262.8|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|438.00||||438.00|24.09|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|438.00||||438.00|24.45|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|438.00||||438.00|23.27|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|AETNA [1015]|COVENTRY HEALTHCARE [101502]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|TRUSTMARK [2030]|STARMARK [203000]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|HEALTHNET [1495]|HEALTHNET [149500]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|438.00||||438.00|31.96|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MULTIPLAN [1680]|IHC HS [168011]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|FMH BENEFIT SERVICES [1390]|FMH [139000]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MULTIPLAN [1680]|HMA [168003]|438.00||||438.00|33.35|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|FIRST HEALTH [1375]|QUALCHOICE [137513]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|438.00||||438.00|27.45|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|438.00||||438.00|27.54|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|438.00||||438.00|22.67|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|AETNA [1015]|AETNA ACO WILCO [101532]|438.00||||438.00|35.15|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|UMR [2035]|UMR OPTIONS [203501]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|438.00||||438.00|14.83|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|438.00||||438.00|32.46|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|438.00||||438.00|91.98|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|438.00||||438.00|438|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|438.00||||438.00|210.02|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|438.00||||438.00|23.34|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|438.00||||438.00|186.59|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|438.00||||438.00|284.7|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|||438.00||||438.00|131.4|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|438.00||||438.00|24.09|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|438.00||||438.00|22.23|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|438.00||||438.00|22.16|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|CHAMPVA [1240]|CHAMP VA [124000]|438.00||||438.00|328.5|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|438.00||||438.00|31.96|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|CORESOURCE [1315]|CORESOURCE [131500]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|438.00||||438.00|25.04|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|GEHA [1415]|GEHA [141500]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|438.00||||438.00|394.2|438|14.83 30182627|EAP|0301 - LABORATORY-CHEMISTRY|HC DHEA-S|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|438.00||||438.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|GEHA [1415]|GEHA [141500]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|508.00||||508.00|34.88|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|CORESOURCE [1315]|CORESOURCE [131500]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|508.00||||508.00|30.87|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|508.00||||508.00|33.56|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|||508.00||||508.00|152.4|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|508.00||||508.00|330.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|508.00||||508.00|243.59|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|508.00||||508.00|508|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|508.00||||508.00|106.68|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|UMR [2035]|UMR OPTIONS [203501]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|508.00||||508.00|38.37|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|508.00||||508.00|38.25|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MULTIPLAN [1680]|IHC HS [168011]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|HEALTHNET [1495]|HEALTHNET [149500]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|TRUSTMARK [2030]|STARMARK [203000]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|AETNA [1015]|AETNA ACO WILCO [101532]|508.00||||508.00|48.98|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|508.00||||508.00|20.66|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|508.00||||508.00|32.41|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|CHAMPVA [1240]|CHAMP VA [124000]|508.00||||508.00|381|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|508.00||||508.00|33.56|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|508.00||||508.00|304.8|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|508.00||||508.00|254|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|508.00||||508.00|178.31|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|508.00||||508.00|216.41|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|508.00||||508.00|254.51|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|508.00||||508.00|38.25|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|508.00||||508.00|457.2|508|20.66 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MULTIPLAN [1680]|HMA [168003]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|508.00||||508.00||| 30182633|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTICOSTERONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|508.00||||508.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|494.00||||494.00|210.44|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494.00||||494.00|36.14|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|494.00||||494.00|247.49|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494.00||||494.00|173.39|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494.00||||494.00|296.4|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494.00||||494.00|31.72|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494.00||||494.00|30.64|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|494.00||||494.00|19.52|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|AETNA [1015]|AETNA ACO WILCO [101532]|494.00||||494.00|46.27|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|TRUSTMARK [2030]|STARMARK [203000]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MULTIPLAN [1680]|IHC HS [168011]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494.00||||494.00|36.14|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|HEALTHNET [1495]|HEALTHNET [149500]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|494.00||||494.00|36.26|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|UMR [2035]|UMR OPTIONS [203501]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494.00||||494.00|103.74|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494.00||||494.00|494|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494.00||||494.00|247|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494.00||||494.00|236.87|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494.00||||494.00|321.1|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|||494.00||||494.00|148.2|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494.00||||494.00|31.72|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494.00||||494.00|29.18|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|CHAMPVA [1240]|CHAMP VA [124000]|494.00||||494.00|370.5|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|CORESOURCE [1315]|CORESOURCE [131500]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|494.00||||494.00|32.97|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|GEHA [1415]|GEHA [141500]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494.00||||494.00|444.6|494|19.52 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MULTIPLAN [1680]|HMA [168003]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494.00||||494.00||| 30182634|EAP|0301 - LABORATORY-CHEMISTRY|HC DEOXYCORTISOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|494.00||||494.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|GEHA [1415]|GEHA [141500]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|152.00||||152.00|13.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|CHAMPVA [1240]|CHAMP VA [124000]|152.00||||152.00|114|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|152.00||||152.00|12.21|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|152.00||||152.00|13.28|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|||152.00||||152.00|45.6|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|152.00||||152.00|98.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|152.00||||152.00|72.88|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|152.00||||152.00|31.92|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|UMR [2035]|UMR OPTIONS [203501]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|152.00||||152.00|15.19|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|152.00||||152.00|15.12|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|FIRST HEALTH [1375]|QUALCHOICE [137513]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|FMH BENEFIT SERVICES [1390]|FMH [139000]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MULTIPLAN [1680]|IHC HS [168011]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|HEALTHNET [1495]|HEALTHNET [149500]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|152.00||||152.00|152|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|TRUSTMARK [2030]|STARMARK [203000]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|AETNA [1015]|AETNA ACO WILCO [101532]|152.00||||152.00|19.35|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|152.00||||152.00|8.17|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|152.00||||152.00|12.82|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|CORESOURCE [1315]|CORESOURCE [131500]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|152.00||||152.00|13.28|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|152.00||||152.00|91.2|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|152.00||||152.00|76|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|152.00||||152.00|53.35|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|152.00||||152.00|15.12|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|152.00||||152.00|64.75|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|152.00||||152.00|76.15|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|152.00||||152.00|136.8|152|8.17 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MULTIPLAN [1680]|HMA [168003]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|152.00||||152.00||| 30182638|EAP|0301 - LABORATORY-CHEMISTRY|HC DIBUCAINE NUMBER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|152.00||||152.00||| 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|666.00||||666.00|42.35|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|666.00||||666.00|233.77|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|666.00||||666.00|333.67|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|666.00||||666.00|47.53|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|666.00||||666.00|333|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|666.00||||666.00|399.6|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|666.00||||666.00|40.43|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|666.00||||666.00|41.71|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|666.00||||666.00|42.35|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|666.00||||666.00|40.28|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|AETNA [1015]|AETNA ACO WILCO [101532]|666.00||||666.00|60.85|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|TRUSTMARK [2030]|STARMARK [203000]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|HEALTHNET [1495]|HEALTHNET [149500]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|666.00||||666.00|55.35|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MULTIPLAN [1680]|IHC HS [168011]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MULTIPLAN [1680]|HMA [168003]|666.00||||666.00|57.75|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|FMH BENEFIT SERVICES [1390]|FMH [139000]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|FIRST HEALTH [1375]|QUALCHOICE [137513]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|666.00||||666.00|47.53|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|666.00||||666.00|47.69|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|666.00||||666.00|39.27|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|UMR [2035]|UMR OPTIONS [203501]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|666.00||||666.00|25.67|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|666.00||||666.00|56.21|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|666.00||||666.00|139.86|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|666.00||||666.00|666|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|666.00||||666.00|319.35|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|666.00||||666.00|283.72|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|666.00||||666.00|432.9|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|||666.00||||666.00|199.8|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|666.00||||666.00|41.71|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|666.00||||666.00|38.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|666.00||||666.00|38.36|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|CHAMPVA [1240]|CHAMP VA [124000]|666.00||||666.00|499.5|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|666.00||||666.00|55.35|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|CORESOURCE [1315]|CORESOURCE [131500]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|666.00||||666.00|43.35|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|GEHA [1415]|GEHA [141500]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|666.00||||666.00|599.4|666|25.67 30182652|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN D (1,25 DIHYDROXY)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|666.00||||666.00||| 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|196.00||||196.00|12.98|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|CORESOURCE [1315]|CORESOURCE [131500]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|196.00||||196.00|16.58|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|196.00||||196.00|11.5|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|196.00||||196.00|12.49|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|||196.00||||196.00|58.8|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|196.00||||196.00|127.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|196.00||||196.00|196|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|196.00||||196.00|41.16|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|196.00||||196.00|16.83|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|UMR [2035]|UMR OPTIONS [203501]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|196.00||||196.00|11.76|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|196.00||||196.00|14.28|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|196.00||||196.00|14.24|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|FIRST HEALTH [1375]|QUALCHOICE [137513]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|FMH BENEFIT SERVICES [1390]|FMH [139000]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MULTIPLAN [1680]|HMA [168003]|196.00||||196.00|17.3|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MULTIPLAN [1680]|IHC HS [168011]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|196.00||||196.00|16.58|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|196.00||||196.00|93.98|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|HEALTHNET [1495]|HEALTHNET [149500]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|TRUSTMARK [2030]|STARMARK [203000]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|AETNA [1015]|AETNA ACO WILCO [101532]|196.00||||196.00|18.22|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|196.00||||196.00|7.69|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|196.00||||196.00|12.07|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|CHAMPVA [1240]|CHAMP VA [124000]|196.00||||196.00|147|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|196.00||||196.00|12.68|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|196.00||||196.00|12.49|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|196.00||||196.00|12.11|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|GEHA [1415]|GEHA [141500]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|196.00||||196.00|117.6|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|196.00||||196.00|98|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|196.00||||196.00|83.5|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|196.00||||196.00|98.2|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|196.00||||196.00|68.8|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|196.00||||196.00|14.24|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|196.00||||196.00|11.53|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|196.00||||196.00|176.4|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|196.00||||196.00|12.68|196|7.69 30182656|EAP|0301 - LABORATORY-CHEMISTRY|HC ELASTASE PANCREATIC EL-1|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|196.00||||196.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|293.00||||293.00|146.79|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|293.00||||293.00|124.82|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|293.00||||293.00|22.29|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|293.00||||293.00|175.8|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|293.00||||293.00|24.02|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|293.00||||293.00|23.2|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|293.00||||293.00|13.3|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|TRUSTMARK [2030]|STARMARK [203000]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MULTIPLAN [1680]|IHC HS [168011]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|293.00||||293.00|22.29|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|HEALTHNET [1495]|HEALTHNET [149500]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|293.00||||293.00|27.46|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|AETNA [1015]|AETNA ACO WILCO [101532]|293.00||||293.00|31.54|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|UMR [2035]|UMR OPTIONS [203501]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|293.00||||293.00|61.53|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|293.00||||293.00|293|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|293.00||||293.00|140.49|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|293.00||||293.00|190.45|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|293.00||||293.00|146.5|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|293.00||||293.00|102.84|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|||293.00||||293.00|87.9|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|293.00||||293.00|24.02|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|293.00||||293.00|22.1|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|CHAMPVA [1240]|CHAMP VA [124000]|293.00||||293.00|219.75|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|CORESOURCE [1315]|CORESOURCE [131500]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|293.00||||293.00|24.97|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|GEHA [1415]|GEHA [141500]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|293.00||||293.00|263.7|293|13.3 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MULTIPLAN [1680]|HMA [168003]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|293.00||||293.00||| 30182657|EAP|0301 - LABORATORY-CHEMISTRY|HC NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|293.00||||293.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|GEHA [1415]|GEHA [141500]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|423.00||||423.00|69.25|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|CORESOURCE [1315]|CORESOURCE [131500]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|CHAMPVA [1240]|CHAMP VA [124000]|423.00||||423.00|317.25|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|423.00||||423.00|66.63|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|||423.00||||423.00|126.9|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|423.00||||423.00|274.95|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|423.00||||423.00|202.83|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|423.00||||423.00|423|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|423.00||||423.00|88.83|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|UMR [2035]|UMR OPTIONS [203501]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|423.00||||423.00|76.18|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|423.00||||423.00|61.5|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|FIRST HEALTH [1375]|QUALCHOICE [137513]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|FMH BENEFIT SERVICES [1390]|FMH [139000]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MULTIPLAN [1680]|IHC HS [168011]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|HEALTHNET [1495]|HEALTHNET [149500]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|TRUSTMARK [2030]|STARMARK [203000]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|AETNA [1015]|AETNA ACO WILCO [101532]|423.00||||423.00|87.48|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|423.00||||423.00|61.29|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|423.00||||423.00|36.9|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|423.00||||423.00|64.36|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|423.00||||423.00|66.63|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|423.00||||423.00|253.8|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|423.00||||423.00|211.5|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|423.00||||423.00|148.47|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|423.00||||423.00|61.5|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|423.00||||423.00|211.92|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|423.00||||423.00|180.2|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|423.00||||423.00|380.7|423|36.9 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MULTIPLAN [1680]|HMA [168003]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|423.00||||423.00||| 30182664|EAP|0301 - LABORATORY-CHEMISTRY|HC ELECTROPHORETIC TEST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|423.00||||423.00||| 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|332.00||||332.00|20.67|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|332.00||||332.00|23.2|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|332.00||||332.00|166.33|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|332.00||||332.00|141.43|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|332.00||||332.00|116.53|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|332.00||||332.00|166|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|332.00||||332.00|199.2|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|332.00||||332.00|20.35|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|332.00||||332.00|20.67|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|332.00||||332.00|19.66|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|AETNA [1015]|AETNA ACO WILCO [101532]|332.00||||332.00|29.7|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|TRUSTMARK [2030]|STARMARK [203000]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|HEALTHNET [1495]|HEALTHNET [149500]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|332.00||||332.00|27.01|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MULTIPLAN [1680]|IHC HS [168011]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MULTIPLAN [1680]|HMA [168003]|332.00||||332.00|28.19|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|332.00||||332.00|23.2|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|332.00||||332.00|23.27|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|332.00||||332.00|19.17|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|UMR [2035]|UMR OPTIONS [203501]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|332.00||||332.00|12.53|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|332.00||||332.00|27.43|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|332.00||||332.00|69.72|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|332.00||||332.00|19.73|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|332.00||||332.00|332|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|332.00||||332.00|159.19|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|332.00||||332.00|215.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|||332.00||||332.00|99.6|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|332.00||||332.00|20.35|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|332.00||||332.00|18.79|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|332.00||||332.00|18.72|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|CHAMPVA [1240]|CHAMP VA [124000]|332.00||||332.00|249|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|332.00||||332.00|27.01|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|CORESOURCE [1315]|CORESOURCE [131500]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|332.00||||332.00|21.15|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|GEHA [1415]|GEHA [141500]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|332.00||||332.00|298.8|332|12.53 30182668|EAP|0301 - LABORATORY-CHEMISTRY|HC ERYTHROPOIETIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|332.00||||332.00||| 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|434.00||||434.00|31.46|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|CORESOURCE [1315]|CORESOURCE [131500]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|434.00||||434.00|40.17|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|434.00||||434.00|27.85|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|||434.00||||434.00|130.2|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|434.00||||434.00|282.1|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|434.00||||434.00|434|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|434.00||||434.00|91.14|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|434.00||||434.00|40.79|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|UMR [2035]|UMR OPTIONS [203501]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|434.00||||434.00|34.61|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|434.00||||434.00|34.49|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|434.00||||434.00|28.5|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|434.00||||434.00|40.17|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MULTIPLAN [1680]|IHC HS [168011]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MULTIPLAN [1680]|HMA [168003]|434.00||||434.00|41.91|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|HEALTHNET [1495]|HEALTHNET [149500]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|TRUSTMARK [2030]|STARMARK [203000]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|434.00||||434.00|208.1|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|434.00||||434.00|30.27|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|AETNA [1015]|AETNA ACO WILCO [101532]|434.00||||434.00|44.15|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|434.00||||434.00|18.62|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|434.00||||434.00|29.24|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|CHAMPVA [1240]|CHAMP VA [124000]|434.00||||434.00|325.5|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|434.00||||434.00|30.73|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|GEHA [1415]|GEHA [141500]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|434.00||||434.00|30.27|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|434.00||||434.00|29.34|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|434.00||||434.00|260.4|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|434.00||||434.00|217|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|434.00||||434.00|34.49|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|434.00||||434.00|152.33|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|434.00||||434.00|184.88|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|434.00||||434.00|217.43|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|434.00||||434.00|27.94|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|434.00||||434.00|390.6|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|434.00||||434.00|30.73|434|18.62 30182670|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRADIOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|434.00||||434.00||| 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|454.00||||454.00|227.45|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|454.00||||454.00|159.35|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|454.00||||454.00|26.78|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|454.00||||454.00|272.4|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|454.00||||454.00|22.79|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|454.00||||454.00|23.51|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|454.00||||454.00|23.87|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|454.00||||454.00|22.71|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|454.00||||454.00|14.47|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|TRUSTMARK [2030]|STARMARK [203000]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MULTIPLAN [1680]|HMA [168003]|454.00||||454.00|32.55|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MULTIPLAN [1680]|IHC HS [168011]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|454.00||||454.00|31.2|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|454.00||||454.00|26.78|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|454.00||||454.00|26.88|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|454.00||||454.00|22.13|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|454.00||||454.00|34.29|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|UMR [2035]|UMR OPTIONS [203501]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|454.00||||454.00|31.68|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|454.00||||454.00|95.34|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|454.00||||454.00|454|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|454.00||||454.00|217.69|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|454.00||||454.00|227|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|454.00||||454.00|295.1|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|454.00||||454.00|193.4|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|||454.00||||454.00|136.2|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|454.00||||454.00|23.51|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|454.00||||454.00|23.87|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|454.00||||454.00|21.7|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|454.00||||454.00|21.63|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|454.00||||454.00|340.5|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|454.00||||454.00|31.2|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|454.00||||454.00|24.44|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|GEHA [1415]|GEHA [141500]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|454.00||||454.00|408.6|454|14.47 30182672|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTROGEN TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|454.00||||454.00||| 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|GEHA [1415]|GEHA [141500]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|334.00||||334.00|27.23|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|334.00||||334.00|34.76|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|CHAMPVA [1240]|CHAMP VA [124000]|334.00||||334.00|250.5|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|334.00||||334.00|26.2|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|||334.00||||334.00|100.2|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|334.00||||334.00|217.1|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|334.00||||334.00|160.15|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|334.00||||334.00|70.14|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|UMR [2035]|UMR OPTIONS [203501]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|334.00||||334.00|24.66|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|334.00||||334.00|29.95|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|334.00||||334.00|29.85|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|334.00||||334.00|35.3|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MULTIPLAN [1680]|HMA [168003]|334.00||||334.00|36.27|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|334.00||||334.00|334|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|334.00||||334.00|34.76|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MULTIPLAN [1680]|IHC HS [168011]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|HEALTHNET [1495]|HEALTHNET [149500]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|TRUSTMARK [2030]|STARMARK [203000]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|334.00||||334.00|38.21|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|334.00||||334.00|16.12|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|334.00||||334.00|24.09|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|334.00||||334.00|25.3|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|CORESOURCE [1315]|CORESOURCE [131500]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|334.00||||334.00|26.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|334.00||||334.00|26.2|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|334.00||||334.00|25.39|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|334.00||||334.00|200.4|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|334.00||||334.00|167|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|334.00||||334.00|117.23|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|334.00||||334.00|142.28|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|334.00||||334.00|29.85|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|334.00||||334.00|167.33|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|334.00||||334.00|24.18|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|334.00||||334.00|300.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|334.00||||334.00|26.6|334|16.12 30182677|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRIOL SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|334.00||||334.00||| 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|379.00||||379.00|27.45|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|379.00||||379.00|133.03|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|379.00||||379.00|189.88|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|379.00||||379.00|161.45|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|379.00||||379.00|189.5|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|379.00||||379.00|227.4|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|379.00||||379.00|27.03|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|379.00||||379.00|27.45|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|379.00||||379.00|26.11|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|379.00||||379.00|16.64|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|TRUSTMARK [2030]|STARMARK [203000]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|HEALTHNET [1495]|HEALTHNET [149500]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MULTIPLAN [1680]|HMA [168003]|379.00||||379.00|37.43|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|379.00||||379.00|35.87|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MULTIPLAN [1680]|IHC HS [168011]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|379.00||||379.00|30.81|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|379.00||||379.00|30.9|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|379.00||||379.00|25.45|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|AETNA [1015]|AETNA ACO WILCO [101532]|379.00||||379.00|39.45|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|UMR [2035]|UMR OPTIONS [203501]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|379.00||||379.00|36.43|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|379.00||||379.00|79.59|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|379.00||||379.00|26.2|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|379.00||||379.00|379|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|379.00||||379.00|181.73|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|379.00||||379.00|246.35|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|||379.00||||379.00|113.7|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|379.00||||379.00|27.03|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|379.00||||379.00|30.81|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|379.00||||379.00|24.95|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|379.00||||379.00|24.86|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|CHAMPVA [1240]|CHAMP VA [124000]|379.00||||379.00|284.25|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|379.00||||379.00|35.87|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|CORESOURCE [1315]|CORESOURCE [131500]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|379.00||||379.00|28.09|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|GEHA [1415]|GEHA [141500]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|379.00||||379.00|341.1|379|16.64 30182679|EAP|0301 - LABORATORY-CHEMISTRY|HC ESTRONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|379.00||||379.00||| 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|245.00||||245.00|16.79|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|CORESOURCE [1315]|CORESOURCE [131500]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|245.00||||245.00|21.42|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|CHAMPVA [1240]|CHAMP VA [124000]|245.00||||245.00|183.75|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|245.00||||245.00|14.85|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|||245.00||||245.00|73.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|245.00||||245.00|159.25|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|245.00||||245.00|245|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|245.00||||245.00|51.45|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|245.00||||245.00|21.75|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|UMR [2035]|UMR OPTIONS [203501]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|245.00||||245.00|18.47|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|245.00||||245.00|18.4|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|245.00||||245.00|15.2|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MULTIPLAN [1680]|IHC HS [168011]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MULTIPLAN [1680]|HMA [168003]|245.00||||245.00|22.35|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|245.00||||245.00|21.42|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|245.00||||245.00|117.48|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|HEALTHNET [1495]|HEALTHNET [149500]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|TRUSTMARK [2030]|STARMARK [203000]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|AETNA [1015]|AETNA ACO WILCO [101532]|245.00||||245.00|23.55|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|245.00||||245.00|16.15|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|245.00||||245.00|9.94|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|245.00||||245.00|15.6|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|245.00||||245.00|16.39|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|245.00||||245.00|16.15|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|245.00||||245.00|15.65|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|GEHA [1415]|GEHA [141500]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|245.00||||245.00|147|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|245.00||||245.00|122.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|245.00||||245.00|122.75|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|245.00||||245.00|104.37|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|245.00||||245.00|18.4|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|245.00||||245.00|86|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|245.00||||245.00|14.9|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|245.00||||245.00|220.5|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|245.00||||245.00|16.39|245|9.94 30182693|EAP|0301 - LABORATORY-CHEMISTRY|HC ETHYLENE GLYCOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|245.00||||245.00||| 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.00||||58.00|29.06|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.00||||58.00|24.71|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.00||||58.00|6.29|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.00||||58.00|29|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.00||||58.00|34.8|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.00||||58.00|5.36|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.00||||58.00|5.52|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.00||||58.00|5.61|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.00||||58.00|5.34|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.00||||58.00|3.4|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|TRUSTMARK [2030]|STARMARK [203000]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|HEALTHNET [1495]|HEALTHNET [149500]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.00||||58.00|7.33|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MULTIPLAN [1680]|HMA [168003]|58.00||||58.00|7.65|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MULTIPLAN [1680]|IHC HS [168011]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.00||||58.00|6.29|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.00||||58.00|6.31|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.00||||58.00|5.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|AETNA [1015]|AETNA ACO WILCO [101532]|58.00||||58.00|8.05|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|UMR [2035]|UMR OPTIONS [203501]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.00||||58.00|7.45|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.00||||58.00|12.18|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.00||||58.00|58|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.00||||58.00|27.81|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.00||||58.00|37.7|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.00||||58.00|20.36|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|||58.00||||58.00|17.4|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.00||||58.00|5.52|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.00||||58.00|5.1|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.00||||58.00|5.08|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.00||||58.00|5.61|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|CHAMPVA [1240]|CHAMP VA [124000]|58.00||||58.00|43.5|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.00||||58.00|7.33|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|CORESOURCE [1315]|CORESOURCE [131500]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.00||||58.00|5.74|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|GEHA [1415]|GEHA [141500]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.00||||58.00|52.2|58|3.4 30182705|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.00||||58.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|GEHA [1415]|GEHA [141500]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|211.00||||211.00|18.92|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|CHAMPVA [1240]|CHAMP VA [124000]|211.00||||211.00|158.25|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211.00||||211.00|18.2|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|||211.00||||211.00|63.3|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211.00||||211.00|137.15|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211.00||||211.00|101.17|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211.00||||211.00|44.31|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|UMR [2035]|UMR OPTIONS [203501]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|211.00||||211.00|20.81|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.00||||211.00|20.75|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211.00||||211.00|211|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MULTIPLAN [1680]|IHC HS [168011]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|HEALTHNET [1495]|HEALTHNET [149500]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|TRUSTMARK [2030]|STARMARK [203000]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|AETNA [1015]|AETNA ACO WILCO [101532]|211.00||||211.00|26.56|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|211.00||||211.00|11.2|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211.00||||211.00|16.74|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211.00||||211.00|17.58|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|CORESOURCE [1315]|CORESOURCE [131500]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211.00||||211.00|18.2|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211.00||||211.00|126.6|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211.00||||211.00|105.5|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211.00||||211.00|20.75|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|211.00||||211.00|105.71|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211.00||||211.00|74.06|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|211.00||||211.00|89.89|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211.00||||211.00|189.9|211|11.2 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MULTIPLAN [1680]|HMA [168003]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211.00||||211.00||| 30182710|EAP|0301 - LABORATORY-CHEMISTRY|HC FAT/LIPIDS FECES QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211.00||||211.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230.00||||230.00|18.77|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230.00||||230.00|115.23|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230.00||||230.00|97.98|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230.00||||230.00|115|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230.00||||230.00|138|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230.00||||230.00|20.33|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230.00||||230.00|19.63|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|TRUSTMARK [2030]|STARMARK [203000]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|HEALTHNET [1495]|HEALTHNET [149500]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MULTIPLAN [1680]|IHC HS [168011]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|FMH BENEFIT SERVICES [1390]|FMH [139000]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|FIRST HEALTH [1375]|QUALCHOICE [137513]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230.00||||230.00|18.77|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230.00||||230.00|23.24|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|AETNA [1015]|AETNA ACO WILCO [101532]|230.00||||230.00|26.7|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|UMR [2035]|UMR OPTIONS [203501]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230.00||||230.00|11.26|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230.00||||230.00|48.3|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230.00||||230.00|230|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230.00||||230.00|110.29|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230.00||||230.00|80.73|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230.00||||230.00|149.5|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|||230.00||||230.00|69|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230.00||||230.00|20.33|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230.00||||230.00|18.7|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|CHAMPVA [1240]|CHAMP VA [124000]|230.00||||230.00|172.5|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|CORESOURCE [1315]|CORESOURCE [131500]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230.00||||230.00|21.13|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|GEHA [1415]|GEHA [141500]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230.00||||230.00|207|230|11.26 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MULTIPLAN [1680]|HMA [168003]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230.00||||230.00||| 30182725|EAP|0301 - LABORATORY-CHEMISTRY|HC FATTY ACIDS NON-ESTERIFIED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230.00||||230.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|GEHA [1415]|GEHA [141500]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|222.00||||222.00|22.24|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|CORESOURCE [1315]|CORESOURCE [131500]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222.00||||222.00|19.69|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|||222.00||||222.00|66.6|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222.00||||222.00|144.3|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222.00||||222.00|106.45|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222.00||||222.00|222|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222.00||||222.00|46.62|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|UMR [2035]|UMR OPTIONS [203501]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|222.00||||222.00|24.47|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222.00||||222.00|22.29|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|FIRST HEALTH [1375]|QUALCHOICE [137513]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|FMH BENEFIT SERVICES [1390]|FMH [139000]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MULTIPLAN [1680]|IHC HS [168011]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|HEALTHNET [1495]|HEALTHNET [149500]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|TRUSTMARK [2030]|STARMARK [203000]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222.00||||222.00|21.4|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|AETNA [1015]|AETNA ACO WILCO [101532]|222.00||||222.00|28.54|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|222.00||||222.00|12.04|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222.00||||222.00|20.67|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|CHAMPVA [1240]|CHAMP VA [124000]|222.00||||222.00|166.5|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222.00||||222.00|21.4|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222.00||||222.00|133.2|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222.00||||222.00|111|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222.00||||222.00|22.29|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222.00||||222.00|77.92|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|222.00||||222.00|111.22|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|222.00||||222.00|94.57|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222.00||||222.00|199.8|222|12.04 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MULTIPLAN [1680]|HMA [168003]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222.00||||222.00||| 30182726|EAP|0301 - LABORATORY-CHEMISTRY|HC VERY LONG CHAIN FATTY ACIDS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222.00||||222.00||| 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|271.00||||271.00|135.77|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|271.00||||271.00|115.45|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|271.00||||271.00|16.83|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|271.00||||271.00|95.12|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|271.00||||271.00|162.6|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|271.00||||271.00|14.31|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|271.00||||271.00|14.76|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|271.00||||271.00|14.99|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|271.00||||271.00|14.26|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|271.00||||271.00|9.09|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|AETNA [1015]|AETNA ACO WILCO [101532]|271.00||||271.00|21.55|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|TRUSTMARK [2030]|STARMARK [203000]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MULTIPLAN [1680]|HMA [168003]|271.00||||271.00|20.45|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MULTIPLAN [1680]|IHC HS [168011]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|271.00||||271.00|19.59|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|271.00||||271.00|16.83|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|271.00||||271.00|16.88|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|271.00||||271.00|13.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|HEALTHNET [1495]|HEALTHNET [149500]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|UMR [2035]|UMR OPTIONS [203501]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|271.00||||271.00|19.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|271.00||||271.00|56.91|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|271.00||||271.00|271|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|271.00||||271.00|135.5|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|271.00||||271.00|129.94|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|271.00||||271.00|176.15|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|||271.00||||271.00|81.3|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|271.00||||271.00|14.76|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|271.00||||271.00|14.99|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|271.00||||271.00|13.63|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|271.00||||271.00|13.58|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|CHAMPVA [1240]|CHAMP VA [124000]|271.00||||271.00|203.25|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|271.00||||271.00|19.59|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|CORESOURCE [1315]|CORESOURCE [131500]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|271.00||||271.00|15.34|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|GEHA [1415]|GEHA [141500]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|271.00||||271.00|243.9|271|9.09 30182728|EAP|0301 - LABORATORY-CHEMISTRY|HC FERRITIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|271.00||||271.00||| 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|886.00||||886.00|92.6|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|CHAMPVA [1240]|CHAMP VA [124000]|886.00||||886.00|664.5|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|886.00||||886.00|64.19|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|886.00||||886.00|69.79|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|||886.00||||886.00|265.8|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|886.00||||886.00|575.9|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|886.00||||886.00|424.84|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|886.00||||886.00|186.06|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|886.00||||886.00|94.04|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|UMR [2035]|UMR OPTIONS [203501]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|886.00||||886.00|65.7|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|886.00||||886.00|79.79|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|886.00||||886.00|79.52|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MULTIPLAN [1680]|HMA [168003]|886.00||||886.00|96.62|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|886.00||||886.00|92.6|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MULTIPLAN [1680]|IHC HS [168011]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|HEALTHNET [1495]|HEALTHNET [149500]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|886.00||||886.00|886|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|TRUSTMARK [2030]|STARMARK [203000]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|AETNA [1015]|AETNA ACO WILCO [101532]|886.00||||886.00|101.8|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|886.00||||886.00|42.94|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|886.00||||886.00|67.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|886.00||||886.00|70.85|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|886.00||||886.00|69.79|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|886.00||||886.00|67.63|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|886.00||||886.00|531.6|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|886.00||||886.00|443|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|CORESOURCE [1315]|CORESOURCE [131500]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|886.00||||886.00|79.52|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|886.00||||886.00|310.99|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|886.00||||886.00|377.44|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|886.00||||886.00|443.89|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|886.00||||886.00|64.41|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|886.00||||886.00|70.85|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|GEHA [1415]|GEHA [141500]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|886.00||||886.00|797.4|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|886.00||||886.00|72.54|886|42.94 30182731|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL FIBRONECTIN SQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|886.00||||886.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|319.00||||319.00|22.89|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|319.00||||319.00|159.5|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|319.00||||319.00|159.82|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|319.00||||319.00|152.96|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|UMR [2035]|UMR OPTIONS [203501]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|CORESOURCE [1315]|CORESOURCE [131500]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|HEALTHNET [1495]|HEALTHNET [149500]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|319.00||||319.00|135.89|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|319.00||||319.00|20.88|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|319.00||||319.00|191.4|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|319.00||||319.00|66.99|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|319.00||||319.00|20.09|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|GEHA [1415]|GEHA [141500]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|CHAMPVA [1240]|CHAMP VA [124000]|319.00||||319.00|239.25|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|319.00||||319.00|18.48|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|319.00||||319.00|22.97|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|319.00||||319.00|19.41|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|319.00||||319.00|20.09|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|||319.00||||319.00|95.7|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|319.00||||319.00|319|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|319.00||||319.00|111.97|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|TRUSTMARK [2030]|STARMARK [203000]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|AETNA [1015]|AETNA ACO WILCO [101532]|319.00||||319.00|29.3|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|319.00||||319.00|12.36|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|319.00||||319.00|22.89|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|319.00||||319.00|207.35|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MULTIPLAN [1680]|IHC HS [168011]|319.00||||319.00|287.1|319|12.36 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MULTIPLAN [1680]|HMA [168003]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|319.00||||319.00||| 30182735|EAP|0301 - LABORATORY-CHEMISTRY|HC FLUORIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|319.00||||319.00||| 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219.00||||219.00|45.99|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219.00||||219.00|219|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219.00||||219.00|105.01|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|UMR [2035]|UMR OPTIONS [203501]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219.00||||219.00|18.15|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219.00||||219.00|15.93|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|TRUSTMARK [2030]|STARMARK [203000]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219.00||||219.00|14.66|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|219.00||||219.00|21.13|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MULTIPLAN [1680]|HMA [168003]|219.00||||219.00|22.05|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219.00||||219.00|21.46|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219.00||||219.00|16.17|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|219.00||||219.00|109.72|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219.00||||219.00|109.5|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219.00||||219.00|142.35|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|||219.00||||219.00|65.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|219.00||||219.00|18.21|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|219.00||||219.00|93.29|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219.00||||219.00|18.15|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219.00||||219.00|14.99|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219.00||||219.00|15.39|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219.00||||219.00|76.87|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219.00||||219.00|131.4|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|219.00||||219.00|16.56|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|HEALTHNET [1495]|HEALTHNET [149500]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|219.00||||219.00|9.8|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219.00||||219.00|15.93|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|219.00||||219.00|23.24|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|GEHA [1415]|GEHA [141500]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MULTIPLAN [1680]|IHC HS [168011]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219.00||||219.00|15.44|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219.00||||219.00|16.17|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|219.00||||219.00|21.13|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|CHAMPVA [1240]|CHAMP VA [124000]|219.00||||219.00|164.25|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219.00||||219.00|14.7|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|CORESOURCE [1315]|CORESOURCE [131500]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219.00||||219.00|197.1|219|9.8 30182746|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|219.00||||219.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|CORESOURCE [1315]|CORESOURCE [131500]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|189.00||||189.00|21.38|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|AETNA [1015]|AETNA ACO WILCO [101532]|189.00||||189.00|27.38|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|189.00||||189.00|66.34|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|189.00||||189.00|94.69|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|189.00||||189.00|94.5|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|TRUSTMARK [2030]|STARMARK [203000]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|FIRST HEALTH [1375]|QUALCHOICE [137513]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|HEALTHNET [1495]|HEALTHNET [149500]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|189.00||||189.00|21.38|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|FMH BENEFIT SERVICES [1390]|FMH [139000]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|189.00||||189.00|113.4|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|189.00||||189.00|18.47|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|189.00||||189.00|21.86|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|189.00||||189.00|189|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|189.00||||189.00|122.85|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|189.00||||189.00|11.55|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|189.00||||189.00|39.69|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MULTIPLAN [1680]|IHC HS [168011]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|189.00||||189.00|19.12|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|||189.00||||189.00|56.7|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|CHAMPVA [1240]|CHAMP VA [124000]|189.00||||189.00|141.75|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|189.00||||189.00|80.51|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|189.00||||189.00|19.12|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|GEHA [1415]|GEHA [141500]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|UMR [2035]|UMR OPTIONS [203501]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|189.00||||189.00|17.59|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|189.00||||189.00|170.1|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|189.00||||189.00|19.87|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|189.00||||189.00|90.63|189|11.55 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MULTIPLAN [1680]|HMA [168003]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|189.00||||189.00||| 30182747|EAP|0301 - LABORATORY-CHEMISTRY|HC FOLIC ACID RBC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|189.00||||189.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|293.00||||293.00|140.49|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|293.00||||293.00|61.53|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|293.00||||293.00|21.4|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|293.00||||293.00|21.48|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|UMR [2035]|UMR OPTIONS [203501]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|293.00||||293.00|190.45|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|TRUSTMARK [2030]|STARMARK [203000]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|AETNA [1015]|AETNA ACO WILCO [101532]|293.00||||293.00|27.4|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MULTIPLAN [1680]|IHC HS [168011]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|293.00||||293.00|18.79|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|293.00||||293.00|175.8|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|293.00||||293.00|146.79|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|293.00||||293.00|11.56|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|293.00||||293.00|146.5|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|HEALTHNET [1495]|HEALTHNET [149500]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|293.00||||293.00|102.84|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|293.00||||293.00|124.82|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|293.00||||293.00|293|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|293.00||||293.00|21.4|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|293.00||||293.00|18.15|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|GEHA [1415]|GEHA [141500]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|293.00||||293.00|19.53|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|CORESOURCE [1315]|CORESOURCE [131500]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|293.00||||293.00|17.29|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|CHAMPVA [1240]|CHAMP VA [124000]|293.00||||293.00|219.75|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|293.00||||293.00|18.79|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|||293.00||||293.00|87.9|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|293.00||||293.00|263.7|293|11.56 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MULTIPLAN [1680]|HMA [168003]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|293.00||||293.00||| 30182757|EAP|0301 - LABORATORY-CHEMISTRY|HC SEMINAL FRUCTOSE QUANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|293.00||||293.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MULTIPLAN [1680]|IHC HS [168011]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139.00||||139.00|69.64|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.00||||139.00|83.4|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.00||||139.00|13.82|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139.00||||139.00|7.46|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.00||||139.00|11.2|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.00||||139.00|11.2|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.00||||139.00|11.2|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139.00||||139.00|16.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.00||||139.00|11.2|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|AETNA [1015]|AETNA ACO WILCO [101532]|139.00||||139.00|17.7|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.00||||139.00|13.82|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MULTIPLAN [1680]|HMA [168003]|139.00||||139.00|16.8|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.00||||139.00|69.5|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|HEALTHNET [1495]|HEALTHNET [149500]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.00||||139.00|11.76|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.00||||139.00|11.42|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|GEHA [1415]|GEHA [141500]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.00||||139.00|48.79|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139.00||||139.00|59.21|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.00||||139.00|90.35|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.00||||139.00|66.65|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.00||||139.00|12.14|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.00||||139.00|29.19|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|TRUSTMARK [2030]|STARMARK [203000]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.00||||139.00|11.2|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.00||||139.00|11.16|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139.00||||139.00|13.88|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.00||||139.00|139|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.00||||139.00|11.2|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.00||||139.00|11.72|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139.00||||139.00|86.18|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|CORESOURCE [1315]|CORESOURCE [131500]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|CHAMPVA [1240]|CHAMP VA [124000]|139.00||||139.00|104.25|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|UMR [2035]|UMR OPTIONS [203501]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|||139.00||||139.00|41.7|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139.00||||139.00|12.62|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.00||||139.00|86.32|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.00||||139.00|125.1|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.00||||139.00|12.14|139|7.46 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.00||||139.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.00||||139.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139.00||||139.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139.00||||139.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.00||||139.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.00||||139.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.00||||139.00||| 30182760|EAP|0301 - LABORATORY-CHEMISTRY|HC GALACTOSE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139.00||||139.00||| 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|GEHA [1415]|GEHA [141500]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|197.00||||197.00|9.26|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|197.00||||197.00|11.52|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|197.00||||197.00|10.07|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|197.00||||197.00|128.05|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|197.00||||197.00|94.46|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|UMR [2035]|UMR OPTIONS [203501]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|197.00||||197.00|41.37|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|197.00||||197.00|13.58|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|||197.00||||197.00|59.1|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|197.00||||197.00|11.48|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|197.00||||197.00|13.37|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|197.00||||197.00|10.47|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|197.00||||197.00|197|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|CORESOURCE [1315]|CORESOURCE [131500]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MULTIPLAN [1680]|HMA [168003]|197.00||||197.00|13.95|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|197.00||||197.00|6.2|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|TRUSTMARK [2030]|STARMARK [203000]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|197.00||||197.00|9.49|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|197.00||||197.00|10.07|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|HEALTHNET [1495]|HEALTHNET [149500]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|197.00||||197.00|11.48|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|197.00||||197.00|9.77|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|197.00||||197.00|10.23|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|197.00||||197.00|10.23|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MULTIPLAN [1680]|IHC HS [168011]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|197.00||||197.00|98.7|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|197.00||||197.00|13.37|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|CHAMPVA [1240]|CHAMP VA [124000]|197.00||||197.00|147.75|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|197.00||||197.00|83.92|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|197.00||||197.00|98.5|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|197.00||||197.00|9.72|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|197.00||||197.00|177.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|197.00||||197.00|9.3|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|197.00||||197.00|69.15|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|AETNA [1015]|AETNA ACO WILCO [101532]|197.00||||197.00|14.71|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|197.00||||197.00|118.2|197|6.2 30182784|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGA/IGD/IGG/IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|197.00||||197.00||| 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|288.00||||288.00|18.11|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|288.00||||288.00|17.83|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|288.00||||288.00|144|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|288.00||||288.00|18.11|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|288.00||||288.00|144.29|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|288.00||||288.00|10.97|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|288.00||||288.00|17.22|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|AETNA [1015]|AETNA ACO WILCO [101532]|288.00||||288.00|26.02|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|288.00||||288.00|23.66|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|288.00||||288.00|20.32|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|288.00||||288.00|101.09|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|288.00||||288.00|17.28|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|288.00||||288.00|172.8|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|288.00||||288.00|24.03|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|288.00||||288.00|20.38|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|288.00||||288.00|122.69|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|288.00||||288.00|20.32|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MULTIPLAN [1680]|IHC HS [168011]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MULTIPLAN [1680]|HMA [168003]|288.00||||288.00|24.69|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|||288.00||||288.00|86.4|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|288.00||||288.00|17.83|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|288.00||||288.00|16.4|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|HEALTHNET [1495]|HEALTHNET [149500]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|GEHA [1415]|GEHA [141500]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|288.00||||288.00|138.1|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|288.00||||288.00|18.53|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|CHAMPVA [1240]|CHAMP VA [124000]|288.00||||288.00|216|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|288.00||||288.00|23.66|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|288.00||||288.00|288|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|CORESOURCE [1315]|CORESOURCE [131500]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|UMR [2035]|UMR OPTIONS [203501]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|288.00||||288.00|16.46|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|288.00||||288.00|16.79|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|288.00||||288.00|187.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|TRUSTMARK [2030]|STARMARK [203000]|288.00||||288.00|259.2|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|288.00||||288.00|60.48|288|10.97 30182785|EAP|0301 - LABORATORY-CHEMISTRY|HC GAMMAGLOBULIN IGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|288.00||||288.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|632.00||||632.00|9.94|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|HEALTHNET [1495]|HEALTHNET [149500]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MULTIPLAN [1680]|IHC HS [168011]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|632.00||||632.00|221.83|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|632.00||||632.00|8.39|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|632.00||||632.00|5.35|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|632.00||||632.00|379.2|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|632.00||||632.00|316.63|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|632.00||||632.00|9.9|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|632.00||||632.00|8.69|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|TRUSTMARK [2030]|STARMARK [203000]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|632.00||||632.00|316|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|632.00||||632.00|9.9|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|AETNA [1015]|AETNA ACO WILCO [101532]|632.00||||632.00|12.68|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|632.00||||632.00|269.23|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|GEHA [1415]|GEHA [141500]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|632.00||||632.00|303.04|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|CHAMPVA [1240]|CHAMP VA [124000]|632.00||||632.00|474|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|||632.00||||632.00|189.6|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|632.00||||632.00|8.69|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|CORESOURCE [1315]|CORESOURCE [131500]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|UMR [2035]|UMR OPTIONS [203501]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|632.00||||632.00|7.99|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|632.00||||632.00|632|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|632.00||||632.00|410.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|632.00||||632.00|9.03|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|632.00||||632.00|132.72|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|632.00||||632.00|568.8|632|5.35 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MULTIPLAN [1680]|HMA [168003]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|632.00||||632.00||| 30182787|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOGLOB SUBCLASSES EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|632.00||||632.00||| 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|152.00||||152.00|12.1|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|152.00||||152.00|64.75|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|152.00||||152.00|15.81|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|152.00||||152.00|91.2|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|152.00||||152.00|53.35|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|152.00||||152.00|76.15|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|152.00||||152.00|15.65|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|TRUSTMARK [2030]|STARMARK [203000]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|152.00||||152.00|11.55|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MULTIPLAN [1680]|HMA [168003]|152.00||||152.00|16.5|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|152.00||||152.00|11.92|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|152.00||||152.00|152|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|152.00||||152.00|72.88|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MULTIPLAN [1680]|IHC HS [168011]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|UMR [2035]|UMR OPTIONS [203501]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|HEALTHNET [1495]|HEALTHNET [149500]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|152.00||||152.00|6.6|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|||152.00||||152.00|45.6|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|152.00||||152.00|98.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|152.00||||152.00|11.92|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|GEHA [1415]|GEHA [141500]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|152.00||||152.00|16.06|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|152.00||||152.00|12.1|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|152.00||||152.00|31.92|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|CORESOURCE [1315]|CORESOURCE [131500]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|CHAMPVA [1240]|CHAMP VA [124000]|152.00||||152.00|114|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|152.00||||152.00|15.81|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|152.00||||152.00|11.22|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|152.00||||152.00|12.39|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|152.00||||152.00|13.63|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|152.00||||152.00|11|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|152.00||||152.00|136.8|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|152.00||||152.00|11.51|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|152.00||||152.00|76|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|152.00||||152.00|10.97|152|6.6 30182800|EAP|0301 - LABORATORY-CHEMISTRY|HC GASES BLOOD PH ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|152.00||||152.00||| 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|GEHA [1415]|GEHA [141500]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|443.00||||443.00|37.48|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|443.00||||443.00|28.25|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|CHAMPVA [1240]|CHAMP VA [124000]|443.00||||443.00|332.25|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|443.00||||443.00|212.42|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|443.00||||443.00|443|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|443.00||||443.00|287.95|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|443.00||||443.00|32.3|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|FIRST HEALTH [1375]|QUALCHOICE [137513]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|UMR [2035]|UMR OPTIONS [203501]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|443.00||||443.00|26.59|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|443.00||||443.00|25.99|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|443.00||||443.00|93.03|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|CORESOURCE [1315]|CORESOURCE [131500]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|FMH BENEFIT SERVICES [1390]|FMH [139000]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|||443.00||||443.00|132.9|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|HEALTHNET [1495]|HEALTHNET [149500]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MULTIPLAN [1680]|HMA [168003]|443.00||||443.00|39.11|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|TRUSTMARK [2030]|STARMARK [203000]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|443.00||||443.00|221.5|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|443.00||||443.00|38.06|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|443.00||||443.00|28.68|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|443.00||||443.00|29.36|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|443.00||||443.00|27.29|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|443.00||||443.00|28.25|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|443.00||||443.00|37.48|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|443.00||||443.00|265.8|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|443.00||||443.00|188.72|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|443.00||||443.00|221.94|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|443.00||||443.00|155.49|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|AETNA [1015]|COVENTRY HEALTHCARE [101502]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MULTIPLAN [1680]|IHC HS [168011]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|443.00||||443.00|15.64|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|AETNA [1015]|AETNA ACO WILCO [101532]|443.00||||443.00|37.08|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|443.00||||443.00|28.68|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|443.00||||443.00|26.07|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|443.00||||443.00|398.7|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|443.00||||443.00|27.37|443|15.64 30182803|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS VEN/ART PH P02 &/OR PC02|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|443.00||||443.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|386.00||||386.00|164.44|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|386.00||||386.00|193|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|386.00||||386.00|82.42|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|386.00||||386.00|85.34|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|386.00||||386.00|47.26|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|TRUSTMARK [2030]|STARMARK [203000]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|HEALTHNET [1495]|HEALTHNET [149500]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|386.00||||386.00|82.71|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MULTIPLAN [1680]|IHC HS [168011]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|AETNA [1015]|AETNA ACO WILCO [101532]|386.00||||386.00|112.04|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|FMH BENEFIT SERVICES [1390]|FMH [139000]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|FIRST HEALTH [1375]|QUALCHOICE [137513]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|386.00||||386.00|97.57|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|386.00||||386.00|135.49|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|386.00||||386.00|113.24|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|386.00||||386.00|185.09|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|386.00||||386.00|239.71|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|386.00||||386.00|231.6|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MULTIPLAN [1680]|HMA [168003]|386.00||||386.00|118.16|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|386.00||||386.00|386|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|||386.00||||386.00|115.8|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|386.00||||386.00|85.34|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|386.00||||386.00|81.06|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|386.00||||386.00|250.9|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|GEHA [1415]|GEHA [141500]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|386.00||||386.00|78.77|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|CORESOURCE [1315]|CORESOURCE [131500]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|386.00||||386.00|78.5|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|CHAMPVA [1240]|CHAMP VA [124000]|386.00||||386.00|289.5|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|UMR [2035]|UMR OPTIONS [203501]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|386.00||||386.00|239.32|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|386.00||||386.00|80.35|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|386.00||||386.00|88.7|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|386.00||||386.00|193.39|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|386.00||||386.00|347.4|386|47.26 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|386.00||||386.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|386.00||||386.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|386.00||||386.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|386.00||||386.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|386.00||||386.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|386.00||||386.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|386.00||||386.00||| 30182805|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS W/02 SAT AND DIRECT MEASURE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|386.00||||386.00||| 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|GEHA [1415]|GEHA [141500]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137.00||||137.00|65.69|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137.00||||137.00|89.05|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|||137.00||||137.00|41.1|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137.00||||137.00|9.73|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137.00||||137.00|137|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137.00||||137.00|28.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137.00||||137.00|14.26|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.00||||137.00|9.97|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137.00||||137.00|10.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|137.00||||137.00|11|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MULTIPLAN [1680]|IHC HS [168011]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|137.00||||137.00|14.05|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137.00||||137.00|10.58|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|137.00||||137.00|14.05|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|UMR [2035]|UMR OPTIONS [203501]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|137.00||||137.00|12.1|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|HEALTHNET [1495]|HEALTHNET [149500]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|137.00||||137.00|13.9|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.00||||137.00|82.2|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|CORESOURCE [1315]|CORESOURCE [131500]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|137.00||||137.00|5.86|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.00||||137.00|10.22|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137.00||||137.00|10.75|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137.00||||137.00|10.58|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|TRUSTMARK [2030]|STARMARK [203000]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|CHAMPVA [1240]|CHAMP VA [124000]|137.00||||137.00|102.75|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137.00||||137.00|10.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|137.00||||137.00|68.64|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137.00||||137.00|48.09|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|137.00||||137.00|58.36|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.00||||137.00|9.77|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137.00||||137.00|10.26|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MULTIPLAN [1680]|HMA [168003]|137.00||||137.00|14.66|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137.00||||137.00|123.3|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137.00||||137.00|68.5|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137.00||||137.00|10.75|137|5.86 30182810|EAP|0301 - LABORATORY-CHEMISTRY|HC BLD GAS O2 SAT ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|137.00||||137.00||| 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|416.00||||416.00|19.39|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|416.00||||416.00|21.77|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|416.00||||416.00|146.02|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|416.00||||416.00|19.39|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|416.00||||416.00|249.6|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|416.00||||416.00|18.51|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|416.00||||416.00|208.42|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|416.00||||416.00|11.75|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|TRUSTMARK [2030]|STARMARK [203000]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|416.00||||416.00|25.34|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MULTIPLAN [1680]|HMA [168003]|416.00||||416.00|26.45|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|HEALTHNET [1495]|HEALTHNET [149500]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|AETNA [1015]|AETNA ACO WILCO [101532]|416.00||||416.00|27.87|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|416.00||||416.00|199.47|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|416.00||||416.00|416|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|416.00||||416.00|21.77|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|UMR [2035]|UMR OPTIONS [203501]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|416.00||||416.00|18.44|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|416.00||||416.00|208|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MULTIPLAN [1680]|IHC HS [168011]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|416.00||||416.00|19.1|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|416.00||||416.00|177.22|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|416.00||||416.00|87.36|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|416.00||||416.00|270.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|||416.00||||416.00|124.8|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|416.00||||416.00|19.1|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|GEHA [1415]|GEHA [141500]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|416.00||||416.00|17.98|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|416.00||||416.00|17.57|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|CHAMPVA [1240]|CHAMP VA [124000]|416.00||||416.00|312|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|416.00||||416.00|25.74|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|416.00||||416.00|25.34|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|416.00||||416.00|19.85|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|416.00||||416.00|21.84|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|CORESOURCE [1315]|CORESOURCE [131500]|416.00||||416.00|374.4|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|416.00||||416.00|17.63|416|11.75 30182941|EAP|0301 - LABORATORY-CHEMISTRY|HC GASTRIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|416.00||||416.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|GEHA [1415]|GEHA [141500]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|CORESOURCE [1315]|CORESOURCE [131500]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177.00||||177.00|115.05|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177.00||||177.00|15.48|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177.00||||177.00|177|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177.00||||177.00|37.17|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|FIRST HEALTH [1375]|QUALCHOICE [137513]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|177.00||||177.00|17.7|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|UMR [2035]|UMR OPTIONS [203501]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177.00||||177.00|17.64|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|177.00||||177.00|16.09|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177.00||||177.00|14.24|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|||177.00||||177.00|53.1|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|FMH BENEFIT SERVICES [1390]|FMH [139000]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|CHAMPVA [1240]|CHAMP VA [124000]|177.00||||177.00|132.75|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|177.00||||177.00|9.53|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|HEALTHNET [1495]|HEALTHNET [149500]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|AETNA [1015]|AETNA ACO WILCO [101532]|177.00||||177.00|22.59|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177.00||||177.00|84.87|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177.00||||177.00|88.5|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177.00||||177.00|14.95|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177.00||||177.00|15.48|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177.00||||177.00|106.2|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177.00||||177.00|17.64|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|177.00||||177.00|75.4|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|177.00||||177.00|88.68|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|TRUSTMARK [2030]|STARMARK [203000]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177.00||||177.00|62.13|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MULTIPLAN [1680]|IHC HS [168011]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177.00||||177.00|159.3|177|9.53 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MULTIPLAN [1680]|HMA [168003]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|177.00||||177.00||| 30182943|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCAGON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177.00||||177.00||| 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218.00||||218.00|4.32|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218.00||||218.00|4.85|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218.00||||218.00|109|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|218.00||||218.00|109.22|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218.00||||218.00|4.32|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218.00||||218.00|4.25|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218.00||||218.00|130.8|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|218.00||||218.00|2.62|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|TRUSTMARK [2030]|STARMARK [203000]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|HEALTHNET [1495]|HEALTHNET [149500]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MULTIPLAN [1680]|HMA [168003]|218.00||||218.00|5.9|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MULTIPLAN [1680]|IHC HS [168011]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|AETNA [1015]|AETNA ACO WILCO [101532]|218.00||||218.00|6.22|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|218.00||||218.00|5.65|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218.00||||218.00|4.1|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|218.00||||218.00|92.87|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|218.00||||218.00|4.86|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218.00||||218.00|104.53|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218.00||||218.00|4.13|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218.00||||218.00|218|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218.00||||218.00|45.78|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218.00||||218.00|76.52|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|||218.00||||218.00|65.4|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218.00||||218.00|4.25|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218.00||||218.00|141.7|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|GEHA [1415]|GEHA [141500]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|CORESOURCE [1315]|CORESOURCE [131500]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218.00||||218.00|3.91|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218.00||||218.00|5.74|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|218.00||||218.00|5.65|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218.00||||218.00|4.85|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|CHAMPVA [1240]|CHAMP VA [124000]|218.00||||218.00|163.5|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|218.00||||218.00|4.42|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218.00||||218.00|4.01|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218.00||||218.00|3.93|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|UMR [2035]|UMR OPTIONS [203501]|218.00||||218.00|196.2|218|2.62 30182945|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BODY FLUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|218.00||||218.00||| 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225.00||||225.00|4.25|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225.00||||225.00|135|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225.00||||225.00|112.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225.00||||225.00|78.98|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|225.00||||225.00|112.73|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225.00||||225.00|4.13|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|225.00||||225.00|95.85|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225.00||||225.00|4.85|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225.00||||225.00|4.32|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225.00||||225.00|4.32|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|GEHA [1415]|GEHA [141500]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|225.00||||225.00|4.42|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|CORESOURCE [1315]|CORESOURCE [131500]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|225.00||||225.00|5.65|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225.00||||225.00|3.91|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225.00||||225.00|4.25|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|||225.00||||225.00|67.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225.00||||225.00|225|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225.00||||225.00|5.74|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225.00||||225.00|47.25|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225.00||||225.00|146.25|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|UMR [2035]|UMR OPTIONS [203501]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225.00||||225.00|4.01|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|CHAMPVA [1240]|CHAMP VA [124000]|225.00||||225.00|168.75|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|225.00||||225.00|4.86|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225.00||||225.00|4.85|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|225.00||||225.00|5.65|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MULTIPLAN [1680]|HMA [168003]|225.00||||225.00|5.9|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MULTIPLAN [1680]|IHC HS [168011]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|HEALTHNET [1495]|HEALTHNET [149500]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|TRUSTMARK [2030]|STARMARK [203000]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|AETNA [1015]|AETNA ACO WILCO [101532]|225.00||||225.00|6.22|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225.00||||225.00|3.93|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|225.00||||225.00|2.62|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225.00||||225.00|202.5|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225.00||||225.00|107.89|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225.00||||225.00|4.1|225|2.62 30182947|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|225.00||||225.00||| 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81.00||||81.00|5.23|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81.00||||81.00|28.43|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81.00||||81.00|34.51|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81.00||||81.00|40.58|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81.00||||81.00|5.15|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81.00||||81.00|4.99|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81.00||||81.00|4.98|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81.00||||81.00|3.16|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|AETNA [1015]|AETNA ACO WILCO [101532]|81.00||||81.00|7.49|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|HEALTHNET [1495]|HEALTHNET [149500]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81.00||||81.00|40.5|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MULTIPLAN [1680]|HMA [168003]|81.00||||81.00|7.13|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MULTIPLAN [1680]|IHC HS [168011]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|FMH BENEFIT SERVICES [1390]|FMH [139000]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|FIRST HEALTH [1375]|QUALCHOICE [137513]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81.00||||81.00|5.86|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81.00||||81.00|6.83|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81.00||||81.00|5.89|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81.00||||81.00|4.85|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81.00||||81.00|48.6|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|TRUSTMARK [2030]|STARMARK [203000]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|UMR [2035]|UMR OPTIONS [203501]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81.00||||81.00|52.65|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|||81.00||||81.00|24.3|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81.00||||81.00|5.15|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81.00||||81.00|5.23|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81.00||||81.00|17.01|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81.00||||81.00|6.94|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81.00||||81.00|4.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81.00||||81.00|4.74|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81.00||||81.00|81|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|CHAMPVA [1240]|CHAMP VA [124000]|81.00||||81.00|60.75|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81.00||||81.00|6.83|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|CORESOURCE [1315]|CORESOURCE [131500]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81.00||||81.00|5.86|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81.00||||81.00|5.35|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|GEHA [1415]|GEHA [141500]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81.00||||81.00|72.9|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81.00||||81.00|38.84|81|3.16 30182950|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE POST DOSE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81.00||||81.00||| 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|GEHA [1415]|GEHA [141500]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|477.00||||477.00|14.5|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|CHAMPVA [1240]|CHAMP VA [124000]|477.00||||477.00|357.75|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|477.00||||477.00|12.83|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|477.00||||477.00|13.95|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|||477.00||||477.00|143.1|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|477.00||||477.00|228.72|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|477.00||||477.00|477|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|477.00||||477.00|100.17|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|477.00||||477.00|18.79|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|477.00||||477.00|13.13|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|477.00||||477.00|15.89|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|CORESOURCE [1315]|CORESOURCE [131500]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|477.00||||477.00|15.95|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|477.00||||477.00|18.5|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|477.00||||477.00|18.5|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|UMR [2035]|UMR OPTIONS [203501]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|HEALTHNET [1495]|HEALTHNET [149500]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|477.00||||477.00|310.05|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|477.00||||477.00|13.47|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|477.00||||477.00|14.16|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|477.00||||477.00|13.95|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MULTIPLAN [1680]|HMA [168003]|477.00||||477.00|19.31|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|477.00||||477.00|13.51|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|477.00||||477.00|8.58|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|477.00||||477.00|286.2|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|477.00||||477.00|238.5|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|477.00||||477.00|238.98|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|477.00||||477.00|167.43|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|TRUSTMARK [2030]|STARMARK [203000]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MULTIPLAN [1680]|IHC HS [168011]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|477.00||||477.00|203.2|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|477.00||||477.00|15.89|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|477.00||||477.00|12.87|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|477.00||||477.00|429.3|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|477.00||||477.00|14.16|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|AETNA [1015]|AETNA ACO WILCO [101532]|477.00||||477.00|20.34|477|8.58 30182951|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOL 1ST 3 SPECIMEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|477.00||||477.00||| 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37.00||||37.00|4.31|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37.00||||37.00|18.54|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37.00||||37.00|18.5|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37.00||||37.00|12.99|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37.00||||37.00|2.62|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37.00||||37.00|4.09|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|TRUSTMARK [2030]|STARMARK [203000]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|HEALTHNET [1495]|HEALTHNET [149500]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MULTIPLAN [1680]|HMA [168003]|37.00||||37.00|5.88|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37.00||||37.00|4.31|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37.00||||37.00|22.2|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37.00||||37.00|5.64|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MULTIPLAN [1680]|IHC HS [168011]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|FMH BENEFIT SERVICES [1390]|FMH [139000]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|FIRST HEALTH [1375]|QUALCHOICE [137513]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37.00||||37.00|4.84|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37.00||||37.00|4.84|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37.00||||37.00|15.76|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37.00||||37.00|4.12|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37.00||||37.00|4.24|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|AETNA [1015]|AETNA ACO WILCO [101532]|37.00||||37.00|6.2|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|UMR [2035]|UMR OPTIONS [203501]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37.00||||37.00|5.72|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37.00||||37.00|7.77|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37.00||||37.00|17.74|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|||37.00||||37.00|11.1|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37.00||||37.00|4.24|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37.00||||37.00|37|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37.00||||37.00|3.92|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37.00||||37.00|4.84|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37.00||||37.00|24.05|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37.00||||37.00|3.9|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|CHAMPVA [1240]|CHAMP VA [124000]|37.00||||37.00|27.75|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37.00||||37.00|4|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37.00||||37.00|5.64|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|CORESOURCE [1315]|CORESOURCE [131500]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37.00||||37.00|4.41|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|GEHA [1415]|GEHA [141500]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37.00||||37.00|33.3|37|2.62 30182952|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE TOLER ADDL SPECMN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37.00||||37.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|GEHA [1415]|GEHA [141500]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|CORESOURCE [1315]|CORESOURCE [131500]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|172.00||||172.00|9.67|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|||172.00||||172.00|51.6|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|172.00||||172.00|111.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|172.00||||172.00|82.47|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|172.00||||172.00|172|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|172.00||||172.00|36.12|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|UMR [2035]|UMR OPTIONS [203501]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|CHAMPVA [1240]|CHAMP VA [124000]|172.00||||172.00|129|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|172.00||||172.00|12.02|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|172.00||||172.00|11.97|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MULTIPLAN [1680]|IHC HS [168011]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|TRUSTMARK [2030]|STARMARK [203000]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|172.00||||172.00|10.51|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|172.00||||172.00|10.15|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|172.00||||172.00|6.46|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|172.00||||172.00|10.51|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|AETNA [1015]|AETNA ACO WILCO [101532]|172.00||||172.00|15.32|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|172.00||||172.00|103.2|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|HEALTHNET [1495]|HEALTHNET [149500]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|172.00||||172.00|86|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|172.00||||172.00|86.17|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|172.00||||172.00|11.97|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|172.00||||172.00|73.27|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|172.00||||172.00|10.92|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|172.00||||172.00|60.37|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|172.00||||172.00|154.8|172|6.46 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MULTIPLAN [1680]|HMA [168003]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|172.00||||172.00||| 30182955|EAP|0301 - LABORATORY-CHEMISTRY|HC G6PD ENZYME QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|172.00||||172.00||| 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|194.00||||194.00|3.61|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|194.00||||194.00|97.19|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|194.00||||194.00|68.09|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|194.00||||194.00|3.55|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|194.00||||194.00|3.44|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|194.00||||194.00|3.43|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|194.00||||194.00|1.97|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|AETNA [1015]|AETNA ACO WILCO [101532]|194.00||||194.00|4.67|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|HEALTHNET [1495]|HEALTHNET [149500]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|194.00||||194.00|97|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MULTIPLAN [1680]|HMA [168003]|194.00||||194.00|4.92|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MULTIPLAN [1680]|IHC HS [168011]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|FMH BENEFIT SERVICES [1390]|FMH [139000]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|FIRST HEALTH [1375]|QUALCHOICE [137513]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|194.00||||194.00|82.64|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|194.00||||194.00|4.72|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|UMR [2035]|UMR OPTIONS [203501]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.00||||194.00|116.4|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|TRUSTMARK [2030]|STARMARK [203000]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|194.00||||194.00|3.61|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.00||||194.00|93.02|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|194.00||||194.00|126.1|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|||194.00||||194.00|58.2|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|194.00||||194.00|3.55|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|194.00||||194.00|40.74|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|194.00||||194.00|194|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|194.00||||194.00|4.79|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|194.00||||194.00|3.26|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|CHAMPVA [1240]|CHAMP VA [124000]|194.00||||194.00|145.5|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|194.00||||194.00|4.72|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|CORESOURCE [1315]|CORESOURCE [131500]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|194.00||||194.00|4.06|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|194.00||||194.00|3.69|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|194.00||||194.00|3.35|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|GEHA [1415]|GEHA [141500]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|194.00||||194.00|174.6|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|194.00||||194.00|3.28|194|1.97 30182962|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUCOSE BLOOD TEST BY DEVICE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|194.00||||194.00||| 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|GEHA [1415]|GEHA [141500]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|234.00||||234.00|8.11|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|CORESOURCE [1315]|CORESOURCE [131500]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|234.00||||234.00|10.35|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|CHAMPVA [1240]|CHAMP VA [124000]|234.00||||234.00|175.5|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234.00||||234.00|7.8|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234.00||||234.00|112.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234.00||||234.00|234|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234.00||||234.00|152.1|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234.00||||234.00|10.51|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234.00||||234.00|7.34|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234.00||||234.00|8.89|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|FIRST HEALTH [1375]|QUALCHOICE [137513]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|FMH BENEFIT SERVICES [1390]|FMH [139000]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|234.00||||234.00|8.92|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234.00||||234.00|7.18|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|UMR [2035]|UMR OPTIONS [203501]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234.00||||234.00|49.14|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|234.00||||234.00|10.35|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|||234.00||||234.00|70.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|HEALTHNET [1495]|HEALTHNET [149500]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|234.00||||234.00|4.8|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|AETNA [1015]|AETNA ACO WILCO [101532]|234.00||||234.00|11.38|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234.00||||234.00|7.54|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234.00||||234.00|7.92|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234.00||||234.00|7.8|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234.00||||234.00|7.56|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234.00||||234.00|140.4|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234.00||||234.00|117|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234.00||||234.00|82.13|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|234.00||||234.00|99.68|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|TRUSTMARK [2030]|STARMARK [203000]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MULTIPLAN [1680]|IHC HS [168011]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|234.00||||234.00|117.23|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234.00||||234.00|8.89|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|MULTIPLAN [1680]|HMA [168003]|234.00||||234.00|10.8|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234.00||||234.00|7.2|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234.00||||234.00|210.6|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234.00||||234.00|7.92|234|4.8 30182977|EAP|0301 - LABORATORY-CHEMISTRY|HC GGT/GGTP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|234.00||||234.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|241.00||||241.00|17.6|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|241.00||||241.00|84.59|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|241.00||||241.00|120.74|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|241.00||||241.00|102.67|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|241.00||||241.00|120.5|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|241.00||||241.00|16.16|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|AETNA [1015]|AETNA ACO WILCO [101532]|241.00||||241.00|22.53|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|TRUSTMARK [2030]|STARMARK [203000]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|HEALTHNET [1495]|HEALTHNET [149500]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MULTIPLAN [1680]|IHC HS [168011]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|241.00||||241.00|144.6|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|241.00||||241.00|19.13|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|UMR [2035]|UMR OPTIONS [203501]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|241.00||||241.00|16.74|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|241.00||||241.00|9.5|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|241.00||||241.00|50.61|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|241.00||||241.00|156.65|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|241.00||||241.00|241|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|||241.00||||241.00|72.3|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|241.00||||241.00|16.74|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|241.00||||241.00|115.56|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|241.00||||241.00|15.39|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|CHAMPVA [1240]|CHAMP VA [124000]|241.00||||241.00|180.75|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|CORESOURCE [1315]|CORESOURCE [131500]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|241.00||||241.00|17.4|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|241.00||||241.00|17.6|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|GEHA [1415]|GEHA [141500]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|241.00||||241.00|216.9|241|9.5 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|MULTIPLAN [1680]|HMA [168003]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|241.00||||241.00||| 30182978|EAP|0301 - LABORATORY-CHEMISTRY|HC GLUTATHIONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|241.00||||241.00||| 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|GEHA [1415]|GEHA [141500]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|200.00||||200.00|18.86|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|CORESOURCE [1315]|CORESOURCE [131500]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|200.00||||200.00|24.09|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200.00||||200.00|16.7|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|||200.00||||200.00|60|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200.00||||200.00|95.9|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200.00||||200.00|200|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200.00||||200.00|24.47|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200.00||||200.00|130|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|UMR [2035]|UMR OPTIONS [203501]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200.00||||200.00|17.1|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|CHAMPVA [1240]|CHAMP VA [124000]|200.00||||200.00|150|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200.00||||200.00|18.61|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|200.00||||200.00|20.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MULTIPLAN [1680]|IHC HS [168011]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MULTIPLAN [1680]|HMA [168003]|200.00||||200.00|25.14|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|HEALTHNET [1495]|HEALTHNET [149500]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|TRUSTMARK [2030]|STARMARK [203000]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200.00||||200.00|42|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200.00||||200.00|17.54|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200.00||||200.00|18.15|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200.00||||200.00|18.44|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|200.00||||200.00|10.06|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200.00||||200.00|18.15|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200.00||||200.00|17.6|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200.00||||200.00|120|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|AETNA [1015]|AETNA ACO WILCO [101532]|200.00||||200.00|23.84|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200.00||||200.00|100|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200.00||||200.00|18.61|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200.00||||200.00|70.2|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|200.00||||200.00|85.2|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|200.00||||200.00|100.2|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|200.00||||200.00|24.09|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200.00||||200.00|16.76|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200.00||||200.00|180|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200.00||||200.00|18.44|200|10.06 30182985|EAP|0301 - LABORATORY-CHEMISTRY|HC GLYCATED PROTEIN-FRUCTOSAMINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|200.00||||200.00||| 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|387.00||||387.00|20.44|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|387.00||||387.00|22.94|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|387.00||||387.00|164.86|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|387.00||||387.00|135.84|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|387.00||||387.00|19.51|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|387.00||||387.00|20.44|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|AETNA [1015]|AETNA ACO WILCO [101532]|387.00||||387.00|29.38|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|HEALTHNET [1495]|HEALTHNET [149500]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|387.00||||387.00|193.5|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MULTIPLAN [1680]|IHC HS [168011]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|387.00||||387.00|193.89|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|387.00||||387.00|26.71|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|FMH BENEFIT SERVICES [1390]|FMH [139000]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|FIRST HEALTH [1375]|QUALCHOICE [137513]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|387.00||||387.00|23.02|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|UMR [2035]|UMR OPTIONS [203501]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MULTIPLAN [1680]|HMA [168003]|387.00||||387.00|27.87|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|387.00||||387.00|20.14|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|387.00||||387.00|232.2|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|TRUSTMARK [2030]|STARMARK [203000]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|387.00||||387.00|19.45|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|387.00||||387.00|12.39|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|387.00||||387.00|251.55|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|387.00||||387.00|185.57|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|||387.00||||387.00|116.1|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|387.00||||387.00|20.14|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|387.00||||387.00|81.27|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|387.00||||387.00|27.13|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|387.00||||387.00|18.52|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|387.00||||387.00|18.58|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|387.00||||387.00|387|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|CHAMPVA [1240]|CHAMP VA [124000]|387.00||||387.00|290.25|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|387.00||||387.00|26.71|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|CORESOURCE [1315]|CORESOURCE [131500]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|387.00||||387.00|22.94|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|387.00||||387.00|20.93|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|GEHA [1415]|GEHA [141500]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|387.00||||387.00|348.3|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|387.00||||387.00|18.95|387|12.39 30183001|EAP|0301 - LABORATORY-CHEMISTRY|HC FSH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|387.00||||387.00||| 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|GEHA [1415]|GEHA [141500]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|350.00||||350.00|20.86|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|CHAMPVA [1240]|CHAMP VA [124000]|350.00||||350.00|262.5|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350.00||||350.00|18.46|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350.00||||350.00|20.07|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350.00||||350.00|227.5|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350.00||||350.00|167.83|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350.00||||350.00|350|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350.00||||350.00|27.04|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350.00||||350.00|18.89|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350.00||||350.00|22.86|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|CORESOURCE [1315]|CORESOURCE [131500]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|FIRST HEALTH [1375]|QUALCHOICE [137513]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|350.00||||350.00|22.95|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|350.00||||350.00|26.62|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|UMR [2035]|UMR OPTIONS [203501]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|FMH BENEFIT SERVICES [1390]|FMH [139000]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|350.00||||350.00|26.62|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350.00||||350.00|73.5|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MULTIPLAN [1680]|IHC HS [168011]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|||350.00||||350.00|105|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|HEALTHNET [1495]|HEALTHNET [149500]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|350.00||||350.00|12.34|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350.00||||350.00|19.38|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350.00||||350.00|20.37|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|AETNA [1015]|AETNA ACO WILCO [101532]|350.00||||350.00|29.25|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350.00||||350.00|20.07|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350.00||||350.00|19.45|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350.00||||350.00|210|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350.00||||350.00|175|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|350.00||||350.00|175.35|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|350.00||||350.00|149.1|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|TRUSTMARK [2030]|STARMARK [203000]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MULTIPLAN [1680]|HMA [168003]|350.00||||350.00|27.78|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350.00||||350.00|22.86|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350.00||||350.00|122.85|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350.00||||350.00|18.52|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350.00||||350.00|315|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350.00||||350.00|20.37|350|12.34 30183002|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING HORMONE (LH)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|350.00||||350.00||| 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|370.00||||370.00|18.34|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|370.00||||370.00|20.58|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|370.00||||370.00|185|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|370.00||||370.00|185.37|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|370.00||||370.00|18.34|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|370.00||||370.00|11.11|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|TRUSTMARK [2030]|STARMARK [203000]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|HEALTHNET [1495]|HEALTHNET [149500]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MULTIPLAN [1680]|IHC HS [168011]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|370.00||||370.00|129.87|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MULTIPLAN [1680]|HMA [168003]|370.00||||370.00|25.01|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|370.00||||370.00|23.96|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|FMH BENEFIT SERVICES [1390]|FMH [139000]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|FIRST HEALTH [1375]|QUALCHOICE [137513]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|370.00||||370.00|20.58|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|370.00||||370.00|17.44|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|370.00||||370.00|20.65|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|370.00||||370.00|222|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|370.00||||370.00|157.62|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|370.00||||370.00|17.5|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|370.00||||370.00|18.06|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|AETNA [1015]|AETNA ACO WILCO [101532]|370.00||||370.00|26.34|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|UMR [2035]|UMR OPTIONS [203501]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|370.00||||370.00|24.34|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|370.00||||370.00|77.7|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|370.00||||370.00|177.42|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|||370.00||||370.00|111|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|370.00||||370.00|18.06|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|370.00||||370.00|370|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|370.00||||370.00|16.67|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|370.00||||370.00|240.5|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|370.00||||370.00|16.61|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|CHAMPVA [1240]|CHAMP VA [124000]|370.00||||370.00|277.5|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|370.00||||370.00|17|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|370.00||||370.00|23.96|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|CORESOURCE [1315]|CORESOURCE [131500]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|370.00||||370.00|18.77|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|GEHA [1415]|GEHA [141500]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|370.00||||370.00|333|370|11.11 30183003|EAP|0301 - LABORATORY-CHEMISTRY|HC GROWTH HORMONE (HGH)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|370.00||||370.00||| 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|GEHA [1415]|GEHA [141500]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|215.00||||215.00|18.09|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|CHAMPVA [1240]|CHAMP VA [124000]|215.00||||215.00|161.25|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215.00||||215.00|12.55|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|||215.00||||215.00|64.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215.00||||215.00|139.75|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215.00||||215.00|103.09|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215.00||||215.00|215|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215.00||||215.00|45.15|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215.00||||215.00|18.37|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|UMR [2035]|UMR OPTIONS [203501]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215.00||||215.00|12.83|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|215.00||||215.00|14.18|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|215.00||||215.00|15.59|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215.00||||215.00|15.53|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MULTIPLAN [1680]|IHC HS [168011]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MULTIPLAN [1680]|HMA [168003]|215.00||||215.00|18.87|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|CORESOURCE [1315]|CORESOURCE [131500]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|TRUSTMARK [2030]|STARMARK [203000]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|215.00||||215.00|8.38|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215.00||||215.00|13.17|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|215.00||||215.00|18.09|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215.00||||215.00|13.84|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215.00||||215.00|13.64|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215.00||||215.00|13.21|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|AETNA [1015]|AETNA ACO WILCO [101532]|215.00||||215.00|19.87|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215.00||||215.00|129|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|HEALTHNET [1495]|HEALTHNET [149500]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215.00||||215.00|107.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215.00||||215.00|15.53|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215.00||||215.00|75.47|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|215.00||||215.00|91.59|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|215.00||||215.00|107.72|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215.00||||215.00|12.58|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215.00||||215.00|193.5|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215.00||||215.00|13.64|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215.00||||215.00|13.84|215|8.38 30183010|EAP|0301 - LABORATORY-CHEMISTRY|HC HAPTOGLOBIN QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|215.00||||215.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1117.00||||1117.00|475.84|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1117.00||||1117.00|559.62|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1117.00||||1117.00|83.16|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1117.00||||1117.00|70.49|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|AETNA [1015]|AETNA ACO WILCO [101532]|1117.00||||1117.00|106.46|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|TRUSTMARK [2030]|STARMARK [203000]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1117.00||||1117.00|72.98|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|HEALTHNET [1495]|HEALTHNET [149500]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1117.00||||1117.00|44.9|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|FMH BENEFIT SERVICES [1390]|FMH [139000]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|FIRST HEALTH [1375]|QUALCHOICE [137513]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1117.00||||1117.00|392.07|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MULTIPLAN [1680]|IHC HS [168011]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1117.00||||1117.00|83.44|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1117.00||||1117.00|726.05|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1117.00||||1117.00|535.6|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|||1117.00||||1117.00|335.1|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1117.00||||1117.00|72.98|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1117.00||||1117.00|234.57|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|UMR [2035]|UMR OPTIONS [203501]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1117.00||||1117.00|1117|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1117.00||||1117.00|67.13|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1117.00||||1117.00|558.5|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|CHAMPVA [1240]|CHAMP VA [124000]|1117.00||||1117.00|837.75|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|CORESOURCE [1315]|CORESOURCE [131500]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1117.00||||1117.00|83.16|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1117.00||||1117.00|75.85|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|GEHA [1415]|GEHA [141500]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1117.00||||1117.00|1005.3|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1117.00||||1117.00|670.2|1117|44.9 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MULTIPLAN [1680]|HMA [168003]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1117.00||||1117.00||| 30183013|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA BREATH TEST FOR HPYLORI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1117.00||||1117.00||| 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|GEHA [1415]|GEHA [141500]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|285.00||||285.00|24.73|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|CHAMPVA [1240]|CHAMP VA [124000]|285.00||||285.00|213.75|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|285.00||||285.00|23.79|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|285.00||||285.00|185.25|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|285.00||||285.00|136.66|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|285.00||||285.00|285|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|||285.00||||285.00|85.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|285.00||||285.00|32.06|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|285.00||||285.00|21.88|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|285.00||||285.00|22.4|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|285.00||||285.00|27.12|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|CORESOURCE [1315]|CORESOURCE [131500]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|FIRST HEALTH [1375]|QUALCHOICE [137513]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|285.00||||285.00|27.2|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|FMH BENEFIT SERVICES [1390]|FMH [139000]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|UMR [2035]|UMR OPTIONS [203501]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|285.00||||285.00|59.85|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|HEALTHNET [1495]|HEALTHNET [149500]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|AETNA [1015]|AETNA ACO WILCO [101532]|285.00||||285.00|34.72|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|285.00||||285.00|14.65|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|285.00||||285.00|22.97|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|285.00||||285.00|24.16|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|285.00||||285.00|23.79|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|285.00||||285.00|31.57|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|285.00||||285.00|23.06|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|285.00||||285.00|171|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|285.00||||285.00|142.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|285.00||||285.00|27.12|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|TRUSTMARK [2030]|STARMARK [203000]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|285.00||||285.00|142.79|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|285.00||||285.00|100.04|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|285.00||||285.00|121.41|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|285.00||||285.00|31.57|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|285.00||||285.00|21.96|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|285.00||||285.00|24.16|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MULTIPLAN [1680]|HMA [168003]|285.00||||285.00|32.94|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|MULTIPLAN [1680]|IHC HS [168011]|285.00||||285.00|256.5|285|14.65 30183018|EAP|0301 - LABORATORY-CHEMISTRY|HC HEAVY METAL QN NES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|285.00||||285.00||| 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371.00||||371.00|15.89|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|371.00||||371.00|15.95|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|UMR [2035]|UMR OPTIONS [203501]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371.00||||371.00|18.79|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371.00||||371.00|77.91|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371.00||||371.00|371|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371.00||||371.00|177.89|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371.00||||371.00|241.15|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|||371.00||||371.00|111.3|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371.00||||371.00|13.13|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371.00||||371.00|13.95|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371.00||||371.00|12.83|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|CORESOURCE [1315]|CORESOURCE [131500]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|371.00||||371.00|14.5|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|GEHA [1415]|GEHA [141500]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|371.00||||371.00|18.5|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|CHAMPVA [1240]|CHAMP VA [124000]|371.00||||371.00|278.25|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371.00||||371.00|14.16|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371.00||||371.00|15.89|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|371.00||||371.00|158.05|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|371.00||||371.00|185.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371.00||||371.00|185.5|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371.00||||371.00|13.51|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371.00||||371.00|13.95|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371.00||||371.00|14.16|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371.00||||371.00|13.47|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371.00||||371.00|222.6|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371.00||||371.00|130.22|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|371.00||||371.00|8.58|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|AETNA [1015]|AETNA ACO WILCO [101532]|371.00||||371.00|20.34|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|TRUSTMARK [2030]|STARMARK [203000]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|HEALTHNET [1495]|HEALTHNET [149500]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|371.00||||371.00|18.5|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MULTIPLAN [1680]|IHC HS [168011]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|MULTIPLAN [1680]|HMA [168003]|371.00||||371.00|19.31|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371.00||||371.00|12.87|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|371.00||||371.00|333.9|371|8.58 30183020|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN ELECTROPHORESIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|371.00||||371.00||| 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|GEHA [1415]|GEHA [141500]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|222.00||||222.00|20.34|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|CORESOURCE [1315]|CORESOURCE [131500]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|CHAMPVA [1240]|CHAMP VA [124000]|222.00||||222.00|166.5|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222.00||||222.00|18|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222.00||||222.00|19.57|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|||222.00||||222.00|66.6|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222.00||||222.00|144.3|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222.00||||222.00|106.45|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222.00||||222.00|222|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222.00||||222.00|46.62|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222.00||||222.00|26.37|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|UMR [2035]|UMR OPTIONS [203501]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222.00||||222.00|18.42|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|222.00||||222.00|22.38|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222.00||||222.00|22.29|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|FIRST HEALTH [1375]|QUALCHOICE [137513]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|FMH BENEFIT SERVICES [1390]|FMH [139000]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|222.00||||222.00|25.96|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MULTIPLAN [1680]|HMA [168003]|222.00||||222.00|27.09|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MULTIPLAN [1680]|IHC HS [168011]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|HEALTHNET [1495]|HEALTHNET [149500]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|TRUSTMARK [2030]|STARMARK [203000]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|AETNA [1015]|AETNA ACO WILCO [101532]|222.00||||222.00|28.54|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|222.00||||222.00|12.04|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222.00||||222.00|18.9|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|222.00||||222.00|25.96|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222.00||||222.00|19.87|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222.00||||222.00|19.57|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222.00||||222.00|18.96|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222.00||||222.00|133.2|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222.00||||222.00|111|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222.00||||222.00|22.29|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|222.00||||222.00|94.57|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|222.00||||222.00|111.22|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222.00||||222.00|77.92|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222.00||||222.00|18.06|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222.00||||222.00|199.8|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222.00||||222.00|19.87|222|12.04 30183021|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB FRACT QUANT CHROMATOGRAPHY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|222.00||||222.00||| 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191.00||||191.00|10.68|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191.00||||191.00|11.99|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|191.00||||191.00|81.37|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|191.00||||191.00|95.69|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191.00||||191.00|95.5|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191.00||||191.00|114.6|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191.00||||191.00|10.2|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191.00||||191.00|10.68|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|191.00||||191.00|6.47|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|AETNA [1015]|AETNA ACO WILCO [101532]|191.00||||191.00|15.34|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|HEALTHNET [1495]|HEALTHNET [149500]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MULTIPLAN [1680]|HMA [168003]|191.00||||191.00|14.57|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|191.00||||191.00|13.96|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|FMH BENEFIT SERVICES [1390]|FMH [139000]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|FIRST HEALTH [1375]|QUALCHOICE [137513]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191.00||||191.00|11.99|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|191.00||||191.00|12.03|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191.00||||191.00|9.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MULTIPLAN [1680]|IHC HS [168011]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|TRUSTMARK [2030]|STARMARK [203000]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|UMR [2035]|UMR OPTIONS [203501]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191.00||||191.00|10.16|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191.00||||191.00|14.18|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191.00||||191.00|40.11|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191.00||||191.00|10.52|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191.00||||191.00|191|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191.00||||191.00|67.04|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191.00||||191.00|91.58|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191.00||||191.00|124.15|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|||191.00||||191.00|57.3|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191.00||||191.00|10.52|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191.00||||191.00|9.71|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191.00||||191.00|9.68|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|CHAMPVA [1240]|CHAMP VA [124000]|191.00||||191.00|143.25|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|191.00||||191.00|13.96|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|CORESOURCE [1315]|CORESOURCE [131500]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|191.00||||191.00|10.93|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|GEHA [1415]|GEHA [141500]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191.00||||191.00|171.9|191|6.47 30183036|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN GLYCOSYLATED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|191.00||||191.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|GEHA [1415]|GEHA [141500]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|CORESOURCE [1315]|CORESOURCE [131500]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|CHAMPVA [1240]|CHAMP VA [124000]|138.00||||138.00|103.5|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138.00||||138.00|8.17|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138.00||||138.00|8.89|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138.00||||138.00|89.7|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138.00||||138.00|66.17|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138.00||||138.00|138|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138.00||||138.00|28.98|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138.00||||138.00|10.17|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138.00||||138.00|9.05|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|UMR [2035]|UMR OPTIONS [203501]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MULTIPLAN [1680]|IHC HS [168011]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|HEALTHNET [1495]|HEALTHNET [149500]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|TRUSTMARK [2030]|STARMARK [203000]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|||138.00||||138.00|41.4|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|AETNA [1015]|AETNA ACO WILCO [101532]|138.00||||138.00|11.66|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138.00||||138.00|4.92|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138.00||||138.00|8.58|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138.00||||138.00|9.24|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138.00||||138.00|8.89|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138.00||||138.00|82.8|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138.00||||138.00|69|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138.00||||138.00|69.14|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138.00||||138.00|48.44|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138.00||||138.00|58.79|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138.00||||138.00|9.05|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138.00||||138.00|124.2|138|4.92 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MULTIPLAN [1680]|HMA [168003]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138.00||||138.00||| 30183050|EAP|0301 - LABORATORY-CHEMISTRY|HC METHEMOGLOBIN QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138.00||||138.00||| 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219.00||||219.00|8.04|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219.00||||219.00|9.03|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219.00||||219.00|76.87|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|219.00||||219.00|93.29|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219.00||||219.00|109.5|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219.00||||219.00|131.4|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219.00||||219.00|7.68|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219.00||||219.00|7.92|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219.00||||219.00|7.65|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|219.00||||219.00|4.87|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|TRUSTMARK [2030]|STARMARK [203000]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|HEALTHNET [1495]|HEALTHNET [149500]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|219.00||||219.00|10.51|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MULTIPLAN [1680]|IHC HS [168011]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MULTIPLAN [1680]|HMA [168003]|219.00||||219.00|10.97|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219.00||||219.00|9.03|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|219.00||||219.00|9.05|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219.00||||219.00|7.46|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|UMR [2035]|UMR OPTIONS [203501]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219.00||||219.00|10.67|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219.00||||219.00|45.99|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|AETNA [1015]|AETNA ACO WILCO [101532]|219.00||||219.00|11.55|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219.00||||219.00|8.04|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219.00||||219.00|219|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219.00||||219.00|105.01|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219.00||||219.00|142.35|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|||219.00||||219.00|65.7|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|219.00||||219.00|109.72|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219.00||||219.00|7.92|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219.00||||219.00|7.31|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219.00||||219.00|7.29|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|CHAMPVA [1240]|CHAMP VA [124000]|219.00||||219.00|164.25|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|219.00||||219.00|10.51|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|CORESOURCE [1315]|CORESOURCE [131500]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|219.00||||219.00|8.23|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|GEHA [1415]|GEHA [141500]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219.00||||219.00|197.1|219|4.87 30183051|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN PLASMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|219.00||||219.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|GEHA [1415]|GEHA [141500]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70.00||||70.00|4.45|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|CORESOURCE [1315]|CORESOURCE [131500]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|CHAMPVA [1240]|CHAMP VA [124000]|70.00||||70.00|52.5|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70.00||||70.00|3.93|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70.00||||70.00|4.28|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|||70.00||||70.00|21|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70.00||||70.00|33.57|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70.00||||70.00|70|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70.00||||70.00|14.7|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|UMR [2035]|UMR OPTIONS [203501]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70.00||||70.00|4.9|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70.00||||70.00|4.88|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MULTIPLAN [1680]|IHC HS [168011]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|HEALTHNET [1495]|HEALTHNET [149500]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|TRUSTMARK [2030]|STARMARK [203000]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|AETNA [1015]|AETNA ACO WILCO [101532]|70.00||||70.00|6.25|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70.00||||70.00|45.5|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70.00||||70.00|2.63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70.00||||70.00|4.13|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70.00||||70.00|4.28|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70.00||||70.00|42|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70.00||||70.00|35|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70.00||||70.00|4.88|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70.00||||70.00|24.57|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70.00||||70.00|29.82|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70.00||||70.00|35.07|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70.00||||70.00|63|70|2.63 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MULTIPLAN [1680]|HMA [168003]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70.00||||70.00||| 30183069|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOGLOBIN URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70.00||||70.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|179.00||||179.00|89.68|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179.00||||179.00|62.83|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|179.00||||179.00|76.25|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179.00||||179.00|89.5|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179.00||||179.00|107.4|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179.00||||179.00|4.98|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|179.00||||179.00|3.16|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|AETNA [1015]|AETNA ACO WILCO [101532]|179.00||||179.00|7.49|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|HEALTHNET [1495]|HEALTHNET [149500]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MULTIPLAN [1680]|IHC HS [168011]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179.00||||179.00|5.86|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|179.00||||179.00|5.89|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|TRUSTMARK [2030]|STARMARK [203000]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|UMR [2035]|UMR OPTIONS [203501]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179.00||||179.00|37.59|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179.00||||179.00|179|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179.00||||179.00|85.83|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179.00||||179.00|116.35|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179.00||||179.00|5.15|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179.00||||179.00|5.86|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|||179.00||||179.00|53.7|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179.00||||179.00|5.15|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179.00||||179.00|4.74|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|CHAMPVA [1240]|CHAMP VA [124000]|179.00||||179.00|134.25|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|CORESOURCE [1315]|CORESOURCE [131500]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|179.00||||179.00|5.35|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|GEHA [1415]|GEHA [141500]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179.00||||179.00|161.1|179|3.16 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MULTIPLAN [1680]|HMA [168003]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179.00||||179.00||| 30183070|EAP|0301 - LABORATORY-CHEMISTRY|HC HEMOSIDERIN QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|179.00||||179.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|GEHA [1415]|GEHA [141500]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|295.00||||295.00|19|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|CORESOURCE [1315]|CORESOURCE [131500]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|CHAMPVA [1240]|CHAMP VA [124000]|295.00||||295.00|221.25|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|295.00||||295.00|16.82|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|295.00||||295.00|18.28|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|295.00||||295.00|191.75|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|295.00||||295.00|141.45|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|295.00||||295.00|295|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|295.00||||295.00|20.9|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|295.00||||295.00|20.83|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|FIRST HEALTH [1375]|QUALCHOICE [137513]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|UMR [2035]|UMR OPTIONS [203501]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|FMH BENEFIT SERVICES [1390]|FMH [139000]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|295.00||||295.00|61.95|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MULTIPLAN [1680]|IHC HS [168011]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|HEALTHNET [1495]|HEALTHNET [149500]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|TRUSTMARK [2030]|STARMARK [203000]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|AETNA [1015]|COVENTRY HEALTHCARE [101502]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|||295.00||||295.00|88.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|AETNA [1015]|AETNA ACO WILCO [101532]|295.00||||295.00|26.66|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|295.00||||295.00|11.24|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|295.00||||295.00|17.66|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|295.00||||295.00|18.28|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|295.00||||295.00|177|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|295.00||||295.00|147.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|295.00||||295.00|125.67|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|295.00||||295.00|147.8|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|295.00||||295.00|103.55|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|295.00||||295.00|20.83|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|295.00||||295.00|265.5|295|11.24 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MULTIPLAN [1680]|HMA [168003]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|295.00||||295.00||| 30183080|EAP|0301 - LABORATORY-CHEMISTRY|HC HGB HEXOSAMINIDASE A|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|295.00||||295.00||| 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|364.00||||364.00|32.48|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|364.00||||364.00|36.46|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|364.00||||364.00|127.76|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|364.00||||364.00|182.36|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|364.00||||364.00|155.06|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|364.00||||364.00|182|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|364.00||||364.00|31.01|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|364.00||||364.00|32|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|364.00||||364.00|30.91|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|364.00||||364.00|19.69|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|AETNA [1015]|AETNA ACO WILCO [101532]|364.00||||364.00|46.67|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|TRUSTMARK [2030]|STARMARK [203000]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|HEALTHNET [1495]|HEALTHNET [149500]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|364.00||||364.00|42.45|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MULTIPLAN [1680]|HMA [168003]|364.00||||364.00|44.3|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MULTIPLAN [1680]|IHC HS [168011]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|364.00||||364.00|36.46|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|364.00||||364.00|36.59|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|364.00||||364.00|30.12|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|UMR [2035]|UMR OPTIONS [203501]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|364.00||||364.00|43.11|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|364.00||||364.00|76.44|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|364.00||||364.00|32.48|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|364.00||||364.00|364|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|364.00||||364.00|218.4|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|364.00||||364.00|174.54|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|364.00||||364.00|236.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|||364.00||||364.00|109.2|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|364.00||||364.00|32|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|364.00||||364.00|29.53|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|364.00||||364.00|29.44|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|CHAMPVA [1240]|CHAMP VA [124000]|364.00||||364.00|273|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|364.00||||364.00|42.45|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|CORESOURCE [1315]|CORESOURCE [131500]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|364.00||||364.00|33.26|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|GEHA [1415]|GEHA [141500]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|364.00||||364.00|327.6|364|19.69 30183088|EAP|0301 - LABORATORY-CHEMISTRY|HC HISTAMINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|364.00||||364.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|GEHA [1415]|GEHA [141500]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|351.00||||351.00|20.17|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|CORESOURCE [1315]|CORESOURCE [131500]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|CHAMPVA [1240]|CHAMP VA [124000]|351.00||||351.00|263.25|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351.00||||351.00|17.86|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351.00||||351.00|17.92|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351.00||||351.00|19.41|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|||351.00||||351.00|105.3|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351.00||||351.00|168.3|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351.00||||351.00|351|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351.00||||351.00|73.71|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351.00||||351.00|217.97|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|UMR [2035]|UMR OPTIONS [203501]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351.00||||351.00|18.28|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|351.00||||351.00|22.19|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351.00||||351.00|20.83|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351.00||||351.00|17.92|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|351.00||||351.00|25.76|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MULTIPLAN [1680]|HMA [168003]|351.00||||351.00|26.88|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MULTIPLAN [1680]|IHC HS [168011]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|HEALTHNET [1495]|HEALTHNET [149500]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|TRUSTMARK [2030]|STARMARK [203000]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351.00||||351.00|228.15|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351.00||||351.00|17.92|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|AETNA [1015]|AETNA ACO WILCO [101532]|351.00||||351.00|26.66|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|351.00||||351.00|11.24|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351.00||||351.00|18.75|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|351.00||||351.00|217.62|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351.00||||351.00|17.92|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351.00||||351.00|19.41|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351.00||||351.00|18.82|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351.00||||351.00|210.6|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351.00||||351.00|175.5|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351.00||||351.00|20.83|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351.00||||351.00|123.2|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|351.00||||351.00|149.53|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|351.00||||351.00|175.85|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351.00||||351.00|17.92|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351.00||||351.00|17.92|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351.00||||351.00|315.9|351|11.24 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|351.00||||351.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351.00||||351.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351.00||||351.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351.00||||351.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|351.00||||351.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|351.00||||351.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351.00||||351.00||| 30183090|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOCYSTEINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351.00||||351.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|23.89|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|77.96|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|91.68|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183.00||||183.00|109.8|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|24.29|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|183.00||||183.00|13.45|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|AETNA [1015]|AETNA ACO WILCO [101532]|183.00||||183.00|31.88|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|23.89|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|27.77|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|23.45|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|183|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183.00||||183.00|87.75|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|64.23|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|||183.00||||183.00|54.9|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|24.29|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|22.34|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|CHAMPVA [1240]|CHAMP VA [124000]|183.00||||183.00|137.25|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|25.25|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|GEHA [1415]|GEHA [141500]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|183|13.45 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MULTIPLAN [1680]|HMA [168003]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00||| 30183150|EAP|0301 - LABORATORY-CHEMISTRY|HC HOMOVANILLIC ACID (HVA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|GEHA [1415]|GEHA [141500]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|CORESOURCE [1315]|CORESOURCE [131500]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|CHAMPVA [1240]|CHAMP VA [124000]|217.00||||217.00|162.75|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|217.00||||217.00|17.85|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|217.00||||217.00|19.4|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|||217.00||||217.00|65.1|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|217.00||||217.00|141.05|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|217.00||||217.00|104.05|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|217.00||||217.00|217|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|217.00||||217.00|22.18|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|217.00||||217.00|21.64|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|FIRST HEALTH [1375]|QUALCHOICE [137513]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|UMR [2035]|UMR OPTIONS [203501]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|FMH BENEFIT SERVICES [1390]|FMH [139000]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|217.00||||217.00|45.57|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MULTIPLAN [1680]|IHC HS [168011]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|HEALTHNET [1495]|HEALTHNET [149500]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|TRUSTMARK [2030]|STARMARK [203000]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|AETNA [1015]|AETNA ACO WILCO [101532]|217.00||||217.00|27.7|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|217.00||||217.00|11.68|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|217.00||||217.00|18.74|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|217.00||||217.00|20.16|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|217.00||||217.00|19.4|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|217.00||||217.00|130.2|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|217.00||||217.00|108.5|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|217.00||||217.00|108.72|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|217.00||||217.00|76.17|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|217.00||||217.00|92.44|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|217.00||||217.00|21.64|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|217.00||||217.00|195.3|217|11.68 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MULTIPLAN [1680]|HMA [168003]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|217.00||||217.00||| 30183491|EAP|0301 - LABORATORY-CHEMISTRY|HC 17-OH-CORTICOSTEROIDS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|217.00||||217.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|495.00||||495.00|15.92|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|495.00||||495.00|248|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|495.00||||495.00|210.87|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|495.00||||495.00|247.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|495.00||||495.00|13.98|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|495.00||||495.00|13.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|495.00||||495.00|8.6|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|TRUSTMARK [2030]|STARMARK [203000]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|HEALTHNET [1495]|HEALTHNET [149500]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MULTIPLAN [1680]|IHC HS [168011]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|495.00||||495.00|15.92|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|495.00||||495.00|15.99|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|AETNA [1015]|AETNA ACO WILCO [101532]|495.00||||495.00|20.38|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|UMR [2035]|UMR OPTIONS [203501]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|495.00||||495.00|103.95|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|495.00||||495.00|495|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|495.00||||495.00|297|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|495.00||||495.00|237.35|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|495.00||||495.00|321.75|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|||495.00||||495.00|148.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|495.00||||495.00|173.75|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|495.00||||495.00|13.98|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|495.00||||495.00|12.86|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|CHAMPVA [1240]|CHAMP VA [124000]|495.00||||495.00|371.25|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|CORESOURCE [1315]|CORESOURCE [131500]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|495.00||||495.00|14.53|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|GEHA [1415]|GEHA [141500]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|495.00||||495.00|445.5|495|8.6 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MULTIPLAN [1680]|HMA [168003]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|495.00||||495.00||| 30183497|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYINDOLACETIC 5-(HIAA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|495.00||||495.00||| 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|GEHA [1415]|GEHA [141500]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|367.00||||367.00|30.6|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|CORESOURCE [1315]|CORESOURCE [131500]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|367.00||||367.00|39.06|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|CHAMPVA [1240]|CHAMP VA [124000]|367.00||||367.00|275.25|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|367.00||||367.00|27.08|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|367.00||||367.00|29.44|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|||367.00||||367.00|110.1|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|367.00||||367.00|175.98|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|367.00||||367.00|367|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|367.00||||367.00|77.07|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|367.00||||367.00|39.67|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|UMR [2035]|UMR OPTIONS [203501]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|367.00||||367.00|27.71|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|367.00||||367.00|33.65|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|367.00||||367.00|33.54|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|FIRST HEALTH [1375]|QUALCHOICE [137513]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|FMH BENEFIT SERVICES [1390]|FMH [139000]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|367.00||||367.00|39.06|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MULTIPLAN [1680]|HMA [168003]|367.00||||367.00|40.76|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MULTIPLAN [1680]|IHC HS [168011]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|HEALTHNET [1495]|HEALTHNET [149500]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|TRUSTMARK [2030]|STARMARK [203000]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|367.00||||367.00|238.55|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|AETNA [1015]|COVENTRY HEALTHCARE [101502]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|AETNA [1015]|AETNA ACO WILCO [101532]|367.00||||367.00|42.94|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|367.00||||367.00|18.11|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|367.00||||367.00|28.43|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|367.00||||367.00|29.89|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|367.00||||367.00|29.44|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|367.00||||367.00|28.53|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|367.00||||367.00|220.2|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|367.00||||367.00|183.5|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|367.00||||367.00|33.54|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|367.00||||367.00|128.82|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|367.00||||367.00|156.34|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|367.00||||367.00|183.87|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|367.00||||367.00|27.17|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|367.00||||367.00|330.3|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|367.00||||367.00|29.89|367|18.11 30183498|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROGESTERONE 17-D|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|367.00||||367.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|314.00||||314.00|27.96|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|314.00||||314.00|157.31|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|314.00||||314.00|133.76|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|314.00||||314.00|110.21|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|314.00||||314.00|157|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|314.00||||314.00|188.4|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|314.00||||314.00|15.1|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|AETNA [1015]|AETNA ACO WILCO [101532]|314.00||||314.00|35.81|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|TRUSTMARK [2030]|STARMARK [203000]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|HEALTHNET [1495]|HEALTHNET [149500]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MULTIPLAN [1680]|IHC HS [168011]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|314.00||||314.00|27.96|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|314.00||||314.00|28.05|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|UMR [2035]|UMR OPTIONS [203501]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|314.00||||314.00|23.71|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|314.00||||314.00|65.94|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|314.00||||314.00|24.54|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|314.00||||314.00|314|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|314.00||||314.00|150.56|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|314.00||||314.00|204.1|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|||314.00||||314.00|94.2|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|314.00||||314.00|24.54|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|314.00||||314.00|22.58|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|CHAMPVA [1240]|CHAMP VA [124000]|314.00||||314.00|235.5|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|CORESOURCE [1315]|CORESOURCE [131500]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|314.00||||314.00|25.51|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|GEHA [1415]|GEHA [141500]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|314.00||||314.00|282.6|314|15.1 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MULTIPLAN [1680]|HMA [168003]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|314.00||||314.00||| 30183500|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|314.00||||314.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|GEHA [1415]|GEHA [141500]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|300.00||||300.00|225|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|300.00||||300.00|24.22|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|300.00||||300.00|26.33|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|300.00||||300.00|195|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|300.00||||300.00|143.85|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|300.00||||300.00|300|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|UMR [2035]|UMR OPTIONS [203501]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|300.00||||300.00|30.1|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|300.00||||300.00|30.01|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|300.00||||300.00|63|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MULTIPLAN [1680]|IHC HS [168011]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|TRUSTMARK [2030]|STARMARK [203000]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|300.00||||300.00|38.42|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|||300.00||||300.00|90|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|300.00||||300.00|16.21|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|300.00||||300.00|25.43|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|300.00||||300.00|27.37|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|300.00||||300.00|26.33|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|300.00||||300.00|180|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|300.00||||300.00|150|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|300.00||||300.00|30.01|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|300.00||||300.00|150.3|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|300.00||||300.00|105.3|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|300.00||||300.00|127.8|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|300.00||||300.00|270|300|16.21 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MULTIPLAN [1680]|HMA [168003]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|300.00||||300.00||| 30183505|EAP|0301 - LABORATORY-CHEMISTRY|HC HYDROXYPROLINE TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|300.00||||300.00||| 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|241.00||||241.00|12.68|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|241.00||||241.00|14.24|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|241.00||||241.00|102.67|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|241.00||||241.00|84.59|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|241.00||||241.00|120.5|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|241.00||||241.00|12.11|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|241.00||||241.00|12.49|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|241.00||||241.00|12.68|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|241.00||||241.00|12.07|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|AETNA [1015]|AETNA ACO WILCO [101532]|241.00||||241.00|18.22|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|TRUSTMARK [2030]|STARMARK [203000]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|HEALTHNET [1495]|HEALTHNET [149500]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MULTIPLAN [1680]|HMA [168003]|241.00||||241.00|17.3|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|241.00||||241.00|16.58|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MULTIPLAN [1680]|IHC HS [168011]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|241.00||||241.00|14.24|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|241.00||||241.00|14.28|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|241.00||||241.00|11.76|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|UMR [2035]|UMR OPTIONS [203501]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|241.00||||241.00|7.69|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|241.00||||241.00|16.83|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|241.00||||241.00|50.61|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|241.00||||241.00|241|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|241.00||||241.00|144.6|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|241.00||||241.00|115.56|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|241.00||||241.00|156.65|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|||241.00||||241.00|72.3|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|241.00||||241.00|120.74|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|241.00||||241.00|12.49|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|241.00||||241.00|11.53|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|241.00||||241.00|11.5|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|CHAMPVA [1240]|CHAMP VA [124000]|241.00||||241.00|180.75|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|241.00||||241.00|16.58|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|CORESOURCE [1315]|CORESOURCE [131500]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|241.00||||241.00|12.98|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|GEHA [1415]|GEHA [141500]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|241.00||||241.00|216.9|241|7.69 30183516|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL SQN MULTIPLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|241.00||||241.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|GEHA [1415]|GEHA [141500]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|247.00||||247.00|10.85|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|CORESOURCE [1315]|CORESOURCE [131500]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|CHAMPVA [1240]|CHAMP VA [124000]|247.00||||247.00|185.25|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247.00||||247.00|9.6|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247.00||||247.00|10.44|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|||247.00||||247.00|74.1|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247.00||||247.00|160.55|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247.00||||247.00|118.44|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247.00||||247.00|247|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247.00||||247.00|51.87|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|UMR [2035]|UMR OPTIONS [203501]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|247.00||||247.00|11.93|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247.00||||247.00|10.47|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MULTIPLAN [1680]|IHC HS [168011]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|HEALTHNET [1495]|HEALTHNET [149500]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|TRUSTMARK [2030]|STARMARK [203000]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|AETNA [1015]|AETNA ACO WILCO [101532]|247.00||||247.00|13.71|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|247.00||||247.00|5.78|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247.00||||247.00|10.08|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247.00||||247.00|10.44|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247.00||||247.00|148.2|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247.00||||247.00|123.5|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247.00||||247.00|10.47|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|247.00||||247.00|105.22|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|247.00||||247.00|123.75|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247.00||||247.00|86.7|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247.00||||247.00|222.3|247|5.78 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MULTIPLAN [1680]|HMA [168003]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247.00||||247.00||| 30183518|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO QL/SQ SINGLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247.00||||247.00||| 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|451.00||||451.00|20.24|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|451.00||||451.00|192.13|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|451.00||||451.00|225.95|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|451.00||||451.00|225.5|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|451.00||||451.00|270.6|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|451.00||||451.00|19.32|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|451.00||||451.00|20.24|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|451.00||||451.00|11.04|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|AETNA [1015]|AETNA ACO WILCO [101532]|451.00||||451.00|26.17|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|HEALTHNET [1495]|HEALTHNET [149500]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|451.00||||451.00|26.45|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MULTIPLAN [1680]|IHC HS [168011]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MULTIPLAN [1680]|HMA [168003]|451.00||||451.00|27.6|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|451.00||||451.00|22.79|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|451.00||||451.00|18.77|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|TRUSTMARK [2030]|STARMARK [203000]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|UMR [2035]|UMR OPTIONS [203501]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|451.00||||451.00|19.26|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|451.00||||451.00|26.86|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|451.00||||451.00|94.71|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|451.00||||451.00|19.94|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|451.00||||451.00|451|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|451.00||||451.00|158.3|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|451.00||||451.00|216.25|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|451.00||||451.00|293.15|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|||451.00||||451.00|135.3|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|451.00||||451.00|19.94|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|451.00||||451.00|18.4|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|451.00||||451.00|18.35|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|CHAMPVA [1240]|CHAMP VA [124000]|451.00||||451.00|338.25|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|451.00||||451.00|26.45|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|CORESOURCE [1315]|CORESOURCE [131500]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|451.00||||451.00|20.73|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|GEHA [1415]|GEHA [141500]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|451.00||||451.00|405.9|451|11.04 30183519|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNO RIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|451.00||||451.00||| 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|GEHA [1415]|GEHA [141500]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|CORESOURCE [1315]|CORESOURCE [131500]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|595.00||||595.00|24.83|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|CHAMPVA [1240]|CHAMP VA [124000]|595.00||||595.00|446.25|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|595.00||||595.00|17.2|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|595.00||||595.00|18.71|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|595.00||||595.00|386.75|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|595.00||||595.00|285.3|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|595.00||||595.00|595|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|595.00||||595.00|124.95|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|595.00||||595.00|25.21|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|595.00||||595.00|17.62|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|595.00||||595.00|21.39|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|FIRST HEALTH [1375]|QUALCHOICE [137513]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|UMR [2035]|UMR OPTIONS [203501]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|FMH BENEFIT SERVICES [1390]|FMH [139000]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MULTIPLAN [1680]|HMA [168003]|595.00||||595.00|25.91|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|595.00||||595.00|24.83|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MULTIPLAN [1680]|IHC HS [168011]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|HEALTHNET [1495]|HEALTHNET [149500]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|TRUSTMARK [2030]|STARMARK [203000]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|||595.00||||595.00|178.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|AETNA [1015]|AETNA ACO WILCO [101532]|595.00||||595.00|24.56|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|595.00||||595.00|10.36|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|595.00||||595.00|18.06|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|595.00||||595.00|19|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|595.00||||595.00|18.71|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|595.00||||595.00|18.13|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|595.00||||595.00|357|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|595.00||||595.00|19.45|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|595.00||||595.00|297.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|595.00||||595.00|298.1|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|595.00||||595.00|208.85|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|595.00||||595.00|253.47|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|595.00||||595.00|17.27|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|595.00||||595.00|535.5|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|595.00||||595.00|19|595|10.36 30183520|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY OTHER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|595.00||||595.00||| 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218.00||||218.00|12.57|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218.00||||218.00|14.11|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|218.00||||218.00|109.22|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|218.00||||218.00|92.87|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218.00||||218.00|109|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218.00||||218.00|130.8|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218.00||||218.00|12|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218.00||||218.00|12.38|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218.00||||218.00|11.95|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|218.00||||218.00|18.07|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|TRUSTMARK [2030]|STARMARK [203000]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MULTIPLAN [1680]|HMA [168003]|218.00||||218.00|17.15|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|218.00||||218.00|16.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MULTIPLAN [1680]|IHC HS [168011]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218.00||||218.00|14.11|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|218.00||||218.00|14.16|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218.00||||218.00|11.66|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|UMR [2035]|UMR OPTIONS [203501]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218.00||||218.00|16.69|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218.00||||218.00|45.78|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|218.00||||218.00|7.62|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218.00||||218.00|12.57|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218.00||||218.00|218|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218.00||||218.00|104.53|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218.00||||218.00|141.7|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|||218.00||||218.00|65.4|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218.00||||218.00|76.52|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218.00||||218.00|12.38|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218.00||||218.00|11.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218.00||||218.00|11.38|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|218.00||||218.00|163.5|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|218.00||||218.00|16.43|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|218.00||||218.00|12.87|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|GEHA [1415]|GEHA [141500]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218.00||||218.00|196.2|218|7.62 30183525|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|218.00||||218.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|GEHA [1415]|GEHA [141500]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|223.00||||223.00|14.58|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|CORESOURCE [1315]|CORESOURCE [131500]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|CHAMPVA [1240]|CHAMP VA [124000]|223.00||||223.00|167.25|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|223.00||||223.00|12.9|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|223.00||||223.00|14.03|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|||223.00||||223.00|66.9|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|223.00||||223.00|106.93|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|223.00||||223.00|223|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|223.00||||223.00|46.83|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|UMR [2035]|UMR OPTIONS [203501]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|223.00||||223.00|16.04|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|223.00||||223.00|15.98|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MULTIPLAN [1680]|IHC HS [168011]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|HEALTHNET [1495]|HEALTHNET [149500]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|TRUSTMARK [2030]|STARMARK [203000]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|223.00||||223.00|144.95|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|AETNA [1015]|AETNA ACO WILCO [101532]|223.00||||223.00|20.47|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|223.00||||223.00|8.63|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|223.00||||223.00|13.54|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|223.00||||223.00|14.03|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|223.00||||223.00|133.8|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|223.00||||223.00|111.5|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|223.00||||223.00|15.98|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|223.00||||223.00|78.27|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|223.00||||223.00|95|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|223.00||||223.00|111.72|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|223.00||||223.00|200.7|223|8.63 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MULTIPLAN [1680]|HMA [168003]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|223.00||||223.00||| 30183527|EAP|0301 - LABORATORY-CHEMISTRY|HC INSULIN FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|223.00||||223.00||| 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195.00||||195.00|7.12|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195.00||||195.00|7.99|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|195.00||||195.00|97.7|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|195.00||||195.00|83.07|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195.00||||195.00|97.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195.00||||195.00|117|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195.00||||195.00|6.79|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195.00||||195.00|7.12|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195.00||||195.00|6.77|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|195.00||||195.00|4.31|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|AETNA [1015]|AETNA ACO WILCO [101532]|195.00||||195.00|10.23|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|HEALTHNET [1495]|HEALTHNET [149500]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|195.00||||195.00|9.3|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MULTIPLAN [1680]|IHC HS [168011]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|FMH BENEFIT SERVICES [1390]|FMH [139000]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|FIRST HEALTH [1375]|QUALCHOICE [137513]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MULTIPLAN [1680]|HMA [168003]|195.00||||195.00|9.71|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195.00||||195.00|7.99|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|195.00||||195.00|8.01|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|TRUSTMARK [2030]|STARMARK [203000]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195.00||||195.00|6.6|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|UMR [2035]|UMR OPTIONS [203501]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195.00||||195.00|9.45|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195.00||||195.00|40.95|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195.00||||195.00|7.01|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195.00||||195.00|195|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195.00||||195.00|93.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195.00||||195.00|126.75|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195.00||||195.00|68.45|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|||195.00||||195.00|58.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195.00||||195.00|7.01|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195.00||||195.00|6.47|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195.00||||195.00|6.44|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|CHAMPVA [1240]|CHAMP VA [124000]|195.00||||195.00|146.25|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|195.00||||195.00|9.3|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|CORESOURCE [1315]|CORESOURCE [131500]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|195.00||||195.00|7.29|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|GEHA [1415]|GEHA [141500]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195.00||||195.00|175.5|195|4.31 30183540|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|195.00||||195.00||| 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|GEHA [1415]|GEHA [141500]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|201.00||||201.00|9.84|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|CORESOURCE [1315]|CORESOURCE [131500]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|201.00||||201.00|12.56|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|CHAMPVA [1240]|CHAMP VA [124000]|201.00||||201.00|150.75|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201.00||||201.00|8.71|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201.00||||201.00|9.47|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201.00||||201.00|130.65|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201.00||||201.00|96.38|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201.00||||201.00|201|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201.00||||201.00|12.76|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201.00||||201.00|8.91|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|201.00||||201.00|10.83|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201.00||||201.00|10.79|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|UMR [2035]|UMR OPTIONS [203501]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201.00||||201.00|42.21|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|201.00||||201.00|12.56|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MULTIPLAN [1680]|IHC HS [168011]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MULTIPLAN [1680]|HMA [168003]|201.00||||201.00|13.11|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|HEALTHNET [1495]|HEALTHNET [149500]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|TRUSTMARK [2030]|STARMARK [203000]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|||201.00||||201.00|60.3|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|AETNA [1015]|AETNA ACO WILCO [101532]|201.00||||201.00|13.81|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|201.00||||201.00|5.83|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201.00||||201.00|9.15|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201.00||||201.00|9.61|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201.00||||201.00|9.47|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201.00||||201.00|9.18|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201.00||||201.00|120.6|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201.00||||201.00|100.5|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201.00||||201.00|10.79|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|201.00||||201.00|100.7|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|201.00||||201.00|85.63|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201.00||||201.00|70.55|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201.00||||201.00|8.74|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201.00||||201.00|180.9|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201.00||||201.00|9.61|201|5.83 30183550|EAP|0301 - LABORATORY-CHEMISTRY|HC IRON BINDING CAPACITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|201.00||||201.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179.00||||179.00|15.8|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179.00||||179.00|62.83|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|179.00||||179.00|89.68|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|179.00||||179.00|76.25|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179.00||||179.00|89.5|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179.00||||179.00|13.87|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179.00||||179.00|13.39|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|179.00||||179.00|8.53|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|179.00||||179.00|20.23|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|TRUSTMARK [2030]|STARMARK [203000]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MULTIPLAN [1680]|IHC HS [168011]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179.00||||179.00|15.8|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|179.00||||179.00|15.86|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|UMR [2035]|UMR OPTIONS [203501]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179.00||||179.00|37.59|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179.00||||179.00|179|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179.00||||179.00|107.4|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179.00||||179.00|85.83|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179.00||||179.00|116.35|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|||179.00||||179.00|53.7|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179.00||||179.00|13.87|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179.00||||179.00|12.75|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|179.00||||179.00|134.25|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|179.00||||179.00|14.42|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|GEHA [1415]|GEHA [141500]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179.00||||179.00|161.1|179|8.53 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MULTIPLAN [1680]|HMA [168003]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179.00||||179.00||| 30183586|EAP|0301 - LABORATORY-CHEMISTRY|HC KETOSTEROIDS (17-KS) TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|179.00||||179.00||| 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|GEHA [1415]|GEHA [141500]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.00||||464.00|13.03|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|CORESOURCE [1315]|CORESOURCE [131500]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|CHAMPVA [1240]|CHAMP VA [124000]|464.00||||464.00|348|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.00||||464.00|11.54|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.00||||464.00|12.54|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|||464.00||||464.00|139.2|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.00||||464.00|222.49|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.00||||464.00|464|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.00||||464.00|97.44|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.00||||464.00|16.89|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|UMR [2035]|UMR OPTIONS [203501]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.00||||464.00|11.8|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.00||||464.00|14.33|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.00||||464.00|13.19|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MULTIPLAN [1680]|HMA [168003]|464.00||||464.00|17.36|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.00||||464.00|16.63|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MULTIPLAN [1680]|IHC HS [168011]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|HEALTHNET [1495]|HEALTHNET [149500]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|TRUSTMARK [2030]|STARMARK [203000]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.00||||464.00|301.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|AETNA [1015]|AETNA ACO WILCO [101532]|464.00||||464.00|16.88|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|464.00||||464.00|7.12|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.00||||464.00|12.11|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.00||||464.00|16.63|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.00||||464.00|12.73|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.00||||464.00|12.54|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.00||||464.00|12.15|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.00||||464.00|278.4|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.00||||464.00|232|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.00||||464.00|13.19|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.00||||464.00|162.86|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.00||||464.00|197.66|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.00||||464.00|232.46|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.00||||464.00|11.57|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.00||||464.00|417.6|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.00||||464.00|12.73|464|7.12 30183605|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE/LACTIC ACID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.00||||464.00||| 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230.00||||230.00|6.64|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230.00||||230.00|7.45|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230.00||||230.00|97.98|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230.00||||230.00|115.23|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230.00||||230.00|115|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230.00||||230.00|138|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230.00||||230.00|6.34|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230.00||||230.00|6.55|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230.00||||230.00|6.64|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230.00||||230.00|4.03|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|AETNA [1015]|AETNA ACO WILCO [101532]|230.00||||230.00|9.54|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|HEALTHNET [1495]|HEALTHNET [149500]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MULTIPLAN [1680]|IHC HS [168011]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230.00||||230.00|8.68|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MULTIPLAN [1680]|HMA [168003]|230.00||||230.00|9.06|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|FMH BENEFIT SERVICES [1390]|FMH [139000]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|FIRST HEALTH [1375]|QUALCHOICE [137513]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230.00||||230.00|7.45|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230.00||||230.00|7.49|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230.00||||230.00|6.16|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|TRUSTMARK [2030]|STARMARK [203000]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|UMR [2035]|UMR OPTIONS [203501]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230.00||||230.00|8.82|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230.00||||230.00|48.3|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230.00||||230.00|6.32|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230.00||||230.00|230|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230.00||||230.00|110.29|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230.00||||230.00|149.5|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230.00||||230.00|80.73|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|||230.00||||230.00|69|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230.00||||230.00|6.55|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230.00||||230.00|6.04|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230.00||||230.00|6.02|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|CHAMPVA [1240]|CHAMP VA [124000]|230.00||||230.00|172.5|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230.00||||230.00|8.68|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|CORESOURCE [1315]|CORESOURCE [131500]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230.00||||230.00|6.81|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|GEHA [1415]|GEHA [141500]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230.00||||230.00|207|230|4.03 30183615|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTATE DEHYDROGENASE (LDH)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230.00||||230.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|GEHA [1415]|GEHA [141500]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|CORESOURCE [1315]|CORESOURCE [131500]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|CHAMPVA [1240]|CHAMP VA [124000]|264.00||||264.00|198|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|264.00||||264.00|12.74|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|264.00||||264.00|13.85|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|||264.00||||264.00|79.2|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|264.00||||264.00|171.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|264.00||||264.00|126.59|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|264.00||||264.00|264|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|264.00||||264.00|15.84|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|264.00||||264.00|15.8|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|FIRST HEALTH [1375]|QUALCHOICE [137513]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|UMR [2035]|UMR OPTIONS [203501]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|FMH BENEFIT SERVICES [1390]|FMH [139000]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|264.00||||264.00|55.44|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MULTIPLAN [1680]|IHC HS [168011]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|HEALTHNET [1495]|HEALTHNET [149500]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|TRUSTMARK [2030]|STARMARK [203000]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|AETNA [1015]|AETNA ACO WILCO [101532]|264.00||||264.00|20.23|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|AETNA [1015]|COVENTRY HEALTHCARE [101502]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|264.00||||264.00|8.53|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|264.00||||264.00|13.38|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|264.00||||264.00|14.4|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|264.00||||264.00|13.85|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|264.00||||264.00|158.4|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|264.00||||264.00|132|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|264.00||||264.00|132.26|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|264.00||||264.00|92.66|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|264.00||||264.00|112.46|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|264.00||||264.00|15.8|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|264.00||||264.00|237.6|264|8.53 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MULTIPLAN [1680]|HMA [168003]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|264.00||||264.00||| 30183625|EAP|0301 - LABORATORY-CHEMISTRY|HC LDH ISOENZYME|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|264.00||||264.00||| 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244.00||||244.00|21.67|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244.00||||244.00|24.24|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|244.00||||244.00|122.24|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|244.00||||244.00|103.94|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244.00||||244.00|122|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244.00||||244.00|20.69|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244.00||||244.00|21.35|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244.00||||244.00|20.62|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|244.00||||244.00|13.09|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|AETNA [1015]|AETNA ACO WILCO [101532]|244.00||||244.00|31.02|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|TRUSTMARK [2030]|STARMARK [203000]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|HEALTHNET [1495]|HEALTHNET [149500]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MULTIPLAN [1680]|HMA [168003]|244.00||||244.00|29.55|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|244.00||||244.00|28.32|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MULTIPLAN [1680]|IHC HS [168011]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244.00||||244.00|24.24|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|244.00||||244.00|24.41|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244.00||||244.00|20.09|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|UMR [2035]|UMR OPTIONS [203501]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244.00||||244.00|28.76|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244.00||||244.00|51.24|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244.00||||244.00|21.67|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244.00||||244.00|244|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244.00||||244.00|117|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244.00||||244.00|158.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|||244.00||||244.00|73.2|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244.00||||244.00|146.4|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244.00||||244.00|85.64|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244.00||||244.00|21.35|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244.00||||244.00|19.7|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244.00||||244.00|19.63|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|CHAMPVA [1240]|CHAMP VA [124000]|244.00||||244.00|183|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|244.00||||244.00|28.32|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|CORESOURCE [1315]|CORESOURCE [131500]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|244.00||||244.00|22.19|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|GEHA [1415]|GEHA [141500]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244.00||||244.00|219.6|244|13.09 30183630|EAP|0301 - LABORATORY-CHEMISTRY|HC LACTOFERRIN FECAL QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|244.00||||244.00||| 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|GEHA [1415]|GEHA [141500]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|169.00||||169.00|13.64|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|CORESOURCE [1315]|CORESOURCE [131500]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|169.00||||169.00|17.41|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|CHAMPVA [1240]|CHAMP VA [124000]|169.00||||169.00|126.75|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169.00||||169.00|12.07|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169.00||||169.00|13.12|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|||169.00||||169.00|50.7|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169.00||||169.00|81.04|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169.00||||169.00|169|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169.00||||169.00|35.49|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169.00||||169.00|17.68|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|UMR [2035]|UMR OPTIONS [203501]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169.00||||169.00|12.35|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|169.00||||169.00|15|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169.00||||169.00|14.95|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|FIRST HEALTH [1375]|QUALCHOICE [137513]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|FMH BENEFIT SERVICES [1390]|FMH [139000]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MULTIPLAN [1680]|HMA [168003]|169.00||||169.00|18.17|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|169.00||||169.00|17.41|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MULTIPLAN [1680]|IHC HS [168011]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|HEALTHNET [1495]|HEALTHNET [149500]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|TRUSTMARK [2030]|STARMARK [203000]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169.00||||169.00|109.85|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|AETNA [1015]|AETNA ACO WILCO [101532]|169.00||||169.00|19.13|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|169.00||||169.00|8.07|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169.00||||169.00|12.67|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169.00||||169.00|13.32|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169.00||||169.00|13.12|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169.00||||169.00|12.72|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169.00||||169.00|101.4|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169.00||||169.00|84.5|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169.00||||169.00|14.95|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169.00||||169.00|59.32|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|169.00||||169.00|71.99|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|169.00||||169.00|84.67|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169.00||||169.00|12.11|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169.00||||169.00|152.1|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169.00||||169.00|13.32|169|8.07 30183655|EAP|0301 - LABORATORY-CHEMISTRY|HC LEAD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|169.00||||169.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|||306.00||||306.00|91.8|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|306.00||||306.00|23.82|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|306.00||||306.00|21.91|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|CHAMPVA [1240]|CHAMP VA [124000]|306.00||||306.00|229.5|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|CORESOURCE [1315]|CORESOURCE [131500]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|306.00||||306.00|24.76|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|GEHA [1415]|GEHA [141500]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|306.00||||306.00|64.26|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|306.00||||306.00|146.73|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|306.00||||306.00|14.66|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|UMR [2035]|UMR OPTIONS [203501]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|TRUSTMARK [2030]|STARMARK [203000]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|306.00||||306.00|27.23|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|FIRST HEALTH [1375]|QUALCHOICE [137513]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|306.00||||306.00|27.14|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MULTIPLAN [1680]|IHC HS [168011]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|306.00||||306.00|198.9|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|AETNA [1015]|AETNA ACO WILCO [101532]|306.00||||306.00|34.75|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|306.00||||306.00|27.14|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|306.00||||306.00|130.36|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|306.00||||306.00|23.01|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|306.00||||306.00|183.6|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|306.00||||306.00|153|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|306.00||||306.00|153.31|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|306.00||||306.00|306|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|306.00||||306.00|23.82|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|HEALTHNET [1495]|HEALTHNET [149500]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|306.00||||306.00|107.41|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|FMH BENEFIT SERVICES [1390]|FMH [139000]|306.00||||306.00|275.4|306|14.66 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|306.00||||306.00||| 30183661|EAP|0301 - LABORATORY-CHEMISTRY|HC LECITHIN SPHINGO (L/S RATIO)|MULTIPLAN [1680]|HMA [168003]|306.00||||306.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|393.00||||393.00|167.42|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|GEHA [1415]|GEHA [141500]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|CORESOURCE [1315]|CORESOURCE [131500]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|393.00||||393.00|137.94|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|UMR [2035]|UMR OPTIONS [203501]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|393.00||||393.00|18.85|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|393.00||||393.00|20.49|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|393.00||||393.00|20.49|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MULTIPLAN [1680]|IHC HS [168011]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|393.00||||393.00|21.3|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|393.00||||393.00|393|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|FMH BENEFIT SERVICES [1390]|FMH [139000]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|AETNA [1015]|AETNA ACO WILCO [101532]|393.00||||393.00|29.88|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|393.00||||393.00|196.89|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|||393.00||||393.00|117.9|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|FIRST HEALTH [1375]|QUALCHOICE [137513]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|393.00||||393.00|82.53|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|TRUSTMARK [2030]|STARMARK [203000]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|393.00||||393.00|19.8|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|393.00||||393.00|255.45|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|393.00||||393.00|188.44|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|CHAMPVA [1240]|CHAMP VA [124000]|393.00||||393.00|294.75|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|HEALTHNET [1495]|HEALTHNET [149500]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|393.00||||393.00|23.43|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|393.00||||393.00|23.35|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|393.00||||393.00|23.35|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|393.00||||393.00|235.8|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|393.00||||393.00|196.5|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|393.00||||393.00|353.7|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|393.00||||393.00|12.61|393|12.61 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|MULTIPLAN [1680]|HMA [168003]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|393.00||||393.00||| 30183663|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATUR FLUOR POLARZ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|393.00||||393.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|CORESOURCE [1315]|CORESOURCE [131500]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|CHAMPVA [1240]|CHAMP VA [124000]|326.00||||326.00|244.5|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|326.00||||326.00|21.75|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|326.00||||326.00|19.25|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|326.00||||326.00|68.46|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|GEHA [1415]|GEHA [141500]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|AETNA [1015]|AETNA ACO WILCO [101532]|326.00||||326.00|29.88|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|326.00||||326.00|20.21|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|326.00||||326.00|114.43|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|326.00||||326.00|163|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|FMH BENEFIT SERVICES [1390]|FMH [139000]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|326.00||||326.00|12.61|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|326.00||||326.00|195.6|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|HEALTHNET [1495]|HEALTHNET [149500]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|326.00||||326.00|163.33|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|326.00||||326.00|23.35|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MULTIPLAN [1680]|IHC HS [168011]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|326.00||||326.00|20.93|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|326.00||||326.00|211.9|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|326.00||||326.00|23.93|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|TRUSTMARK [2030]|STARMARK [203000]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|326.00||||326.00|20.93|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|326.00||||326.00|138.88|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|326.00||||326.00|156.32|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|UMR [2035]|UMR OPTIONS [203501]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|326.00||||326.00|23.35|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|326.00||||326.00|326|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|FIRST HEALTH [1375]|QUALCHOICE [137513]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|326.00||||326.00|293.4|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|||326.00||||326.00|97.8|326|12.61 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MULTIPLAN [1680]|HMA [168003]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|326.00||||326.00||| 30183664|EAP|0301 - LABORATORY-CHEMISTRY|HC FETAL LUNG MATURITY LAMELLAR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|326.00||||326.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|GEHA [1415]|GEHA [141500]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|115.00||||115.00|48.99|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|CHAMPVA [1240]|CHAMP VA [124000]|115.00||||115.00|86.25|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|115.00||||115.00|55.14|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|115.00||||115.00|115|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|115.00||||115.00|24.15|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|115.00||||115.00|11.05|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|115.00||||115.00|11.31|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|115.00||||115.00|6.11|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|TRUSTMARK [2030]|STARMARK [203000]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|CORESOURCE [1315]|CORESOURCE [131500]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|115.00||||115.00|57.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|115.00||||115.00|10.63|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|115.00||||115.00|40.37|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|HEALTHNET [1495]|HEALTHNET [149500]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|115.00||||115.00|9.77|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|115.00||||115.00|74.75|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|UMR [2035]|UMR OPTIONS [203501]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|||115.00||||115.00|34.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|115.00||||115.00|14.48|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|115.00||||115.00|10.26|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|115.00||||115.00|11.31|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MULTIPLAN [1680]|IHC HS [168011]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|115.00||||115.00|69|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|115.00||||115.00|10.63|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|115.00||||115.00|12.15|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|115.00||||115.00|103.5|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|115.00||||115.00|57.62|115|6.11 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|115.00||||115.00||| 30183670|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUCINE AMINOPEPTIDASE SERUM|MULTIPLAN [1680]|HMA [168003]|115.00||||115.00||| 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|CORESOURCE [1315]|CORESOURCE [131500]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|310.00||||310.00|7.76|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|GEHA [1415]|GEHA [141500]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|310.00||||310.00|186|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|310.00||||310.00|7.23|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|310.00||||310.00|8.51|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|310.00||||310.00|7.58|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MULTIPLAN [1680]|IHC HS [168011]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|310.00||||310.00|155|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|310.00||||310.00|155.31|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|310.00||||310.00|7.58|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|310.00||||310.00|7.47|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|310.00||||310.00|132.06|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|310.00||||310.00|4.59|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|310.00||||310.00|9.91|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|310.00||||310.00|7.03|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|HEALTHNET [1495]|HEALTHNET [149500]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|310.00||||310.00|8.51|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MULTIPLAN [1680]|HMA [168003]|310.00||||310.00|10.34|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|310.00||||310.00|7.21|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|TRUSTMARK [2030]|STARMARK [203000]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|310.00||||310.00|10.06|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|310.00||||310.00|8.54|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|310.00||||310.00|201.5|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|310.00||||310.00|7.47|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|310.00||||310.00|310|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|310.00||||310.00|148.65|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|||310.00||||310.00|93|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|310.00||||310.00|108.81|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|UMR [2035]|UMR OPTIONS [203501]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|AETNA [1015]|AETNA ACO WILCO [101532]|310.00||||310.00|10.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|310.00||||310.00|6.87|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|310.00||||310.00|65.1|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|CHAMPVA [1240]|CHAMP VA [124000]|310.00||||310.00|232.5|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|310.00||||310.00|6.89|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|310.00||||310.00|279|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|310.00||||310.00|9.91|310|4.59 30183690|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|310.00||||310.00||| 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MULTIPLAN [1680]|IHC HS [168011]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|209.00||||209.00|16.12|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209.00||||209.00|20.91|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|GEHA [1415]|GEHA [141500]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|UMR [2035]|UMR OPTIONS [203501]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|CHAMPVA [1240]|CHAMP VA [124000]|209.00||||209.00|156.75|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|CORESOURCE [1315]|CORESOURCE [131500]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209.00||||209.00|15.51|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209.00||||209.00|14.27|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209.00||||209.00|135.85|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|209.00||||209.00|20.59|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|||209.00||||209.00|62.7|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209.00||||209.00|43.89|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209.00||||209.00|209|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|AETNA [1015]|AETNA ACO WILCO [101532]|209.00||||209.00|20.47|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209.00||||209.00|15.75|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|HEALTHNET [1495]|HEALTHNET [149500]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209.00||||209.00|15.98|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209.00||||209.00|14.98|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209.00||||209.00|73.36|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|TRUSTMARK [2030]|STARMARK [203000]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|209.00||||209.00|8.63|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MULTIPLAN [1680]|HMA [168003]|209.00||||209.00|21.48|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209.00||||209.00|100.22|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|FIRST HEALTH [1375]|QUALCHOICE [137513]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|209.00||||209.00|17.73|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209.00||||209.00|14.61|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209.00||||209.00|104.5|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209.00||||209.00|15.51|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209.00||||209.00|15.98|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|209.00||||209.00|89.03|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209.00||||209.00|125.4|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|209.00||||209.00|20.59|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209.00||||209.00|15.04|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209.00||||209.00|15.75|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209.00||||209.00|14.32|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|209.00||||209.00|104.71|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|FMH BENEFIT SERVICES [1390]|FMH [139000]|209.00||||209.00|188.1|209|8.63 30183695|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN(A)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|209.00||||209.00||| 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|577.00||||577.00|50.94|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|577.00||||577.00|245.8|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|577.00||||577.00|289.08|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|577.00||||577.00|288.5|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|577.00||||577.00|27.79|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|577.00||||577.00|48.46|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|577.00||||577.00|346.2|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MULTIPLAN [1680]|HMA [168003]|577.00||||577.00|69.47|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|AETNA [1015]|AETNA ACO WILCO [101532]|577.00||||577.00|65.87|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|FMH BENEFIT SERVICES [1390]|FMH [139000]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|TRUSTMARK [2030]|STARMARK [203000]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|577.00||||577.00|57.36|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|UMR [2035]|UMR OPTIONS [203501]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|577.00||||577.00|47.24|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|||577.00||||577.00|173.1|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|577.00||||577.00|67.61|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|577.00||||577.00|50.94|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|FIRST HEALTH [1375]|QUALCHOICE [137513]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|HEALTHNET [1495]|HEALTHNET [149500]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|577.00||||577.00|577|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|577.00||||577.00|375.05|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|577.00||||577.00|276.67|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|AETNA [1015]|COVENTRY HEALTHCARE [101502]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MULTIPLAN [1680]|IHC HS [168011]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|577.00||||577.00|48.63|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|577.00||||577.00|202.53|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|577.00||||577.00|50.17|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|577.00||||577.00|46.15|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|577.00||||577.00|50.17|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|GEHA [1415]|GEHA [141500]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|577.00||||577.00|52.15|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|CORESOURCE [1315]|CORESOURCE [131500]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|577.00||||577.00|66.58|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|577.00||||577.00|46.31|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|577.00||||577.00|519.3|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|577.00||||577.00|66.58|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|577.00||||577.00|121.17|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|CHAMPVA [1240]|CHAMP VA [124000]|577.00||||577.00|432.75|577|27.79 30183698|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROT PHOSPHOLIP LPPLA2|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|577.00||||577.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|436.00||||436.00|209.06|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MULTIPLAN [1680]|HMA [168003]|436.00||||436.00|50.79|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|436.00||||436.00|283.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MULTIPLAN [1680]|IHC HS [168011]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|UMR [2035]|UMR OPTIONS [203501]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|436.00||||436.00|270.76|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|436.00||||436.00|34.54|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|436.00||||436.00|48.68|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|HEALTHNET [1495]|HEALTHNET [149500]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|AETNA [1015]|AETNA ACO WILCO [101532]|436.00||||436.00|48.16|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|436.00||||436.00|20.32|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|436.00||||436.00|35.44|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|TRUSTMARK [2030]|STARMARK [203000]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|436.00||||436.00|91.56|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|436.00||||436.00|436|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|436.00||||436.00|41.95|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|436.00||||436.00|153.04|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|436.00||||436.00|36.69|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|||436.00||||436.00|130.8|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|436.00||||436.00|261.6|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|436.00||||436.00|218|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|436.00||||436.00|218.44|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|436.00||||436.00|33.86|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|436.00||||436.00|36.69|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|436.00||||436.00|35.55|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|436.00||||436.00|185.74|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|436.00||||436.00|38.13|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|GEHA [1415]|GEHA [141500]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|CHAMPVA [1240]|CHAMP VA [124000]|436.00||||436.00|327|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|CORESOURCE [1315]|CORESOURCE [131500]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|436.00||||436.00|270.32|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|436.00||||436.00|33.75|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|436.00||||436.00|392.4|436|20.32 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|436.00||||436.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|436.00||||436.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|436.00||||436.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|436.00||||436.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|436.00||||436.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|436.00||||436.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|436.00||||436.00||| 30183701|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN ULTRACENTRIFUGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|436.00||||436.00||| 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|534.00||||534.00|37.61|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|534.00||||534.00|227.48|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|534.00||||534.00|267|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|534.00||||534.00|37.04|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|534.00||||534.00|21.04|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|534.00||||534.00|320.4|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|534.00||||534.00|35.9|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|534.00||||534.00|35.78|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|534.00||||534.00|267.53|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|AETNA [1015]|AETNA ACO WILCO [101532]|534.00||||534.00|49.87|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|534.00||||534.00|42.34|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|HEALTHNET [1495]|HEALTHNET [149500]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|534.00||||534.00|49.15|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MULTIPLAN [1680]|HMA [168003]|534.00||||534.00|51.29|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MULTIPLAN [1680]|IHC HS [168011]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|534.00||||534.00|38.95|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|534.00||||534.00|34.87|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|534.00||||534.00|37.04|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|||534.00||||534.00|160.2|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|534.00||||534.00|347.1|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|UMR [2035]|UMR OPTIONS [203501]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|534.00||||534.00|49.92|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|FIRST HEALTH [1375]|QUALCHOICE [137513]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|FMH BENEFIT SERVICES [1390]|FMH [139000]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|534.00||||534.00|534|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|534.00||||534.00|112.14|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|534.00||||534.00|256.05|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|TRUSTMARK [2030]|STARMARK [203000]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|534.00||||534.00|38.95|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|534.00||||534.00|187.43|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|534.00||||534.00|37.61|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|534.00||||534.00|34.19|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|CORESOURCE [1315]|CORESOURCE [131500]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|534.00||||534.00|38.5|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|GEHA [1415]|GEHA [141500]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|534.00||||534.00|34.07|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|CHAMPVA [1240]|CHAMP VA [124000]|534.00||||534.00|400.5|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|534.00||||534.00|49.15|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|534.00||||534.00|480.6|534|21.04 30183704|EAP|0301 - LABORATORY-CHEMISTRY|HC LIPOPROTEIN BLD BY NMR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|534.00||||534.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104.00||||104.00|9.23|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|GEHA [1415]|GEHA [141500]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|CHAMPVA [1240]|CHAMP VA [124000]|104.00||||104.00|78|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.00||||104.00|104|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.00||||104.00|49.87|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.00||||104.00|8.88|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.00||||104.00|8.16|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|||104.00||||104.00|31.2|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.00||||104.00|67.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|UMR [2035]|UMR OPTIONS [203501]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.00||||104.00|10.12|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104.00||||104.00|10.15|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MULTIPLAN [1680]|IHC HS [168011]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104.00||||104.00|5.46|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|AETNA [1015]|AETNA ACO WILCO [101532]|104.00||||104.00|12.95|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.00||||104.00|21.84|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|TRUSTMARK [2030]|STARMARK [203000]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|CORESOURCE [1315]|CORESOURCE [131500]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|HEALTHNET [1495]|HEALTHNET [149500]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104.00||||104.00|62.4|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104.00||||104.00|52.1|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.00||||104.00|52|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.00||||104.00|36.5|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.00||||104.00|8.88|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104.00||||104.00|44.3|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.00||||104.00|10.12|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.00||||104.00|93.6|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.00||||104.00|8.57|104|5.46 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MULTIPLAN [1680]|HMA [168003]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.00||||104.00||| 30183718|EAP|0301 - LABORATORY-CHEMISTRY|HC HDL CHOLESTEROL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.00||||104.00||| 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111.00||||111.00|13.01|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111.00||||111.00|11.55|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111.00||||111.00|55.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111.00||||111.00|6.36|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111.00||||111.00|47.29|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111.00||||111.00|11.03|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111.00||||111.00|11.38|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111.00||||111.00|11.55|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111.00||||111.00|11.78|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111.00||||111.00|10.99|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|HEALTHNET [1495]|HEALTHNET [149500]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111.00||||111.00|55.61|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|AETNA [1015]|AETNA ACO WILCO [101532]|111.00||||111.00|15.08|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|TRUSTMARK [2030]|STARMARK [203000]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|FIRST HEALTH [1375]|QUALCHOICE [137513]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|FMH BENEFIT SERVICES [1390]|FMH [139000]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MULTIPLAN [1680]|IHC HS [168011]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111.00||||111.00|66.6|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111.00||||111.00|10.71|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|||111.00||||111.00|33.3|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111.00||||111.00|72.15|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111.00||||111.00|15.33|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|UMR [2035]|UMR OPTIONS [203501]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111.00||||111.00|111|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111.00||||111.00|38.96|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111.00||||111.00|15.09|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111.00||||111.00|53.22|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111.00||||111.00|11.78|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111.00||||111.00|11.38|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MULTIPLAN [1680]|HMA [168003]|111.00||||111.00|15.75|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111.00||||111.00|10.47|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111.00||||111.00|15.09|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|GEHA [1415]|GEHA [141500]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111.00||||111.00|10.5|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111.00||||111.00|23.31|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|CORESOURCE [1315]|CORESOURCE [131500]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111.00||||111.00|11.83|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|CHAMPVA [1240]|CHAMP VA [124000]|111.00||||111.00|83.25|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111.00||||111.00|99.9|111|6.36 30183721|EAP|0301 - LABORATORY-CHEMISTRY|HC LDL CHOLESTEROL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111.00||||111.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|212.00||||212.00|19.36|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|GEHA [1415]|GEHA [141500]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|CORESOURCE [1315]|CORESOURCE [131500]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|||212.00||||212.00|63.6|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|212.00||||212.00|137.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|212.00||||212.00|101.65|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|CHAMPVA [1240]|CHAMP VA [124000]|212.00||||212.00|159|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|212.00||||212.00|212|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|AETNA [1015]|AETNA ACO WILCO [101532]|212.00||||212.00|27.17|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|HEALTHNET [1495]|HEALTHNET [149500]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|212.00||||212.00|11.46|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|TRUSTMARK [2030]|STARMARK [203000]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|212.00||||212.00|17.99|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|212.00||||212.00|17.13|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|212.00||||212.00|18.63|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|UMR [2035]|UMR OPTIONS [203501]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|212.00||||212.00|44.52|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|212.00||||212.00|106|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|212.00||||212.00|21.22|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|212.00||||212.00|74.41|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MULTIPLAN [1680]|IHC HS [168011]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|212.00||||212.00|127.2|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|212.00||||212.00|18.63|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|212.00||||212.00|21.22|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|212.00||||212.00|21.3|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|212.00||||212.00|190.8|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|212.00||||212.00|90.31|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|212.00||||212.00|106.21|212|11.46 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MULTIPLAN [1680]|HMA [168003]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|212.00||||212.00||| 30183727|EAP|0301 - LABORATORY-CHEMISTRY|HC LUTEINIZING RELEASING FACTOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|212.00||||212.00||| 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208.00||||208.00|7.37|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208.00||||208.00|73.01|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|208.00||||208.00|88.61|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208.00||||208.00|124.8|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208.00||||208.00|7.37|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|208.00||||208.00|104.21|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208.00||||208.00|7.26|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208.00||||208.00|7.02|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|208.00||||208.00|4.46|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|AETNA [1015]|AETNA ACO WILCO [101532]|208.00||||208.00|10.58|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|TRUSTMARK [2030]|STARMARK [203000]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|HEALTHNET [1495]|HEALTHNET [149500]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|208.00||||208.00|9.63|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208.00||||208.00|8.27|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MULTIPLAN [1680]|IHC HS [168011]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208.00||||208.00|135.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208.00||||208.00|9.78|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|UMR [2035]|UMR OPTIONS [203501]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208.00||||208.00|208|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208.00||||208.00|43.68|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208.00||||208.00|8.27|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208.00||||208.00|6.83|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208.00||||208.00|99.74|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208.00||||208.00|104|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208.00||||208.00|7.04|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|208.00||||208.00|8.3|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|||208.00||||208.00|62.4|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208.00||||208.00|7.26|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208.00||||208.00|6.7|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208.00||||208.00|6.68|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|CORESOURCE [1315]|CORESOURCE [131500]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|CHAMPVA [1240]|CHAMP VA [124000]|208.00||||208.00|156|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|208.00||||208.00|7.55|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|MULTIPLAN [1680]|HMA [168003]|208.00||||208.00|10.05|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|208.00||||208.00|9.63|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|GEHA [1415]|GEHA [141500]|208.00||||208.00|187.2|208|4.46 30183735|EAP|0301 - LABORATORY-CHEMISTRY|HC MAGNESIUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|208.00||||208.00||| 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|GEHA [1415]|GEHA [141500]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|CHAMPVA [1240]|CHAMP VA [124000]|403.00||||403.00|302.25|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|403.00||||403.00|403|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|403.00||||403.00|38.31|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|403.00||||403.00|30.01|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|403.00||||403.00|26.56|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|403.00||||403.00|193.24|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|||403.00||||403.00|120.9|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|CORESOURCE [1315]|CORESOURCE [131500]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|403.00||||403.00|261.95|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|403.00||||403.00|84.63|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|403.00||||403.00|38.91|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|403.00||||403.00|27.18|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|403.00||||403.00|30.37|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|FIRST HEALTH [1375]|QUALCHOICE [137513]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|FMH BENEFIT SERVICES [1390]|FMH [139000]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|403.00||||403.00|38.31|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MULTIPLAN [1680]|HMA [168003]|403.00||||403.00|39.98|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|403.00||||403.00|27.89|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|HEALTHNET [1495]|HEALTHNET [149500]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|403.00||||403.00|16.4|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|TRUSTMARK [2030]|STARMARK [203000]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MULTIPLAN [1680]|IHC HS [168011]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|AETNA [1015]|AETNA ACO WILCO [101532]|403.00||||403.00|38.88|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|403.00||||403.00|28.87|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|403.00||||403.00|33.01|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|403.00||||403.00|29.32|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|403.00||||403.00|241.8|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|UMR [2035]|UMR OPTIONS [203501]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|403.00||||403.00|27.98|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|403.00||||403.00|201.5|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|403.00||||403.00|201.9|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|403.00||||403.00|362.7|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|403.00||||403.00|171.68|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|403.00||||403.00|29.32|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|403.00||||403.00|28.87|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|403.00||||403.00|141.45|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|403.00||||403.00|30.37|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|403.00||||403.00|26.65|403|16.4 30183785|EAP|0301 - LABORATORY-CHEMISTRY|HC MANGANESE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|403.00||||403.00||| 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|299.00||||299.00|26.52|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|299.00||||299.00|25.32|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|299.00||||299.00|104.95|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|299.00||||299.00|26.12|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|299.00||||299.00|149.8|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|299.00||||299.00|25.22|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|299.00||||299.00|14.47|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|AETNA [1015]|AETNA ACO WILCO [101532]|299.00||||299.00|34.29|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|TRUSTMARK [2030]|STARMARK [203000]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|299.00||||299.00|34.66|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|299.00||||299.00|127.37|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MULTIPLAN [1680]|IHC HS [168011]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|299.00||||299.00|24.59|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|299.00||||299.00|149.5|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|299.00||||299.00|35.2|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|299.00||||299.00|62.79|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|UMR [2035]|UMR OPTIONS [203501]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|299.00||||299.00|299|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|299.00||||299.00|29.86|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|299.00||||299.00|143.37|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|||299.00||||299.00|89.7|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|299.00||||299.00|26.12|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|299.00||||299.00|179.4|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|HEALTHNET [1495]|HEALTHNET [149500]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|299.00||||299.00|24.11|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|299.00||||299.00|26.52|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|299.00||||299.00|24.02|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|299.00||||299.00|194.35|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|299.00||||299.00|34.66|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|GEHA [1415]|GEHA [141500]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|CORESOURCE [1315]|CORESOURCE [131500]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|CHAMPVA [1240]|CHAMP VA [124000]|299.00||||299.00|224.25|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|299.00||||299.00|27.15|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|299.00||||299.00|269.1|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|MULTIPLAN [1680]|HMA [168003]|299.00||||299.00|36.17|299|14.47 30183789|EAP|0301 - LABORATORY-CHEMISTRY|HC MASS SPECTROMETRY QUAL/QUAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|299.00||||299.00||| 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MULTIPLAN [1680]|HMA [168003]|225.00||||225.00|24.39|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|AETNA [1015]|AETNA ACO WILCO [101532]|225.00||||225.00|25.69|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|225.00||||225.00|10.84|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225.00||||225.00|17.01|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MULTIPLAN [1680]|IHC HS [168011]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|225.00||||225.00|23.38|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225.00||||225.00|17.89|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|HEALTHNET [1495]|HEALTHNET [149500]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225.00||||225.00|17.07|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225.00||||225.00|112.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225.00||||225.00|20.07|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225.00||||225.00|78.98|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|TRUSTMARK [2030]|STARMARK [203000]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|225.00||||225.00|112.73|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225.00||||225.00|135|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225.00||||225.00|17.61|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225.00||||225.00|17.89|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|225.00||||225.00|95.85|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225.00||||225.00|225|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|GEHA [1415]|GEHA [141500]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|225.00||||225.00|23.38|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|CHAMPVA [1240]|CHAMP VA [124000]|225.00||||225.00|168.75|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225.00||||225.00|17.61|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225.00||||225.00|16.2|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|225.00||||225.00|18.3|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|||225.00||||225.00|67.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|CORESOURCE [1315]|CORESOURCE [131500]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225.00||||225.00|146.25|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225.00||||225.00|107.89|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225.00||||225.00|47.25|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225.00||||225.00|23.74|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|UMR [2035]|UMR OPTIONS [203501]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225.00||||225.00|16.26|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225.00||||225.00|16.59|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|225.00||||225.00|20.13|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225.00||||225.00|20.07|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|225.00||||225.00|202.5|225|10.84 30183825|EAP|0301 - LABORATORY-CHEMISTRY|HC MERCURY QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|225.00||||225.00||| 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|310.00||||310.00|20.92|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|310.00||||310.00|132.06|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|310.00||||310.00|186|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|310.00||||310.00|17.79|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|310.00||||310.00|155.31|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|310.00||||310.00|18.35|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|310.00||||310.00|18.63|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|310.00||||310.00|17.72|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|310.00||||310.00|11.29|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|TRUSTMARK [2030]|STARMARK [203000]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MULTIPLAN [1680]|IHC HS [168011]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|310.00||||310.00|24.35|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MULTIPLAN [1680]|HMA [168003]|310.00||||310.00|25.41|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|FIRST HEALTH [1375]|QUALCHOICE [137513]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|310.00||||310.00|20.92|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|310.00||||310.00|17.28|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|310.00||||310.00|24.73|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|HEALTHNET [1495]|HEALTHNET [149500]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|310.00||||310.00|65.1|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|AETNA [1015]|AETNA ACO WILCO [101532]|310.00||||310.00|26.77|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|310.00||||310.00|20.98|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|310.00||||310.00|310|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|FMH BENEFIT SERVICES [1390]|FMH [139000]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|310.00||||310.00|148.65|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|UMR [2035]|UMR OPTIONS [203501]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|310.00||||310.00|201.5|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|310.00||||310.00|18.63|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|310.00||||310.00|108.81|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|310.00||||310.00|155|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|||310.00||||310.00|93|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|310.00||||310.00|18.35|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|310.00||||310.00|16.94|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|310.00||||310.00|16.88|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|CORESOURCE [1315]|CORESOURCE [131500]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|310.00||||310.00|19.07|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|GEHA [1415]|GEHA [141500]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|310.00||||310.00|24.35|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|CHAMPVA [1240]|CHAMP VA [124000]|310.00||||310.00|232.5|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|310.00||||310.00|279|310|11.29 30183835|EAP|0301 - LABORATORY-CHEMISTRY|HC METANEPHRINES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|310.00||||310.00||| 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|357.00||||357.00|19.37|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|357.00||||357.00|24.73|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|CHAMPVA [1240]|CHAMP VA [124000]|357.00||||357.00|267.75|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|357.00||||357.00|17.14|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|357.00||||357.00|18.64|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|||357.00||||357.00|107.1|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|357.00||||357.00|232.05|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|357.00||||357.00|171.18|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|GEHA [1415]|GEHA [141500]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|357.00||||357.00|74.97|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|UMR [2035]|UMR OPTIONS [203501]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|357.00||||357.00|17.54|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|357.00||||357.00|21.31|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|357.00||||357.00|21.24|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|FMH BENEFIT SERVICES [1390]|FMH [139000]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|357.00||||357.00|24.73|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MULTIPLAN [1680]|HMA [168003]|357.00||||357.00|25.8|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|HEALTHNET [1495]|HEALTHNET [149500]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|TRUSTMARK [2030]|STARMARK [203000]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|357.00||||357.00|25.11|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MULTIPLAN [1680]|IHC HS [168011]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|AETNA [1015]|AETNA ACO WILCO [101532]|357.00||||357.00|27.19|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|357.00||||357.00|357|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|357.00||||357.00|11.47|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|CORESOURCE [1315]|CORESOURCE [131500]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|FIRST HEALTH [1375]|QUALCHOICE [137513]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|357.00||||357.00|18|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|357.00||||357.00|18.92|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|357.00||||357.00|18.64|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|357.00||||357.00|18.06|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|357.00||||357.00|214.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|357.00||||357.00|178.5|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|357.00||||357.00|152.08|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|357.00||||357.00|18.92|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|357.00||||357.00|321.3|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|357.00||||357.00|17.2|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|357.00||||357.00|178.86|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|357.00||||357.00|21.24|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|357.00||||357.00|125.31|357|11.47 30183873|EAP|0301 - LABORATORY-CHEMISTRY|HC MYELIN BASIC PROTEIN CSF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|357.00||||357.00||| 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|342.00||||342.00|14.21|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|342.00||||342.00|120.04|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|342.00||||342.00|15.95|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|342.00||||342.00|171|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|342.00||||342.00|205.2|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|342.00||||342.00|13.99|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|342.00||||342.00|14.21|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|342.00||||342.00|13.51|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|AETNA [1015]|AETNA ACO WILCO [101532]|342.00||||342.00|20.41|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|TRUSTMARK [2030]|STARMARK [203000]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|HEALTHNET [1495]|HEALTHNET [149500]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MULTIPLAN [1680]|HMA [168003]|342.00||||342.00|19.38|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|342.00||||342.00|15.95|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|342.00||||342.00|16|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|342.00||||342.00|13.18|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|UMR [2035]|UMR OPTIONS [203501]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|342.00||||342.00|18.86|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|342.00||||342.00|71.82|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|342.00||||342.00|342|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|342.00||||342.00|8.61|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|342.00||||342.00|163.99|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|342.00||||342.00|171.34|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|342.00||||342.00|145.69|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|342.00||||342.00|13.57|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|342.00||||342.00|222.3|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|342.00||||342.00|18.57|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|||342.00||||342.00|102.6|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|342.00||||342.00|13.99|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MULTIPLAN [1680]|IHC HS [168011]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|342.00||||342.00|12.92|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|342.00||||342.00|12.87|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|CHAMPVA [1240]|CHAMP VA [124000]|342.00||||342.00|256.5|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|GEHA [1415]|GEHA [141500]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|342.00||||342.00|14.54|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|CORESOURCE [1315]|CORESOURCE [131500]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|342.00||||342.00|18.57|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|342.00||||342.00|307.8|342|8.61 30183874|EAP|0301 - LABORATORY-CHEMISTRY|HC MYOGLOBIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|342.00||||342.00||| 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|GEHA [1415]|GEHA [141500]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|470.00||||470.00|56.44|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|CORESOURCE [1315]|CORESOURCE [131500]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|CHAMPVA [1240]|CHAMP VA [124000]|470.00||||470.00|352.5|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|||470.00||||470.00|141|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|470.00||||470.00|305.5|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|470.00||||470.00|470|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|470.00||||470.00|98.7|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|470.00||||470.00|57.32|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|470.00||||470.00|56.44|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|FIRST HEALTH [1375]|QUALCHOICE [137513]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|470.00||||470.00|41.9|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MULTIPLAN [1680]|HMA [168003]|470.00||||470.00|58.89|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|UMR [2035]|UMR OPTIONS [203501]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|HEALTHNET [1495]|HEALTHNET [149500]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|TRUSTMARK [2030]|STARMARK [203000]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|AETNA [1015]|AETNA ACO WILCO [101532]|470.00||||470.00|55.84|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|FMH BENEFIT SERVICES [1390]|FMH [139000]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|470.00||||470.00|23.56|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|470.00||||470.00|225.37|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|470.00||||470.00|44.2|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|470.00||||470.00|42.53|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|470.00||||470.00|48.62|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|470.00||||470.00|40.05|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|470.00||||470.00|41.08|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|470.00||||470.00|39.12|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|470.00||||470.00|43.19|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|470.00||||470.00|42.53|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|470.00||||470.00|41.22|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|470.00||||470.00|282|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|470.00||||470.00|235|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|470.00||||470.00|235.47|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MULTIPLAN [1680]|IHC HS [168011]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|470.00||||470.00|41.9|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|470.00||||470.00|43.19|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|470.00||||470.00|423|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|470.00||||470.00|200.22|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|470.00||||470.00|39.26|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|470.00||||470.00|164.97|470|23.56 30183880|EAP|0301 - LABORATORY-CHEMISTRY|HC IMMUNOASSAY BNP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|470.00||||470.00||| 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|397.00||||397.00|139.35|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|397.00||||397.00|238.2|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|397.00||||397.00|14.28|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|397.00||||397.00|14.73|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|397.00||||397.00|14.96|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|397.00||||397.00|16.79|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|397.00||||397.00|14.23|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|397.00||||397.00|9.07|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|TRUSTMARK [2030]|STARMARK [203000]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|HEALTHNET [1495]|HEALTHNET [149500]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MULTIPLAN [1680]|HMA [168003]|397.00||||397.00|20.4|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|FIRST HEALTH [1375]|QUALCHOICE [137513]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|397.00||||397.00|16.79|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|UMR [2035]|UMR OPTIONS [203501]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|397.00||||397.00|19.86|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|397.00||||397.00|83.37|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|397.00||||397.00|397|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|AETNA [1015]|AETNA ACO WILCO [101532]|397.00||||397.00|21.49|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|FMH BENEFIT SERVICES [1390]|FMH [139000]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|397.00||||397.00|190.36|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|397.00||||397.00|14.96|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|397.00||||397.00|258.05|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|397.00||||397.00|169.12|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|397.00||||397.00|198.9|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|397.00||||397.00|198.5|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|||397.00||||397.00|119.1|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MULTIPLAN [1680]|IHC HS [168011]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|397.00||||397.00|14.73|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|397.00||||397.00|19.55|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|397.00||||397.00|13.6|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|397.00||||397.00|13.55|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|397.00||||397.00|19.55|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|CORESOURCE [1315]|CORESOURCE [131500]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|GEHA [1415]|GEHA [141500]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|397.00||||397.00|15.31|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|397.00||||397.00|16.84|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|CHAMPVA [1240]|CHAMP VA [124000]|397.00||||397.00|297.75|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|397.00||||397.00|357.3|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|397.00||||397.00|13.87|397|9.07 30183883|EAP|0301 - LABORATORY-CHEMISTRY|HC NEPHELOMETRY EA ANALYTE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|397.00||||397.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|400.00||||400.00|27.61|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|CORESOURCE [1315]|CORESOURCE [131500]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|400.00||||400.00|24.43|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|400.00||||400.00|26.56|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|||400.00||||400.00|120|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|400.00||||400.00|260|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|CHAMPVA [1240]|CHAMP VA [124000]|400.00||||400.00|300|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|400.00||||400.00|191.8|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|400.00||||400.00|84|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|UMR [2035]|UMR OPTIONS [203501]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|400.00||||400.00|30.26|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|400.00||||400.00|30.37|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MULTIPLAN [1680]|IHC HS [168011]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|HEALTHNET [1495]|HEALTHNET [149500]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|TRUSTMARK [2030]|STARMARK [203000]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|AETNA [1015]|AETNA ACO WILCO [101532]|400.00||||400.00|38.73|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|400.00||||400.00|16.34|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|400.00||||400.00|400|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|GEHA [1415]|GEHA [141500]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|400.00||||400.00|25.65|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|400.00||||400.00|26.56|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|400.00||||400.00|240|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|400.00||||400.00|200|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|400.00||||400.00|30.26|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|400.00||||400.00|360|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|400.00||||400.00|170.4|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|400.00||||400.00|140.4|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|400.00||||400.00|200.4|400|16.34 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MULTIPLAN [1680]|HMA [168003]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|400.00||||400.00||| 30183885|EAP|0301 - LABORATORY-CHEMISTRY|HC NICKEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|400.00||||400.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|AETNA [1015]|AETNA ACO WILCO [101532]|138.00||||138.00|17.63|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138.00||||138.00|58.79|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138.00||||138.00|13.77|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138.00||||138.00|69.14|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138.00||||138.00|69|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138.00||||138.00|82.8|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138.00||||138.00|12.08|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138.00||||138.00|48.44|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138.00||||138.00|11.67|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138.00||||138.00|7.43|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|TRUSTMARK [2030]|STARMARK [203000]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|HEALTHNET [1495]|HEALTHNET [149500]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138.00||||138.00|13.81|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|UMR [2035]|UMR OPTIONS [203501]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138.00||||138.00|28.98|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138.00||||138.00|138|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|FIRST HEALTH [1375]|QUALCHOICE [137513]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138.00||||138.00|66.17|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138.00||||138.00|89.7|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138.00||||138.00|13.77|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|FMH BENEFIT SERVICES [1390]|FMH [139000]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|||138.00||||138.00|41.4|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138.00||||138.00|12.08|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MULTIPLAN [1680]|IHC HS [168011]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138.00||||138.00|11.11|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|CHAMPVA [1240]|CHAMP VA [124000]|138.00||||138.00|103.5|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|GEHA [1415]|GEHA [141500]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|CORESOURCE [1315]|CORESOURCE [131500]|138.00||||138.00|124.2|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138.00||||138.00|12.56|138|7.43 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MULTIPLAN [1680]|HMA [168003]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138.00||||138.00||| 30183915|EAP|0301 - LABORATORY-CHEMISTRY|HC NUCLEOTIDASE 5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138.00||||138.00||| 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|GEHA [1415]|GEHA [141500]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|374.00||||374.00|39.38|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374.00||||374.00|27.31|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|CHAMPVA [1240]|CHAMP VA [124000]|374.00||||374.00|280.5|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|||374.00||||374.00|112.2|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|CORESOURCE [1315]|CORESOURCE [131500]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374.00||||374.00|243.1|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374.00||||374.00|374|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374.00||||374.00|78.54|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374.00||||374.00|39.99|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374.00||||374.00|27.94|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|FIRST HEALTH [1375]|QUALCHOICE [137513]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|FMH BENEFIT SERVICES [1390]|FMH [139000]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|374.00||||374.00|39.38|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MULTIPLAN [1680]|IHC HS [168011]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|HEALTHNET [1495]|HEALTHNET [149500]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|TRUSTMARK [2030]|STARMARK [203000]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|AETNA [1015]|AETNA ACO WILCO [101532]|374.00||||374.00|38.96|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MULTIPLAN [1680]|HMA [168003]|374.00||||374.00|41.09|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|374.00||||374.00|16.43|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374.00||||374.00|179.33|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|374.00||||374.00|30.85|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374.00||||374.00|29.68|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374.00||||374.00|28.67|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|374.00||||374.00|33.94|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374.00||||374.00|30.13|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374.00||||374.00|29.68|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374.00||||374.00|28.76|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374.00||||374.00|224.4|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374.00||||374.00|187|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374.00||||374.00|131.27|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374.00||||374.00|30.13|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|374.00||||374.00|187.37|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|374.00||||374.00|159.32|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374.00||||374.00|27.39|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|UMR [2035]|UMR OPTIONS [203501]|374.00||||374.00|336.6|374|16.43 30183916|EAP|0301 - LABORATORY-CHEMISTRY|HC OLIGOCLONAL BANDS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|374.00||||374.00||| 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203.00||||203.00|71.25|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203.00||||203.00|121.8|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203.00||||203.00|24.78|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|203.00||||203.00|101.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203.00||||203.00|25.56|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203.00||||203.00|25.96|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203.00||||203.00|24.69|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|203.00||||203.00|14.16|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|TRUSTMARK [2030]|STARMARK [203000]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|HEALTHNET [1495]|HEALTHNET [149500]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|203.00||||203.00|33.93|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MULTIPLAN [1680]|HMA [168003]|203.00||||203.00|35.4|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MULTIPLAN [1680]|IHC HS [168011]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203.00||||203.00|24.07|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203.00||||203.00|34.46|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203.00||||203.00|42.63|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|203.00||||203.00|29.23|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203.00||||203.00|203|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|AETNA [1015]|AETNA ACO WILCO [101532]|203.00||||203.00|33.57|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203.00||||203.00|97.34|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203.00||||203.00|25.96|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|UMR [2035]|UMR OPTIONS [203501]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203.00||||203.00|131.95|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|203.00||||203.00|86.48|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203.00||||203.00|101.5|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|||203.00||||203.00|60.9|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203.00||||203.00|25.56|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203.00||||203.00|23.6|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203.00||||203.00|23.51|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|CORESOURCE [1315]|CORESOURCE [131500]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|203.00||||203.00|26.57|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|GEHA [1415]|GEHA [141500]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|203.00||||203.00|33.93|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|CHAMPVA [1240]|CHAMP VA [124000]|203.00||||203.00|152.25|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203.00||||203.00|182.7|203|14.16 30183918|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACIDS QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|203.00||||203.00||| 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|338.00||||338.00|23.88|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|338.00||||338.00|30.49|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|338.00||||338.00|21.14|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|CHAMPVA [1240]|CHAMP VA [124000]|338.00||||338.00|253.5|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|338.00||||338.00|22.98|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|||338.00||||338.00|101.4|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|338.00||||338.00|219.7|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|338.00||||338.00|162.07|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|338.00||||338.00|70.98|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|UMR [2035]|UMR OPTIONS [203501]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|338.00||||338.00|21.63|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|338.00||||338.00|26.28|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|338.00||||338.00|30.49|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MULTIPLAN [1680]|IHC HS [168011]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|HEALTHNET [1495]|HEALTHNET [149500]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|TRUSTMARK [2030]|STARMARK [203000]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|AETNA [1015]|AETNA ACO WILCO [101532]|338.00||||338.00|30.17|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MULTIPLAN [1680]|HMA [168003]|338.00||||338.00|31.82|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|338.00||||338.00|30.97|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|GEHA [1415]|GEHA [141500]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|338.00||||338.00|338|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|338.00||||338.00|12.73|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|CORESOURCE [1315]|CORESOURCE [131500]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|338.00||||338.00|22.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|338.00||||338.00|23.33|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|338.00||||338.00|22.98|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|338.00||||338.00|22.27|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|338.00||||338.00|202.8|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|338.00||||338.00|169|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|338.00||||338.00|169.34|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|338.00||||338.00|143.99|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|338.00||||338.00|118.64|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|338.00||||338.00|23.33|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|338.00||||338.00|304.2|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|338.00||||338.00|21.21|338|12.73 30183921|EAP|0301 - LABORATORY-CHEMISTRY|HC ORGANIC ACID SINGLE QUANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|338.00||||338.00||| 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230.00||||230.00|7.27|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230.00||||230.00|97.98|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230.00||||230.00|80.73|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230.00||||230.00|115.23|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230.00||||230.00|8.16|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230.00||||230.00|115|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230.00||||230.00|138|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230.00||||230.00|7.16|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230.00||||230.00|7.27|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230.00||||230.00|6.91|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|TRUSTMARK [2030]|STARMARK [203000]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|HEALTHNET [1495]|HEALTHNET [149500]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230.00||||230.00|9.5|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|FMH BENEFIT SERVICES [1390]|FMH [139000]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230.00||||230.00|8.16|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230.00||||230.00|8.19|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230.00||||230.00|6.74|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230.00||||230.00|9.65|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|AETNA [1015]|AETNA ACO WILCO [101532]|230.00||||230.00|10.45|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230.00||||230.00|48.3|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|UMR [2035]|UMR OPTIONS [203501]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230.00||||230.00|4.41|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230.00||||230.00|230|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|FIRST HEALTH [1375]|QUALCHOICE [137513]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230.00||||230.00|110.29|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230.00||||230.00|6.94|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230.00||||230.00|149.5|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MULTIPLAN [1680]|HMA [168003]|230.00||||230.00|9.92|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|||230.00||||230.00|69|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230.00||||230.00|7.16|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MULTIPLAN [1680]|IHC HS [168011]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230.00||||230.00|6.61|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230.00||||230.00|6.58|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|CHAMPVA [1240]|CHAMP VA [124000]|230.00||||230.00|172.5|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|CORESOURCE [1315]|CORESOURCE [131500]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230.00||||230.00|7.44|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|GEHA [1415]|GEHA [141500]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230.00||||230.00|9.5|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230.00||||230.00|207|230|4.41 30183930|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY BLD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230.00||||230.00||| 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|229.00||||229.00|7.68|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|CORESOURCE [1315]|CORESOURCE [131500]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|229.00||||229.00|9.8|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|||229.00||||229.00|68.7|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|229.00||||229.00|148.85|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|229.00||||229.00|109.81|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|229.00||||229.00|229|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|229.00||||229.00|48.09|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|229.00||||229.00|9.96|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|UMR [2035]|UMR OPTIONS [203501]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|229.00||||229.00|8.42|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|229.00||||229.00|9.8|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|HEALTHNET [1495]|HEALTHNET [149500]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MULTIPLAN [1680]|IHC HS [168011]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|TRUSTMARK [2030]|STARMARK [203000]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|AETNA [1015]|AETNA ACO WILCO [101532]|229.00||||229.00|10.76|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|229.00||||229.00|4.54|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|229.00||||229.00|8.45|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MULTIPLAN [1680]|HMA [168003]|229.00||||229.00|10.23|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|229.00||||229.00|7.14|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|229.00||||229.00|7.39|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|CHAMPVA [1240]|CHAMP VA [124000]|229.00||||229.00|171.75|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|229.00||||229.00|6.8|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|229.00||||229.00|7.5|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|229.00||||229.00|7.39|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|229.00||||229.00|7.16|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|229.00||||229.00|137.4|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|GEHA [1415]|GEHA [141500]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|229.00||||229.00|114.5|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|229.00||||229.00|8.42|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|229.00||||229.00|80.38|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|229.00||||229.00|206.1|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|229.00||||229.00|7.5|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|229.00||||229.00|6.96|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|229.00||||229.00|114.73|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|229.00||||229.00|6.82|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|229.00||||229.00|97.55|229|4.54 30183935|EAP|0301 - LABORATORY-CHEMISTRY|HC OSMOLALITY URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|229.00||||229.00||| 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|390.00||||390.00|166.14|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|390.00||||390.00|195.39|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390.00||||390.00|136.89|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390.00||||390.00|234|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390.00||||390.00|31.34|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390.00||||390.00|32.34|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390.00||||390.00|32.84|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390.00||||390.00|32.84|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390.00||||390.00|31.24|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|390.00||||390.00|19.9|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|AETNA [1015]|AETNA ACO WILCO [101532]|390.00||||390.00|47.16|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|TRUSTMARK [2030]|STARMARK [203000]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MULTIPLAN [1680]|IHC HS [168011]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MULTIPLAN [1680]|HMA [168003]|390.00||||390.00|44.78|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390.00||||390.00|36.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|UMR [2035]|UMR OPTIONS [203501]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390.00||||390.00|43.58|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|HEALTHNET [1495]|HEALTHNET [149500]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390.00||||390.00|81.9|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390.00||||390.00|30.45|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|390.00||||390.00|36.97|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390.00||||390.00|390|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390.00||||390.00|187.01|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390.00||||390.00|36.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390.00||||390.00|253.5|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390.00||||390.00|195|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|||390.00||||390.00|117|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390.00||||390.00|32.34|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390.00||||390.00|29.85|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390.00||||390.00|29.75|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|CORESOURCE [1315]|CORESOURCE [131500]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|390.00||||390.00|42.91|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|GEHA [1415]|GEHA [141500]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|390.00||||390.00|33.61|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|390.00||||390.00|42.91|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390.00||||390.00|351|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|CHAMPVA [1240]|CHAMP VA [124000]|390.00||||390.00|292.5|390|19.9 30183937|EAP|0301 - LABORATORY-CHEMISTRY|HC OSTEOCALCIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|390.00||||390.00||| 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|CHAMPVA [1240]|CHAMP VA [124000]|160.00||||160.00|120|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|160.00||||160.00|16.27|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|CORESOURCE [1315]|CORESOURCE [131500]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|160.00||||160.00|15.65|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|||160.00||||160.00|48|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|160.00||||160.00|104|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|160.00||||160.00|76.72|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|160.00||||160.00|33.6|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|160.00||||160.00|21.1|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|UMR [2035]|UMR OPTIONS [203501]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|160.00||||160.00|15.89|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|160.00||||160.00|17.9|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|160.00||||160.00|14.74|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|160.00||||160.00|20.77|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MULTIPLAN [1680]|IHC HS [168011]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|160.00||||160.00|14.4|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|HEALTHNET [1495]|HEALTHNET [149500]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|TRUSTMARK [2030]|STARMARK [203000]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MULTIPLAN [1680]|HMA [168003]|160.00||||160.00|21.68|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|AETNA [1015]|AETNA ACO WILCO [101532]|160.00||||160.00|20.55|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|160.00||||160.00|160|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|160.00||||160.00|8.67|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|GEHA [1415]|GEHA [141500]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|160.00||||160.00|20.77|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|160.00||||160.00|15.12|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|160.00||||160.00|15.9|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|160.00||||160.00|15.65|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|160.00||||160.00|15.17|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|160.00||||160.00|96|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|160.00||||160.00|80|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|160.00||||160.00|68.16|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|160.00||||160.00|15.9|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|160.00||||160.00|144|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|160.00||||160.00|14.45|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|160.00||||160.00|56.16|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|160.00||||160.00|80.16|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|160.00||||160.00|15.89|160|8.67 30183945|EAP|0301 - LABORATORY-CHEMISTRY|HC OXALATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|160.00||||160.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1105.00||||1105.00|67.4|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1105.00||||1105.00|42.94|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|TRUSTMARK [2030]|STARMARK [203000]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|HEALTHNET [1495]|HEALTHNET [149500]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MULTIPLAN [1680]|IHC HS [168011]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|FMH BENEFIT SERVICES [1390]|FMH [139000]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1105.00||||1105.00|79.52|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1105.00||||1105.00|79.79|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|UMR [2035]|UMR OPTIONS [203501]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1105.00||||1105.00|232.05|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|FIRST HEALTH [1375]|QUALCHOICE [137513]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1105.00||||1105.00|529.85|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1105.00||||1105.00|718.25|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1105.00||||1105.00|1105|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|||1105.00||||1105.00|331.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1105.00||||1105.00|69.79|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|AETNA [1015]|AETNA ACO WILCO [101532]|1105.00||||1105.00|101.8|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1105.00||||1105.00|64.19|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|CHAMPVA [1240]|CHAMP VA [124000]|1105.00||||1105.00|828.75|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|GEHA [1415]|GEHA [141500]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1105.00||||1105.00|72.54|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|CORESOURCE [1315]|CORESOURCE [131500]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1105.00||||1105.00|79.52|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1105.00||||1105.00|387.86|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1105.00||||1105.00|553.61|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1105.00||||1105.00|470.73|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1105.00||||1105.00|552.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1105.00||||1105.00|663|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1105.00||||1105.00|69.79|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1105.00||||1105.00|994.5|1105|42.94 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MULTIPLAN [1680]|HMA [168003]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1105.00||||1105.00||| 30183951|EAP|0301 - LABORATORY-CHEMISTRY|HC DCPDESGAMMACARBOXY PROTHROMB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1105.00||||1105.00||| 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|744.00||||744.00|46.48|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|CORESOURCE [1315]|CORESOURCE [131500]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|744.00||||744.00|59.34|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|744.00||||744.00|41.14|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|744.00||||744.00|44.72|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|||744.00||||744.00|223.2|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|744.00||||744.00|483.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|744.00||||744.00|744|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|744.00||||744.00|156.24|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|744.00||||744.00|60.27|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|UMR [2035]|UMR OPTIONS [203501]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|744.00||||744.00|42.11|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|744.00||||744.00|51.13|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|744.00||||744.00|50.96|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|FIRST HEALTH [1375]|QUALCHOICE [137513]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|FMH BENEFIT SERVICES [1390]|FMH [139000]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MULTIPLAN [1680]|HMA [168003]|744.00||||744.00|61.92|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|744.00||||744.00|59.34|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MULTIPLAN [1680]|IHC HS [168011]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|744.00||||744.00|356.75|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|HEALTHNET [1495]|HEALTHNET [149500]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|TRUSTMARK [2030]|STARMARK [203000]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|AETNA [1015]|AETNA ACO WILCO [101532]|744.00||||744.00|65.23|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|744.00||||744.00|27.52|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|744.00||||744.00|43.2|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|CHAMPVA [1240]|CHAMP VA [124000]|744.00||||744.00|558|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|744.00||||744.00|45.41|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|744.00||||744.00|44.72|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|744.00||||744.00|43.34|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|GEHA [1415]|GEHA [141500]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|744.00||||744.00|446.4|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|744.00||||744.00|372|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|744.00||||744.00|50.96|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|744.00||||744.00|261.14|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|744.00||||744.00|316.94|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|744.00||||744.00|372.74|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|744.00||||744.00|41.28|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|744.00||||744.00|669.6|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|744.00||||744.00|45.41|744|27.52 30183970|EAP|0301 - LABORATORY-CHEMISTRY|HC PARATHORMONE (PTH)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|744.00||||744.00||| 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73.00||||73.00|3.94|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|73.00||||73.00|36.57|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73.00||||73.00|25.62|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|73.00||||73.00|31.1|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73.00||||73.00|43.8|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73.00||||73.00|3.76|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73.00||||73.00|3.88|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73.00||||73.00|3.94|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73.00||||73.00|3.75|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|73.00||||73.00|2.39|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|AETNA [1015]|AETNA ACO WILCO [101532]|73.00||||73.00|5.66|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|TRUSTMARK [2030]|STARMARK [203000]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MULTIPLAN [1680]|IHC HS [168011]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|73.00||||73.00|5.15|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73.00||||73.00|4.42|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MULTIPLAN [1680]|HMA [168003]|73.00||||73.00|5.37|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|HEALTHNET [1495]|HEALTHNET [149500]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|73.00||||73.00|4.44|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73.00||||73.00|3.65|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|UMR [2035]|UMR OPTIONS [203501]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73.00||||73.00|5.23|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73.00||||73.00|15.33|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73.00||||73.00|73|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73.00||||73.00|35|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73.00||||73.00|47.45|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73.00||||73.00|36.5|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73.00||||73.00|4.42|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|||73.00||||73.00|21.9|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73.00||||73.00|3.88|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73.00||||73.00|3.58|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|CHAMPVA [1240]|CHAMP VA [124000]|73.00||||73.00|54.75|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|73.00||||73.00|5.15|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|CORESOURCE [1315]|CORESOURCE [131500]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|73.00||||73.00|4.03|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|GEHA [1415]|GEHA [141500]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73.00||||73.00|65.7|73|2.39 30183986|EAP|0301 - LABORATORY-CHEMISTRY|HC PH BODY FLUID NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|73.00||||73.00||| 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|GEHA [1415]|GEHA [141500]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|343.00||||343.00|22.11|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|CORESOURCE [1315]|CORESOURCE [131500]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|343.00||||343.00|28.22|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|CHAMPVA [1240]|CHAMP VA [124000]|343.00||||343.00|257.25|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|343.00||||343.00|21.27|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|||343.00||||343.00|102.9|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|343.00||||343.00|222.95|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|343.00||||343.00|164.47|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|343.00||||343.00|343|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|343.00||||343.00|72.03|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|UMR [2035]|UMR OPTIONS [203501]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|343.00||||343.00|20.02|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|343.00||||343.00|24.32|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|343.00||||343.00|24.24|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MULTIPLAN [1680]|IHC HS [168011]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|343.00||||343.00|28.66|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MULTIPLAN [1680]|HMA [168003]|343.00||||343.00|29.45|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|343.00||||343.00|28.22|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|HEALTHNET [1495]|HEALTHNET [149500]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|TRUSTMARK [2030]|STARMARK [203000]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|AETNA [1015]|AETNA ACO WILCO [101532]|343.00||||343.00|31.02|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|343.00||||343.00|19.56|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|343.00||||343.00|13.09|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|343.00||||343.00|20.54|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|343.00||||343.00|21.59|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|343.00||||343.00|21.27|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|343.00||||343.00|20.61|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|343.00||||343.00|205.8|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|343.00||||343.00|171.5|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|343.00||||343.00|24.24|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|343.00||||343.00|171.84|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|343.00||||343.00|120.39|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|343.00||||343.00|146.12|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|343.00||||343.00|19.63|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|343.00||||343.00|308.7|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|343.00||||343.00|21.59|343|13.09 30183993|EAP|0301 - LABORATORY-CHEMISTRY|HC CALPROTECTIN FECAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|343.00||||343.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|505.00||||505.00|6.79|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|505.00||||505.00|215.13|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|505.00||||505.00|177.26|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|505.00||||505.00|253.01|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|505.00||||505.00|252.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|505.00||||505.00|303|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|505.00||||505.00|5.96|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|505.00||||505.00|5.75|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|505.00||||505.00|3.67|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|AETNA [1015]|AETNA ACO WILCO [101532]|505.00||||505.00|8.69|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|TRUSTMARK [2030]|STARMARK [203000]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|HEALTHNET [1495]|HEALTHNET [149500]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MULTIPLAN [1680]|IHC HS [168011]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|505.00||||505.00|6.79|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|505.00||||505.00|6.82|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|UMR [2035]|UMR OPTIONS [203501]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|505.00||||505.00|106.05|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|505.00||||505.00|505|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|505.00||||505.00|242.15|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|505.00||||505.00|328.25|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|||505.00||||505.00|151.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|505.00||||505.00|5.96|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|505.00||||505.00|5.48|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|CHAMPVA [1240]|CHAMP VA [124000]|505.00||||505.00|378.75|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|CORESOURCE [1315]|CORESOURCE [131500]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|505.00||||505.00|6.19|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|GEHA [1415]|GEHA [141500]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|505.00||||505.00|454.5|505|3.67 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MULTIPLAN [1680]|HMA [168003]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|505.00||||505.00||| 30184030|EAP|0301 - LABORATORY-CHEMISTRY|HC PHENYLALANINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|505.00||||505.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|122.00||||122.00|8.61|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|CORESOURCE [1315]|CORESOURCE [131500]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122.00||||122.00|7.61|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|||122.00||||122.00|36.6|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122.00||||122.00|79.3|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122.00||||122.00|122|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122.00||||122.00|25.62|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|UMR [2035]|UMR OPTIONS [203501]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|122.00||||122.00|9.47|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122.00||||122.00|9.12|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|FIRST HEALTH [1375]|QUALCHOICE [137513]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|FMH BENEFIT SERVICES [1390]|FMH [139000]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MULTIPLAN [1680]|IHC HS [168011]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|HEALTHNET [1495]|HEALTHNET [149500]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|TRUSTMARK [2030]|STARMARK [203000]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|AETNA [1015]|AETNA ACO WILCO [101532]|122.00||||122.00|11.68|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122.00||||122.00|58.5|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122.00||||122.00|8.28|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|122.00||||122.00|4.93|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122.00||||122.00|7.99|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|CHAMPVA [1240]|CHAMP VA [124000]|122.00||||122.00|91.5|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|GEHA [1415]|GEHA [141500]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122.00||||122.00|8.28|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122.00||||122.00|73.2|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122.00||||122.00|61|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122.00||||122.00|9.12|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122.00||||122.00|42.82|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|122.00||||122.00|51.97|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|122.00||||122.00|61.12|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122.00||||122.00|109.8|122|4.93 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MULTIPLAN [1680]|HMA [168003]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122.00||||122.00||| 30184060|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ACID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122.00||||122.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113.00||||113.00|48.14|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113.00||||113.00|56.61|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113.00||||113.00|39.66|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113.00||||113.00|67.8|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113.00||||113.00|10.47|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113.00||||113.00|10.11|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113.00||||113.00|6.44|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|AETNA [1015]|AETNA ACO WILCO [101532]|113.00||||113.00|15.27|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|TRUSTMARK [2030]|STARMARK [203000]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MULTIPLAN [1680]|IHC HS [168011]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113.00||||113.00|11.93|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|HEALTHNET [1495]|HEALTHNET [149500]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113.00||||113.00|11.97|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|UMR [2035]|UMR OPTIONS [203501]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113.00||||113.00|23.73|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113.00||||113.00|113|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113.00||||113.00|54.18|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113.00||||113.00|56.5|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113.00||||113.00|73.45|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113.00||||113.00|11.93|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|||113.00||||113.00|33.9|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113.00||||113.00|10.47|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113.00||||113.00|9.62|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|CHAMPVA [1240]|CHAMP VA [124000]|113.00||||113.00|84.75|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|CORESOURCE [1315]|CORESOURCE [131500]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113.00||||113.00|10.88|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|GEHA [1415]|GEHA [141500]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113.00||||113.00|101.7|113|6.44 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|MULTIPLAN [1680]|HMA [168003]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113.00||||113.00||| 30184066|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTATIC ACID PHOSPHATASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113.00||||113.00||| 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|GEHA [1415]|GEHA [141500]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|259.00||||259.00|5.83|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|259.00||||259.00|7.45|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|CHAMPVA [1240]|CHAMP VA [124000]|259.00||||259.00|194.25|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|259.00||||259.00|5.61|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|||259.00||||259.00|77.7|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|259.00||||259.00|168.35|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|259.00||||259.00|124.19|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|259.00||||259.00|54.39|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|UMR [2035]|UMR OPTIONS [203501]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|259.00||||259.00|5.28|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|259.00||||259.00|6.41|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|259.00||||259.00|6.39|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|259.00||||259.00|7.56|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|259.00||||259.00|7.45|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|259.00||||259.00|259|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MULTIPLAN [1680]|HMA [168003]|259.00||||259.00|7.77|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MULTIPLAN [1680]|IHC HS [168011]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|HEALTHNET [1495]|HEALTHNET [149500]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|TRUSTMARK [2030]|STARMARK [203000]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|AETNA [1015]|AETNA ACO WILCO [101532]|259.00||||259.00|8.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|259.00||||259.00|3.45|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|259.00||||259.00|5.17|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|259.00||||259.00|5.42|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|CORESOURCE [1315]|CORESOURCE [131500]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|259.00||||259.00|5.7|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|259.00||||259.00|5.61|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|259.00||||259.00|5.44|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|259.00||||259.00|155.4|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|259.00||||259.00|129.5|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|259.00||||259.00|129.76|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|259.00||||259.00|90.91|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|259.00||||259.00|110.33|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|259.00||||259.00|6.39|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|259.00||||259.00|5.18|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|259.00||||259.00|233.1|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|259.00||||259.00|5.7|259|3.45 30184075|EAP|0301 - LABORATORY-CHEMISTRY|HC ALKALINE PHOSPHATASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|259.00||||259.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|407.00||||407.00|18.25|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|407.00||||407.00|142.86|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|407.00||||407.00|203.91|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|407.00||||407.00|203.5|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|407.00||||407.00|244.2|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|407.00||||407.00|16.01|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|407.00||||407.00|15.47|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|407.00||||407.00|9.86|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|AETNA [1015]|AETNA ACO WILCO [101532]|407.00||||407.00|23.37|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|TRUSTMARK [2030]|STARMARK [203000]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|HEALTHNET [1495]|HEALTHNET [149500]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MULTIPLAN [1680]|IHC HS [168011]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|FMH BENEFIT SERVICES [1390]|FMH [139000]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|FIRST HEALTH [1375]|QUALCHOICE [137513]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|407.00||||407.00|18.25|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|407.00||||407.00|18.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|UMR [2035]|UMR OPTIONS [203501]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|407.00||||407.00|85.47|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|407.00||||407.00|407|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|407.00||||407.00|195.16|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|407.00||||407.00|173.38|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|407.00||||407.00|264.55|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|||407.00||||407.00|122.1|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|407.00||||407.00|16.01|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|407.00||||407.00|14.73|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|CHAMPVA [1240]|CHAMP VA [124000]|407.00||||407.00|305.25|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|CORESOURCE [1315]|CORESOURCE [131500]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|407.00||||407.00|16.64|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|GEHA [1415]|GEHA [141500]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|407.00||||407.00|366.3|407|9.86 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MULTIPLAN [1680]|HMA [168003]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|407.00||||407.00||| 30184080|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATASE ALKALINE ISOENZYM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|407.00||||407.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|232.00||||232.00|18.6|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|CORESOURCE [1315]|CORESOURCE [131500]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|CHAMPVA [1240]|CHAMP VA [124000]|232.00||||232.00|174|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232.00||||232.00|16.46|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|||232.00||||232.00|69.6|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232.00||||232.00|150.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232.00||||232.00|232|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232.00||||232.00|48.72|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|UMR [2035]|UMR OPTIONS [203501]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|232.00||||232.00|20.47|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232.00||||232.00|20.39|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|FIRST HEALTH [1375]|QUALCHOICE [137513]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|FMH BENEFIT SERVICES [1390]|FMH [139000]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MULTIPLAN [1680]|IHC HS [168011]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232.00||||232.00|111.24|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|HEALTHNET [1495]|HEALTHNET [149500]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|TRUSTMARK [2030]|STARMARK [203000]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|AETNA [1015]|AETNA ACO WILCO [101532]|232.00||||232.00|26.1|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232.00||||232.00|17.9|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|232.00||||232.00|11.01|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232.00||||232.00|17.29|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232.00||||232.00|17.9|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|GEHA [1415]|GEHA [141500]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232.00||||232.00|139.2|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232.00||||232.00|116|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232.00||||232.00|20.39|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|232.00||||232.00|98.83|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|232.00||||232.00|116.23|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232.00||||232.00|81.43|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232.00||||232.00|208.8|232|11.01 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MULTIPLAN [1680]|HMA [168003]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232.00||||232.00||| 30184081|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHATIDYLGLYCEROL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232.00||||232.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230.00||||230.00|4.74|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230.00||||230.00|4.74|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230.00||||230.00|97.98|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230.00||||230.00|115.23|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230.00||||230.00|5.85|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230.00||||230.00|115|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230.00||||230.00|138|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230.00||||230.00|4.98|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230.00||||230.00|5.14|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230.00||||230.00|4.74|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230.00||||230.00|4.97|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230.00||||230.00|3.16|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230.00||||230.00|4.74|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|AETNA [1015]|AETNA ACO WILCO [101532]|230.00||||230.00|7.49|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|TRUSTMARK [2030]|STARMARK [203000]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|HEALTHNET [1495]|HEALTHNET [149500]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MULTIPLAN [1680]|HMA [168003]|230.00||||230.00|7.11|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MULTIPLAN [1680]|IHC HS [168011]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230.00||||230.00|6.81|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230.00||||230.00|4.74|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230.00||||230.00|5.85|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230.00||||230.00|5.87|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230.00||||230.00|4.83|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|UMR [2035]|UMR OPTIONS [203501]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230.00||||230.00|142.83|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230.00||||230.00|48.3|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230.00||||230.00|230|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230.00||||230.00|110.29|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230.00||||230.00|149.5|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230.00||||230.00|80.73|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|||230.00||||230.00|69|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230.00||||230.00|5.14|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230.00||||230.00|4.74|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230.00||||230.00|4.73|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|CHAMPVA [1240]|CHAMP VA [124000]|230.00||||230.00|172.5|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230.00||||230.00|142.6|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|CORESOURCE [1315]|CORESOURCE [131500]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230.00||||230.00|5.34|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|GEHA [1415]|GEHA [141500]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230.00||||230.00|207|230|3.16 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230.00||||230.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230.00||||230.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230.00||||230.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230.00||||230.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230.00||||230.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230.00||||230.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230.00||||230.00||| 30184100|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230.00||||230.00||| 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|GEHA [1415]|GEHA [141500]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70.00||||70.00|6.51|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70.00||||70.00|8.31|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|CHAMPVA [1240]|CHAMP VA [124000]|70.00||||70.00|52.5|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70.00||||70.00|6.26|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|||70.00||||70.00|21|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70.00||||70.00|45.5|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70.00||||70.00|33.57|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70.00||||70.00|14.7|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|UMR [2035]|UMR OPTIONS [203501]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70.00||||70.00|5.9|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70.00||||70.00|7.16|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70.00||||70.00|6.39|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70.00||||70.00|8.31|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70.00||||70.00|8.44|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70.00||||70.00|70|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MULTIPLAN [1680]|IHC HS [168011]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MULTIPLAN [1680]|HMA [168003]|70.00||||70.00|8.67|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|HEALTHNET [1495]|HEALTHNET [149500]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|TRUSTMARK [2030]|STARMARK [203000]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|AETNA [1015]|AETNA ACO WILCO [101532]|70.00||||70.00|8.22|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70.00||||70.00|3.47|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70.00||||70.00|5.76|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70.00||||70.00|6.05|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70.00||||70.00|6.36|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|CORESOURCE [1315]|CORESOURCE [131500]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70.00||||70.00|6.26|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70.00||||70.00|6.07|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70.00||||70.00|42|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70.00||||70.00|35|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70.00||||70.00|35.07|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70.00||||70.00|29.82|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70.00||||70.00|6.39|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70.00||||70.00|24.57|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70.00||||70.00|5.78|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70.00||||70.00|63|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70.00||||70.00|6.36|70|3.47 30184105|EAP|0301 - LABORATORY-CHEMISTRY|HC PHOSPHORUS INORGANIC URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70.00||||70.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132.00||||132.00|10.42|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132.00||||132.00|66.13|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132.00||||132.00|56.23|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.00||||132.00|66|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132.00||||132.00|79.2|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132.00||||132.00|9.14|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132.00||||132.00|8.83|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|AETNA [1015]|AETNA ACO WILCO [101532]|132.00||||132.00|13.34|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|TRUSTMARK [2030]|STARMARK [203000]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|HEALTHNET [1495]|HEALTHNET [149500]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MULTIPLAN [1680]|IHC HS [168011]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132.00||||132.00|10.42|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132.00||||132.00|10.45|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|UMR [2035]|UMR OPTIONS [203501]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132.00||||132.00|5.63|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132.00||||132.00|27.72|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132.00||||132.00|132|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.00||||132.00|63.29|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132.00||||132.00|46.33|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132.00||||132.00|85.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|||132.00||||132.00|39.6|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132.00||||132.00|9.14|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132.00||||132.00|8.41|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|CHAMPVA [1240]|CHAMP VA [124000]|132.00||||132.00|99|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|CORESOURCE [1315]|CORESOURCE [131500]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132.00||||132.00|9.5|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|GEHA [1415]|GEHA [141500]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132.00||||132.00|118.8|132|5.63 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MULTIPLAN [1680]|HMA [168003]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132.00||||132.00||| 30184110|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHOBILINOGEN URINE QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132.00||||132.00||| 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|GEHA [1415]|GEHA [141500]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|324.00||||324.00|110.48|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|CORESOURCE [1315]|CORESOURCE [131500]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|324.00||||324.00|141.04|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|324.00||||324.00|97.77|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|||324.00||||324.00|97.2|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|324.00||||324.00|210.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|324.00||||324.00|155.36|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|324.00||||324.00|324|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|324.00||||324.00|68.04|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|324.00||||324.00|143.24|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|UMR [2035]|UMR OPTIONS [203501]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|324.00||||324.00|121.52|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|FIRST HEALTH [1375]|QUALCHOICE [137513]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|324.00||||324.00|100.07|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|FMH BENEFIT SERVICES [1390]|FMH [139000]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MULTIPLAN [1680]|HMA [168003]|324.00||||324.00|147.17|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|324.00||||324.00|141.04|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MULTIPLAN [1680]|IHC HS [168011]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|HEALTHNET [1495]|HEALTHNET [149500]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|TRUSTMARK [2030]|STARMARK [203000]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|324.00||||324.00|106.29|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|AETNA [1015]|COVENTRY HEALTHCARE [101502]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|AETNA [1015]|AETNA ACO WILCO [101532]|324.00||||324.00|139.55|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|324.00||||324.00|58.87|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|324.00||||324.00|102.66|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|CHAMPVA [1240]|CHAMP VA [124000]|324.00||||324.00|243|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|324.00||||324.00|107.92|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|324.00||||324.00|106.29|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|324.00||||324.00|103.02|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|324.00||||324.00|194.4|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|324.00||||324.00|162|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|324.00||||324.00|162.32|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|324.00||||324.00|138.02|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|324.00||||324.00|113.72|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|324.00||||324.00|98.11|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|324.00||||324.00|291.6|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|324.00||||324.00|107.92|324|58.87 30184112|EAP|0301 - LABORATORY-CHEMISTRY|HC PLACENTA ALPHA MICRO IG C/V|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|324.00||||324.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|227.00||||227.00|18.16|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|227.00||||227.00|79.68|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|227.00||||227.00|113.73|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|227.00||||227.00|96.7|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|227.00||||227.00|136.2|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|227.00||||227.00|15.94|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|227.00||||227.00|15.4|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|227.00||||227.00|9.81|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|AETNA [1015]|AETNA ACO WILCO [101532]|227.00||||227.00|23.25|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|TRUSTMARK [2030]|STARMARK [203000]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MULTIPLAN [1680]|IHC HS [168011]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|FMH BENEFIT SERVICES [1390]|FMH [139000]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|FIRST HEALTH [1375]|QUALCHOICE [137513]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|227.00||||227.00|18.16|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|HEALTHNET [1495]|HEALTHNET [149500]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|227.00||||227.00|18.22|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|UMR [2035]|UMR OPTIONS [203501]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|227.00||||227.00|47.67|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|227.00||||227.00|227|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|227.00||||227.00|113.5|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|227.00||||227.00|108.85|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|227.00||||227.00|147.55|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|||227.00||||227.00|68.1|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|227.00||||227.00|15.94|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|227.00||||227.00|14.67|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|CHAMPVA [1240]|CHAMP VA [124000]|227.00||||227.00|170.25|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|CORESOURCE [1315]|CORESOURCE [131500]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|227.00||||227.00|16.57|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|GEHA [1415]|GEHA [141500]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|227.00||||227.00|204.3|227|9.81 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|MULTIPLAN [1680]|HMA [168003]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|227.00||||227.00||| 30184120|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS URINE QN & FRACTN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|227.00||||227.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|GEHA [1415]|GEHA [141500]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|413.00||||413.00|44.04|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|CHAMPVA [1240]|CHAMP VA [124000]|413.00||||413.00|309.75|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|413.00||||413.00|38.98|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|413.00||||413.00|42.37|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|||413.00||||413.00|123.9|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|413.00||||413.00|268.45|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|413.00||||413.00|198.03|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|413.00||||413.00|86.73|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|UMR [2035]|UMR OPTIONS [203501]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|413.00||||413.00|48.45|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|413.00||||413.00|39.11|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MULTIPLAN [1680]|IHC HS [168011]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|HEALTHNET [1495]|HEALTHNET [149500]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|413.00||||413.00|413|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|TRUSTMARK [2030]|STARMARK [203000]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|AETNA [1015]|AETNA ACO WILCO [101532]|413.00||||413.00|55.63|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|413.00||||413.00|23.47|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|413.00||||413.00|40.93|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|CORESOURCE [1315]|CORESOURCE [131500]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|413.00||||413.00|42.37|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|413.00||||413.00|247.8|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|413.00||||413.00|206.5|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|413.00||||413.00|39.11|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|413.00||||413.00|144.96|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|413.00||||413.00|206.91|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|413.00||||413.00|175.94|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|413.00||||413.00|371.7|413|23.47 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MULTIPLAN [1680]|HMA [168003]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|413.00||||413.00||| 30184126|EAP|0301 - LABORATORY-CHEMISTRY|HC PORPHYRINS FECES QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|413.00||||413.00||| 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205.00||||205.00|5.24|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|205.00||||205.00|87.33|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205.00||||205.00|71.96|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|205.00||||205.00|102.71|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205.00||||205.00|102.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205.00||||205.00|123|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00|5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205.00||||205.00|5.15|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205.00||||205.00|5.24|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205.00||||205.00|4.98|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|TRUSTMARK [2030]|STARMARK [203000]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|HEALTHNET [1495]|HEALTHNET [149500]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MULTIPLAN [1680]|IHC HS [168011]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|205.00||||205.00|6.84|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MULTIPLAN [1680]|HMA [168003]|205.00||||205.00|7.14|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|5.68|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|205.00||||205.00|5.89|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00|4.86|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|7.27|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|UMR [2035]|UMR OPTIONS [203501]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|205.00||||205.00|3.07|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205.00||||205.00|6.95|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205.00||||205.00|43.05|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205.00||||205.00|205|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|98.3|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205.00||||205.00|5.68|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205.00||||205.00|133.25|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|||205.00||||205.00|61.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205.00||||205.00|5.15|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205.00||||205.00|4.74|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00|153.75|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00|4.76|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|205.00||||205.00|6.84|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|CORESOURCE [1315]|CORESOURCE [131500]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|205.00||||205.00|5.35|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|GEHA [1415]|GEHA [141500]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205.00||||205.00|184.5|205|3.07 30184132|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|205.00||||205.00||| 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|201.00||||201.00|5.33|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|CORESOURCE [1315]|CORESOURCE [131500]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|201.00||||201.00|6.8|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201.00||||201.00|4.72|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201.00||||201.00|5.13|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|||201.00||||201.00|60.3|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201.00||||201.00|130.65|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201.00||||201.00|201|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201.00||||201.00|42.21|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201.00||||201.00|6.91|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|UMR [2035]|UMR OPTIONS [203501]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201.00||||201.00|4.82|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|201.00||||201.00|5.86|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201.00||||201.00|5.32|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|FIRST HEALTH [1375]|QUALCHOICE [137513]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|FMH BENEFIT SERVICES [1390]|FMH [139000]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|201.00||||201.00|6.8|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MULTIPLAN [1680]|IHC HS [168011]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MULTIPLAN [1680]|HMA [168003]|201.00||||201.00|7.1|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201.00||||201.00|96.38|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|HEALTHNET [1495]|HEALTHNET [149500]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|TRUSTMARK [2030]|STARMARK [203000]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|AETNA [1015]|AETNA ACO WILCO [101532]|201.00||||201.00|6.81|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|201.00||||201.00|2.87|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201.00||||201.00|4.95|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|CHAMPVA [1240]|CHAMP VA [124000]|201.00||||201.00|150.75|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201.00||||201.00|5.2|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201.00||||201.00|5.13|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201.00||||201.00|4.97|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|GEHA [1415]|GEHA [141500]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201.00||||201.00|120.6|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201.00||||201.00|100.5|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|201.00||||201.00|85.63|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201.00||||201.00|70.55|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|201.00||||201.00|100.7|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201.00||||201.00|5.32|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201.00||||201.00|4.73|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201.00||||201.00|180.9|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201.00||||201.00|5.2|201|2.87 30184133|EAP|0301 - LABORATORY-CHEMISTRY|HC POTASSIUM URINE RANDOM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|201.00||||201.00||| 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|400.00||||400.00|16.05|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|400.00||||400.00|140.4|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|400.00||||400.00|170.4|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|400.00||||400.00|200.4|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|400.00||||400.00|240|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|400.00||||400.00|15.32|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|400.00||||400.00|15.8|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|400.00||||400.00|16.05|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|400.00||||400.00|15.26|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|400.00||||400.00|9.73|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|AETNA [1015]|AETNA ACO WILCO [101532]|400.00||||400.00|23.06|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|TRUSTMARK [2030]|STARMARK [203000]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MULTIPLAN [1680]|IHC HS [168011]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|400.00||||400.00|20.97|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|400.00||||400.00|18.01|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MULTIPLAN [1680]|HMA [168003]|400.00||||400.00|21.89|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|HEALTHNET [1495]|HEALTHNET [149500]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|400.00||||400.00|18.06|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|400.00||||400.00|14.88|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|UMR [2035]|UMR OPTIONS [203501]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|400.00||||400.00|21.3|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|400.00||||400.00|84|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|400.00||||400.00|400|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|400.00||||400.00|191.8|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|400.00||||400.00|260|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|400.00||||400.00|200|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|400.00||||400.00|18.01|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|||400.00||||400.00|120|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|400.00||||400.00|15.8|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|400.00||||400.00|14.59|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|400.00||||400.00|14.53|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|CHAMPVA [1240]|CHAMP VA [124000]|400.00||||400.00|300|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|400.00||||400.00|20.97|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|CORESOURCE [1315]|CORESOURCE [131500]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|400.00||||400.00|16.42|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|GEHA [1415]|GEHA [141500]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|400.00||||400.00|360|400|9.73 30184134|EAP|0301 - LABORATORY-CHEMISTRY|HC PREALBUMIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|400.00||||400.00||| 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|GEHA [1415]|GEHA [141500]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|239.00||||239.00|23.28|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|CORESOURCE [1315]|CORESOURCE [131500]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|239.00||||239.00|29.72|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|CHAMPVA [1240]|CHAMP VA [124000]|239.00||||239.00|179.25|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|239.00||||239.00|22.4|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|||239.00||||239.00|71.7|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|239.00||||239.00|155.35|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|239.00||||239.00|114.6|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|239.00||||239.00|239|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|239.00||||239.00|50.19|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|UMR [2035]|UMR OPTIONS [203501]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|239.00||||239.00|21.08|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|239.00||||239.00|25.61|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|239.00||||239.00|25.52|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|239.00||||239.00|29.72|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|239.00||||239.00|30.18|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MULTIPLAN [1680]|IHC HS [168011]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MULTIPLAN [1680]|HMA [168003]|239.00||||239.00|31.01|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|HEALTHNET [1495]|HEALTHNET [149500]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|TRUSTMARK [2030]|STARMARK [203000]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|AETNA [1015]|AETNA ACO WILCO [101532]|239.00||||239.00|32.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|239.00||||239.00|20.6|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|239.00||||239.00|13.78|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|239.00||||239.00|21.63|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|239.00||||239.00|22.74|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|239.00||||239.00|22.4|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|239.00||||239.00|21.7|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|239.00||||239.00|143.4|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|239.00||||239.00|119.5|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|239.00||||239.00|119.74|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|239.00||||239.00|25.52|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|239.00||||239.00|83.89|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|239.00||||239.00|101.81|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|239.00||||239.00|20.67|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|239.00||||239.00|215.1|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|239.00||||239.00|22.74|239|13.78 30184140|EAP|0301 - LABORATORY-CHEMISTRY|HC PREGNENOLONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|239.00||||239.00||| 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|295.00||||295.00|22.95|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|295.00||||295.00|25.76|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|295.00||||295.00|125.67|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|295.00||||295.00|147.8|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|295.00||||295.00|103.55|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|295.00||||295.00|147.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|295.00||||295.00|177|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|295.00||||295.00|22.6|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|295.00||||295.00|22.95|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|295.00||||295.00|21.83|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|295.00||||295.00|13.91|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|AETNA [1015]|AETNA ACO WILCO [101532]|295.00||||295.00|32.97|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|TRUSTMARK [2030]|STARMARK [203000]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|HEALTHNET [1495]|HEALTHNET [149500]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|295.00||||295.00|29.99|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MULTIPLAN [1680]|IHC HS [168011]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MULTIPLAN [1680]|HMA [168003]|295.00||||295.00|31.29|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|295.00||||295.00|25.76|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|295.00||||295.00|25.84|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|295.00||||295.00|21.28|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|UMR [2035]|UMR OPTIONS [203501]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|295.00||||295.00|30.46|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|295.00||||295.00|61.95|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|295.00||||295.00|21.9|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|295.00||||295.00|295|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|295.00||||295.00|141.45|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|295.00||||295.00|191.75|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|||295.00||||295.00|88.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|295.00||||295.00|22.6|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|295.00||||295.00|20.86|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|295.00||||295.00|20.79|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|CHAMPVA [1240]|CHAMP VA [124000]|295.00||||295.00|221.25|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|295.00||||295.00|29.99|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|CORESOURCE [1315]|CORESOURCE [131500]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|295.00||||295.00|23.49|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|GEHA [1415]|GEHA [141500]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|295.00||||295.00|265.5|295|13.91 30184144|EAP|0301 - LABORATORY-CHEMISTRY|HC PROGESTERONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|295.00||||295.00||| 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|136.00||||136.00|30.66|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|CORESOURCE [1315]|CORESOURCE [131500]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|136.00||||136.00|39.13|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136.00||||136.00|27.13|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|||136.00||||136.00|40.8|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136.00||||136.00|88.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136.00||||136.00|136|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136.00||||136.00|28.56|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136.00||||136.00|39.74|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|UMR [2035]|UMR OPTIONS [203501]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|136.00||||136.00|33.73|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136.00||||136.00|33.08|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|FIRST HEALTH [1375]|QUALCHOICE [137513]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136.00||||136.00|27.76|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|FMH BENEFIT SERVICES [1390]|FMH [139000]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MULTIPLAN [1680]|IHC HS [168011]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|136.00||||136.00|39.13|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MULTIPLAN [1680]|HMA [168003]|136.00||||136.00|40.83|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|HEALTHNET [1495]|HEALTHNET [149500]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|TRUSTMARK [2030]|STARMARK [203000]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|AETNA [1015]|AETNA ACO WILCO [101532]|136.00||||136.00|42.35|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136.00||||136.00|65.21|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136.00||||136.00|29.5|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|136.00||||136.00|17.86|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136.00||||136.00|28.49|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|CHAMPVA [1240]|CHAMP VA [124000]|136.00||||136.00|102|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136.00||||136.00|29.94|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|GEHA [1415]|GEHA [141500]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136.00||||136.00|29.5|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136.00||||136.00|28.58|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136.00||||136.00|81.6|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136.00||||136.00|68|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|136.00||||136.00|57.94|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|136.00||||136.00|68.14|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136.00||||136.00|47.74|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136.00||||136.00|33.08|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136.00||||136.00|27.22|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136.00||||136.00|122.4|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136.00||||136.00|29.94|136|17.86 30184145|EAP|0301 - LABORATORY-CHEMISTRY|HC PROCALCITONIN (PCT)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|136.00||||136.00||| 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|399.00||||399.00|199.9|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|399.00||||399.00|169.97|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|399.00||||399.00|140.05|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|399.00||||399.00|239.4|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|399.00||||399.00|20.35|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|399.00||||399.00|21|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|399.00||||399.00|21.32|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|399.00||||399.00|20.28|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|399.00||||399.00|12.92|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|AETNA [1015]|AETNA ACO WILCO [101532]|399.00||||399.00|30.62|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|TRUSTMARK [2030]|STARMARK [203000]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MULTIPLAN [1680]|IHC HS [168011]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|399.00||||399.00|27.86|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MULTIPLAN [1680]|HMA [168003]|399.00||||399.00|29.07|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|399.00||||399.00|23.92|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|HEALTHNET [1495]|HEALTHNET [149500]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|399.00||||399.00|24.01|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|399.00||||399.00|19.77|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|UMR [2035]|UMR OPTIONS [203501]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|399.00||||399.00|28.29|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|399.00||||399.00|83.79|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|399.00||||399.00|399|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|399.00||||399.00|191.32|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|399.00||||399.00|199.5|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|399.00||||399.00|259.35|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|399.00||||399.00|23.92|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|||399.00||||399.00|119.7|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|399.00||||399.00|21|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|399.00||||399.00|21.32|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|399.00||||399.00|19.38|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|399.00||||399.00|19.31|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|CHAMPVA [1240]|CHAMP VA [124000]|399.00||||399.00|299.25|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|399.00||||399.00|27.86|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|CORESOURCE [1315]|CORESOURCE [131500]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|399.00||||399.00|21.83|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|GEHA [1415]|GEHA [141500]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|399.00||||399.00|359.1|399|12.92 30184146|EAP|0301 - LABORATORY-CHEMISTRY|HC PROLACTIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|399.00||||399.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|GEHA [1415]|GEHA [141500]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|394.00||||394.00|47.03|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|CHAMPVA [1240]|CHAMP VA [124000]|394.00||||394.00|295.5|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|394.00||||394.00|45.25|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|||394.00||||394.00|118.2|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|394.00||||394.00|256.1|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|394.00||||394.00|188.92|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|394.00||||394.00|82.74|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|UMR [2035]|UMR OPTIONS [203501]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|394.00||||394.00|51.74|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|394.00||||394.00|41.77|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|394.00||||394.00|394|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|MULTIPLAN [1680]|IHC HS [168011]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|HEALTHNET [1495]|HEALTHNET [149500]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|TRUSTMARK [2030]|STARMARK [203000]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|AETNA [1015]|AETNA ACO WILCO [101532]|394.00||||394.00|59.42|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|394.00||||394.00|25.06|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|394.00||||394.00|41.63|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|394.00||||394.00|43.71|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|CORESOURCE [1315]|CORESOURCE [131500]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|394.00||||394.00|45.25|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|394.00||||394.00|236.4|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|394.00||||394.00|197|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|394.00||||394.00|41.77|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|394.00||||394.00|197.39|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|394.00||||394.00|167.84|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|394.00||||394.00|138.29|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|394.00||||394.00|354.6|394|25.06 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|MULTIPLAN [1680]|HMA [168003]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|394.00||||394.00||| 30184150|EAP|0301 - LABORATORY-CHEMISTRY|HC PROSTAGLANDIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|394.00||||394.00||| 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|238.00||||238.00|20.23|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|238.00||||238.00|22.71|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|238.00||||238.00|119.24|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|238.00||||238.00|101.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|238.00||||238.00|119|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|238.00||||238.00|142.8|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|238.00||||238.00|19.93|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|238.00||||238.00|20.23|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|238.00||||238.00|19.25|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|238.00||||238.00|12.26|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|TRUSTMARK [2030]|STARMARK [203000]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|238.00||||238.00|26.44|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MULTIPLAN [1680]|IHC HS [168011]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MULTIPLAN [1680]|HMA [168003]|238.00||||238.00|27.59|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|238.00||||238.00|22.71|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|238.00||||238.00|22.78|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|238.00||||238.00|18.76|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|238.00||||238.00|29.08|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|UMR [2035]|UMR OPTIONS [203501]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|238.00||||238.00|26.85|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|238.00||||238.00|49.98|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|238.00||||238.00|19.31|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|238.00||||238.00|238|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|238.00||||238.00|114.12|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|238.00||||238.00|154.7|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|||238.00||||238.00|71.4|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|238.00||||238.00|19.93|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|238.00||||238.00|83.54|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|238.00||||238.00|18.39|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|238.00||||238.00|18.34|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|238.00||||238.00|178.5|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|238.00||||238.00|26.44|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|238.00||||238.00|20.71|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|GEHA [1415]|GEHA [141500]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|238.00||||238.00|214.2|238|12.26 30184153|EAP|0301 - LABORATORY-CHEMISTRY|HC AG PROSTATE SPECIFIC(PSA) TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|238.00||||238.00||| 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|212.00||||212.00|20.71|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|CORESOURCE [1315]|CORESOURCE [131500]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|212.00||||212.00|26.44|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|CHAMPVA [1240]|CHAMP VA [124000]|212.00||||212.00|159|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|212.00||||212.00|18.34|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|||212.00||||212.00|63.6|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|212.00||||212.00|137.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|212.00||||212.00|212|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|212.00||||212.00|44.52|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|212.00||||212.00|26.85|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|UMR [2035]|UMR OPTIONS [203501]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|212.00||||212.00|22.78|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|212.00||||212.00|22.71|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|212.00||||212.00|18.76|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MULTIPLAN [1680]|IHC HS [168011]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|212.00||||212.00|26.44|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MULTIPLAN [1680]|HMA [168003]|212.00||||212.00|27.59|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|212.00||||212.00|101.65|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|HEALTHNET [1495]|HEALTHNET [149500]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|TRUSTMARK [2030]|STARMARK [203000]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|AETNA [1015]|AETNA ACO WILCO [101532]|212.00||||212.00|29.08|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|212.00||||212.00|19.93|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|212.00||||212.00|12.26|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|212.00||||212.00|19.25|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|212.00||||212.00|20.23|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|212.00||||212.00|19.93|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|212.00||||212.00|19.31|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|GEHA [1415]|GEHA [141500]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|212.00||||212.00|127.2|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|212.00||||212.00|106|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|212.00||||212.00|22.71|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|212.00||||212.00|74.41|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|212.00||||212.00|106.21|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|212.00||||212.00|90.31|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|212.00||||212.00|18.39|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|212.00||||212.00|190.8|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|212.00||||212.00|20.23|212|12.26 30184154|EAP|0301 - LABORATORY-CHEMISTRY|HC LAB AG PROSTATE (PSA) FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|212.00||||212.00||| 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215.00||||215.00|75.47|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|215.00||||215.00|91.59|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|215.00||||215.00|107.72|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215.00||||215.00|107.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215.00||||215.00|129|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215.00||||215.00|3.85|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215.00||||215.00|3.98|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215.00||||215.00|4.04|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215.00||||215.00|3.84|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|215.00||||215.00|2.44|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|215.00||||215.00|5.79|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|TRUSTMARK [2030]|STARMARK [203000]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|HEALTHNET [1495]|HEALTHNET [149500]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MULTIPLAN [1680]|HMA [168003]|215.00||||215.00|5.51|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|215.00||||215.00|5.28|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MULTIPLAN [1680]|IHC HS [168011]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215.00||||215.00|4.53|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|215.00||||215.00|4.55|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215.00||||215.00|3.74|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|UMR [2035]|UMR OPTIONS [203501]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215.00||||215.00|5.36|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215.00||||215.00|45.15|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215.00||||215.00|215|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215.00||||215.00|103.09|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215.00||||215.00|139.75|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215.00||||215.00|4.53|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|||215.00||||215.00|64.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215.00||||215.00|3.98|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215.00||||215.00|3.67|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215.00||||215.00|3.66|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215.00||||215.00|4.04|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|CHAMPVA [1240]|CHAMP VA [124000]|215.00||||215.00|161.25|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|215.00||||215.00|5.28|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|CORESOURCE [1315]|CORESOURCE [131500]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|215.00||||215.00|4.14|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|GEHA [1415]|GEHA [141500]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215.00||||215.00|193.5|215|2.44 30184155|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|215.00||||215.00||| 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|GEHA [1415]|GEHA [141500]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|226.00||||226.00|4.14|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|226.00||||226.00|5.28|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|CHAMPVA [1240]|CHAMP VA [124000]|226.00||||226.00|169.5|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226.00||||226.00|3.98|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|||226.00||||226.00|67.8|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226.00||||226.00|146.9|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226.00||||226.00|108.37|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226.00||||226.00|47.46|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226.00||||226.00|5.36|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|UMR [2035]|UMR OPTIONS [203501]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226.00||||226.00|3.74|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|226.00||||226.00|4.55|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226.00||||226.00|4.53|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MULTIPLAN [1680]|HMA [168003]|226.00||||226.00|5.51|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226.00||||226.00|226|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MULTIPLAN [1680]|IHC HS [168011]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|226.00||||226.00|5.28|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|HEALTHNET [1495]|HEALTHNET [149500]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|TRUSTMARK [2030]|STARMARK [203000]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|AETNA [1015]|AETNA ACO WILCO [101532]|226.00||||226.00|5.79|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|226.00||||226.00|2.44|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226.00||||226.00|3.66|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226.00||||226.00|3.84|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226.00||||226.00|4.04|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|CORESOURCE [1315]|CORESOURCE [131500]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226.00||||226.00|3.98|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226.00||||226.00|3.85|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226.00||||226.00|135.6|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226.00||||226.00|113|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226.00||||226.00|4.53|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|226.00||||226.00|113.23|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226.00||||226.00|79.33|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|226.00||||226.00|96.28|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226.00||||226.00|3.67|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226.00||||226.00|203.4|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226.00||||226.00|4.04|226|2.44 30184156|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN TOTAL URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|226.00||||226.00||| 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|227.00||||227.00|4.4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|227.00||||227.00|4.53|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|227.00||||227.00|113.73|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|227.00||||227.00|96.7|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|227.00||||227.00|113.5|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|227.00||||227.00|136.2|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|227.00||||227.00|4.33|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|227.00||||227.00|4.4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|227.00||||227.00|4.19|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|TRUSTMARK [2030]|STARMARK [203000]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|HEALTHNET [1495]|HEALTHNET [149500]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MULTIPLAN [1680]|HMA [168003]|227.00||||227.00|6|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|227.00||||227.00|5.75|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MULTIPLAN [1680]|IHC HS [168011]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|227.00||||227.00|4.53|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|227.00||||227.00|4.95|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|227.00||||227.00|4.08|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|AETNA [1015]|AETNA ACO WILCO [101532]|227.00||||227.00|5.79|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|UMR [2035]|UMR OPTIONS [203501]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|227.00||||227.00|2.44|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|227.00||||227.00|5.84|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|227.00||||227.00|47.67|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|227.00||||227.00|227|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|227.00||||227.00|108.85|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|227.00||||227.00|4.2|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|227.00||||227.00|79.68|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|227.00||||227.00|147.55|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|||227.00||||227.00|68.1|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|227.00||||227.00|4.33|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|227.00||||227.00|4|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|227.00||||227.00|3.99|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|CHAMPVA [1240]|CHAMP VA [124000]|227.00||||227.00|170.25|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|227.00||||227.00|5.75|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|CORESOURCE [1315]|CORESOURCE [131500]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|227.00||||227.00|4.5|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|GEHA [1415]|GEHA [141500]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|227.00||||227.00|204.3|227|2.44 30184157|EAP|0301 - LABORATORY-CHEMISTRY|HC TOTAL PROTEIN BODY FLUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|227.00||||227.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|GEHA [1415]|GEHA [141500]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|246.00||||246.00|16.95|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|CORESOURCE [1315]|CORESOURCE [131500]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|246.00||||246.00|15|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|||246.00||||246.00|73.8|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|246.00||||246.00|159.9|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|246.00||||246.00|117.96|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|246.00||||246.00|246|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|246.00||||246.00|51.66|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|UMR [2035]|UMR OPTIONS [203501]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|246.00||||246.00|18.65|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|246.00||||246.00|18.59|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MULTIPLAN [1680]|IHC HS [168011]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|HEALTHNET [1495]|HEALTHNET [149500]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|TRUSTMARK [2030]|STARMARK [203000]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|246.00||||246.00|16.31|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|246.00||||246.00|23.8|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|246.00||||246.00|10.04|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|246.00||||246.00|15.75|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|CHAMPVA [1240]|CHAMP VA [124000]|246.00||||246.00|184.5|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|246.00||||246.00|16.31|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|246.00||||246.00|147.6|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|246.00||||246.00|123|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|246.00||||246.00|18.59|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|246.00||||246.00|86.35|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|246.00||||246.00|104.8|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|246.00||||246.00|123.25|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|246.00||||246.00|221.4|246|10.04 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MULTIPLAN [1680]|HMA [168003]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|246.00||||246.00||| 30184163|EAP|0301 - LABORATORY-CHEMISTRY|HC PAPPA SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|246.00||||246.00||| 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|336.00||||336.00|13.26|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|336.00||||336.00|13.3|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|336.00||||336.00|10.95|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|336.00||||336.00|15.68|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|336.00||||336.00|336|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|336.00||||336.00|70.56|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|UMR [2035]|UMR OPTIONS [203501]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|336.00||||336.00|161.11|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|336.00||||336.00|218.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|||336.00||||336.00|100.8|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|336.00||||336.00|11.64|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|336.00||||336.00|10.71|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|CHAMPVA [1240]|CHAMP VA [124000]|336.00||||336.00|252|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|336.00||||336.00|15.44|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|CORESOURCE [1315]|CORESOURCE [131500]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|336.00||||336.00|12.1|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|GEHA [1415]|GEHA [141500]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|336.00||||336.00|168.34|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|336.00||||336.00|11.81|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|336.00||||336.00|11.64|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|336.00||||336.00|11.28|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|336.00||||336.00|168|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|336.00||||336.00|201.6|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|336.00||||336.00|11.81|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|336.00||||336.00|15.44|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MULTIPLAN [1680]|HMA [168003]|336.00||||336.00|16.11|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|336.00||||336.00|13.26|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MULTIPLAN [1680]|IHC HS [168011]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|336.00||||336.00|16.97|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|TRUSTMARK [2030]|STARMARK [203000]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|336.00||||336.00|143.14|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|336.00||||336.00|7.16|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|336.00||||336.00|11.24|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|336.00||||336.00|117.94|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|HEALTHNET [1495]|HEALTHNET [149500]|336.00||||336.00|302.4|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|336.00||||336.00|10.74|336|7.16 30184165|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHORESIS SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|336.00||||336.00||| 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205.00||||205.00|17.77|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205.00||||205.00|19.32|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205.00||||205.00|123|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205.00||||205.00|102.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|UMR [2035]|UMR OPTIONS [203501]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|205.00||||205.00|22.09|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205.00||||205.00|205|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|205.00||||205.00|25.63|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|GEHA [1415]|GEHA [141500]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00|153.75|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|205.00||||205.00|11.89|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205.00||||205.00|19.32|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|98.3|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205.00||||205.00|133.25|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|TRUSTMARK [2030]|STARMARK [203000]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205.00||||205.00|22.01|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205.00||||205.00|43.05|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|205.00||||205.00|25.63|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00|18.72|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205.00||||205.00|71.96|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|205.00||||205.00|102.71|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|FIRST HEALTH [1375]|QUALCHOICE [137513]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205.00||||205.00|26.03|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|205.00||||205.00|87.33|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|22.01|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|CORESOURCE [1315]|CORESOURCE [131500]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205.00||||205.00|19.61|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|HEALTHNET [1495]|HEALTHNET [149500]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|||205.00||||205.00|61.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MULTIPLAN [1680]|HMA [168003]|205.00||||205.00|26.75|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|FMH BENEFIT SERVICES [1390]|FMH [139000]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00|18.19|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|28.18|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MULTIPLAN [1680]|IHC HS [168011]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205.00||||205.00|19.61|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205.00||||205.00|18.66|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00|17.83|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205.00||||205.00|184.5|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|205.00||||205.00|20.08|205|11.89 30184166|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN ELECTROPHOR FLD W/CON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|205.00||||205.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|235.00||||235.00|19.18|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235.00||||235.00|112.68|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|CORESOURCE [1315]|CORESOURCE [131500]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235.00||||235.00|49.35|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|GEHA [1415]|GEHA [141500]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235.00||||235.00|235|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|UMR [2035]|UMR OPTIONS [203501]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235.00||||235.00|152.75|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235.00||||235.00|18.45|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|235.00||||235.00|100.11|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235.00||||235.00|16.97|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|CHAMPVA [1240]|CHAMP VA [124000]|235.00||||235.00|176.25|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|235.00||||235.00|117.74|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235.00||||235.00|21.02|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235.00||||235.00|82.49|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MULTIPLAN [1680]|IHC HS [168011]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|235.00||||235.00|11.35|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235.00||||235.00|17.82|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|FMH BENEFIT SERVICES [1390]|FMH [139000]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235.00||||235.00|18.45|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|AETNA [1015]|AETNA ACO WILCO [101532]|235.00||||235.00|26.91|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|||235.00||||235.00|70.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|TRUSTMARK [2030]|STARMARK [203000]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235.00||||235.00|21.02|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235.00||||235.00|141|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|FIRST HEALTH [1375]|QUALCHOICE [137513]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235.00||||235.00|117.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|HEALTHNET [1495]|HEALTHNET [149500]|235.00||||235.00|211.5|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|235.00||||235.00|21.1|235|11.35 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|MULTIPLAN [1680]|HMA [168003]|235.00||||235.00||| 30184181|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235.00||||235.00||| 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|CHAMPVA [1240]|CHAMP VA [124000]|1515.00||||1515.00|1136.25|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1515.00||||1515.00|41.99|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1515.00||||1515.00|32.9|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|CORESOURCE [1315]|CORESOURCE [131500]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1515.00||||1515.00|29.11|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|UMR [2035]|UMR OPTIONS [203501]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1515.00||||1515.00|318.15|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1515.00||||1515.00|1515|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1515.00||||1515.00|726.44|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1515.00||||1515.00|32.13|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MULTIPLAN [1680]|HMA [168003]|1515.00||||1515.00|43.82|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1515.00||||1515.00|36.19|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|FIRST HEALTH [1375]|QUALCHOICE [137513]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1515.00||||1515.00|30.67|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|FMH BENEFIT SERVICES [1390]|FMH [139000]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1515.00||||1515.00|757.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|HEALTHNET [1495]|HEALTHNET [149500]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1515.00||||1515.00|42.65|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1515.00||||1515.00|645.39|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1515.00||||1515.00|31.65|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1515.00||||1515.00|759.02|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1515.00||||1515.00|909|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1515.00||||1515.00|41.99|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|||1515.00||||1515.00|454.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1515.00||||1515.00|17.53|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1515.00||||1515.00|31.65|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1515.00||||1515.00|32.13|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1515.00||||1515.00|531.77|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|AETNA [1015]|AETNA ACO WILCO [101532]|1515.00||||1515.00|41.55|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|GEHA [1415]|GEHA [141500]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1515.00||||1515.00|29.79|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|TRUSTMARK [2030]|STARMARK [203000]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1515.00||||1515.00|30.57|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|MULTIPLAN [1680]|IHC HS [168011]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1515.00||||1515.00|984.75|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1515.00||||1515.00|1363.5|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1515.00||||1515.00|29.21|1515|17.53 30184182|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTEIN WESTERN BLOT BAND ID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1515.00||||1515.00||| 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|CORESOURCE [1315]|CORESOURCE [131500]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|361.00||||361.00|361|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|CHAMPVA [1240]|CHAMP VA [124000]|361.00||||361.00|270.75|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|361.00||||361.00|15.55|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|361.00||||361.00|75.81|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|361.00||||361.00|234.65|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|361.00||||361.00|14.3|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|GEHA [1415]|GEHA [141500]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|361.00||||361.00|16.16|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|361.00||||361.00|20.63|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|361.00||||361.00|173.1|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|||361.00||||361.00|108.3|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|361.00||||361.00|20.63|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|361.00||||361.00|180.5|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|361.00||||361.00|15.79|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|361.00||||361.00|15.07|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|361.00||||361.00|153.79|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|361.00||||361.00|17.71|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MULTIPLAN [1680]|IHC HS [168011]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|AETNA [1015]|AETNA ACO WILCO [101532]|361.00||||361.00|22.67|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|361.00||||361.00|15.79|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|361.00||||361.00|15.02|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|UMR [2035]|UMR OPTIONS [203501]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|MULTIPLAN [1680]|HMA [168003]|361.00||||361.00|21.53|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|361.00||||361.00|126.71|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|TRUSTMARK [2030]|STARMARK [203000]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|361.00||||361.00|9.56|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|361.00||||361.00|17.71|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|361.00||||361.00|216.6|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|361.00||||361.00|15.55|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|361.00||||361.00|17.78|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|361.00||||361.00|20.95|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|361.00||||361.00|14.35|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|HEALTHNET [1495]|HEALTHNET [149500]|361.00||||361.00|324.9|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|361.00||||361.00|180.86|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|361.00||||361.00|14.64|361|9.56 30184202|EAP|0301 - LABORATORY-CHEMISTRY|HC PROTOPORPHYRIN RBC QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|361.00||||361.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|253.00||||253.00|16.01|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|CORESOURCE [1315]|CORESOURCE [131500]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|253.00||||253.00|30.06|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|GEHA [1415]|GEHA [141500]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|253.00||||253.00|53.13|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|253.00||||253.00|253|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|||253.00||||253.00|75.9|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|253.00||||253.00|28.92|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|253.00||||253.00|121.31|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|253.00||||253.00|26.69|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|253.00||||253.00|33.06|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|HEALTHNET [1495]|HEALTHNET [149500]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|TRUSTMARK [2030]|STARMARK [203000]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MULTIPLAN [1680]|IHC HS [168011]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|253.00||||253.00|27.93|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|253.00||||253.00|151.8|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|253.00||||253.00|164.45|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|UMR [2035]|UMR OPTIONS [203501]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|253.00||||253.00|26.6|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|253.00||||253.00|107.78|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|253.00||||253.00|126.5|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|CHAMPVA [1240]|CHAMP VA [124000]|253.00||||253.00|189.75|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|253.00||||253.00|26.69|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|253.00||||253.00|28.92|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|253.00||||253.00|227.7|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|AETNA [1015]|AETNA ACO WILCO [101532]|253.00||||253.00|37.97|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|253.00||||253.00|88.8|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|253.00||||253.00|126.75|253|16.01 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MULTIPLAN [1680]|HMA [168003]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|253.00||||253.00||| 30184206|EAP|0301 - LABORATORY-CHEMISTRY|HC PROINSULIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|253.00||||253.00||| 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|447.00||||447.00|30.44|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|447.00||||447.00|18.73|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|447.00||||447.00|190.42|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|447.00||||447.00|30.91|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|447.00||||447.00|223.5|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|447.00||||447.00|223.95|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MULTIPLAN [1680]|HMA [168003]|447.00||||447.00|42.15|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MULTIPLAN [1680]|IHC HS [168011]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|447.00||||447.00|29.4|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|447.00||||447.00|34.69|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|TRUSTMARK [2030]|STARMARK [203000]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|447.00||||447.00|30.44|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|AETNA [1015]|COVENTRY HEALTHCARE [101502]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|447.00||||447.00|40.4|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|447.00||||447.00|34.69|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|FIRST HEALTH [1375]|QUALCHOICE [137513]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|FMH BENEFIT SERVICES [1390]|FMH [139000]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|447.00||||447.00|41.03|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|447.00||||447.00|156.9|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|447.00||||447.00|28.66|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|447.00||||447.00|34.8|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|||447.00||||447.00|134.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|UMR [2035]|UMR OPTIONS [203501]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|447.00||||447.00|447|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|447.00||||447.00|290.55|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|447.00||||447.00|214.34|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|447.00||||447.00|40.4|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|447.00||||447.00|28.1|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|447.00||||447.00|268.2|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|447.00||||447.00|29.51|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|CORESOURCE [1315]|CORESOURCE [131500]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|447.00||||447.00|31.64|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|GEHA [1415]|GEHA [141500]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|447.00||||447.00|28|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|CHAMPVA [1240]|CHAMP VA [124000]|447.00||||447.00|335.25|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|HEALTHNET [1495]|HEALTHNET [149500]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|AETNA [1015]|AETNA ACO WILCO [101532]|447.00||||447.00|44.41|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|447.00||||447.00|402.3|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|447.00||||447.00|93.87|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|447.00||||447.00|30.91|447|18.73 30184207|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-6|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|447.00||||447.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|CORESOURCE [1315]|CORESOURCE [131500]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|CHAMPVA [1240]|CHAMP VA [124000]|136.00||||136.00|102|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|136.00||||136.00|16.31|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|GEHA [1415]|GEHA [141500]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136.00||||136.00|88.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136.00||||136.00|65.21|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136.00||||136.00|14.48|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136.00||||136.00|136|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|HEALTHNET [1495]|HEALTHNET [149500]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|AETNA [1015]|AETNA ACO WILCO [101532]|136.00||||136.00|20.6|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136.00||||136.00|14.43|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136.00||||136.00|14.48|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|136.00||||136.00|17.94|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136.00||||136.00|28.56|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|TRUSTMARK [2030]|STARMARK [203000]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136.00||||136.00|15.69|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136.00||||136.00|47.74|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136.00||||136.00|15.15|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|136.00||||136.00|8.69|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|||136.00||||136.00|40.8|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136.00||||136.00|68|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MULTIPLAN [1680]|IHC HS [168011]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|136.00||||136.00|68.14|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136.00||||136.00|81.6|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|UMR [2035]|UMR OPTIONS [203501]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136.00||||136.00|15.69|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136.00||||136.00|122.4|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|136.00||||136.00|57.94|136|8.69 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MULTIPLAN [1680]|HMA [168003]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136.00||||136.00||| 30184210|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|136.00||||136.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|166.00||||166.00|10.62|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|GEHA [1415]|GEHA [141500]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166.00||||166.00|9.41|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|CORESOURCE [1315]|CORESOURCE [131500]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|CHAMPVA [1240]|CHAMP VA [124000]|166.00||||166.00|124.5|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166.00||||166.00|11.66|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|166.00||||166.00|70.72|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166.00||||166.00|58.27|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166.00||||166.00|83|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166.00||||166.00|10.22|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|AETNA [1015]|AETNA ACO WILCO [101532]|166.00||||166.00|14.92|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|TRUSTMARK [2030]|STARMARK [203000]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166.00||||166.00|9.88|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|HEALTHNET [1495]|HEALTHNET [149500]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MULTIPLAN [1680]|IHC HS [168011]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166.00||||166.00|11.66|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|166.00||||166.00|11.68|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|UMR [2035]|UMR OPTIONS [203501]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166.00||||166.00|99.6|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|166.00||||166.00|83.17|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166.00||||166.00|10.22|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166.00||||166.00|34.86|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166.00||||166.00|79.6|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166.00||||166.00|166|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166.00||||166.00|107.9|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|166.00||||166.00|6.29|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|||166.00||||166.00|49.8|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166.00||||166.00|149.4|166|6.29 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MULTIPLAN [1680]|HMA [168003]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166.00||||166.00||| 30184220|EAP|0301 - LABORATORY-CHEMISTRY|HC PYRUVATE KINASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166.00||||166.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161.00||||161.00|77.2|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|CORESOURCE [1315]|CORESOURCE [131500]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|GEHA [1415]|GEHA [141500]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|CHAMPVA [1240]|CHAMP VA [124000]|161.00||||161.00|120.75|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161.00||||161.00|11.59|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|||161.00||||161.00|48.3|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161.00||||161.00|104.65|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161.00||||161.00|161|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161.00||||161.00|33.81|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MULTIPLAN [1680]|IHC HS [168011]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|FMH BENEFIT SERVICES [1390]|FMH [139000]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|161.00||||161.00|14.41|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|FIRST HEALTH [1375]|QUALCHOICE [137513]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161.00||||161.00|14.36|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|UMR [2035]|UMR OPTIONS [203501]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|HEALTHNET [1495]|HEALTHNET [149500]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|161.00||||161.00|13.1|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|TRUSTMARK [2030]|STARMARK [203000]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161.00||||161.00|12.6|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|AETNA [1015]|AETNA ACO WILCO [101532]|161.00||||161.00|18.39|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|161.00||||161.00|7.76|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161.00||||161.00|12.17|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161.00||||161.00|96.6|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161.00||||161.00|14.36|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|161.00||||161.00|80.66|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|161.00||||161.00|68.59|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161.00||||161.00|56.51|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161.00||||161.00|144.9|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161.00||||161.00|12.6|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161.00||||161.00|80.5|161|7.76 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MULTIPLAN [1680]|HMA [168003]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161.00||||161.00||| 30184228|EAP|0301 - LABORATORY-CHEMISTRY|HC QUININE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161.00||||161.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1023.00||||1023.00|359.07|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1023.00||||1023.00|435.8|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1023.00||||1023.00|512.52|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1023.00||||1023.00|71.23|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1023.00||||1023.00|511.5|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1023.00||||1023.00|613.8|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1023.00||||1023.00|77.18|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|HEALTHNET [1495]|HEALTHNET [149500]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MULTIPLAN [1680]|IHC HS [168011]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1023.00||||1023.00|71.23|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1023.00||||1023.00|88.24|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|TRUSTMARK [2030]|STARMARK [203000]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|UMR [2035]|UMR OPTIONS [203501]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1023.00||||1023.00|77.18|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1023.00||||1023.00|1023|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1023.00||||1023.00|214.83|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1023.00||||1023.00|490.53|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1023.00||||1023.00|664.95|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1023.00||||1023.00|70.99|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|AETNA [1015]|AETNA ACO WILCO [101532]|1023.00||||1023.00|101.32|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1023.00||||1023.00|74.54|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1023.00||||1023.00|80.22|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|CORESOURCE [1315]|CORESOURCE [131500]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|CHAMPVA [1240]|CHAMP VA [124000]|1023.00||||1023.00|767.25|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|GEHA [1415]|GEHA [141500]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|||1023.00||||1023.00|306.9|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1023.00||||1023.00|920.7|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1023.00||||1023.00|42.74|1023|42.74 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|MULTIPLAN [1680]|HMA [168003]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1023.00||||1023.00||| 30184235|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ENDOCRINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1023.00||||1023.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|510.00||||510.00|244.55|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|GEHA [1415]|GEHA [141500]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|CORESOURCE [1315]|CORESOURCE [131500]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|510.00||||510.00|41.19|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|CHAMPVA [1240]|CHAMP VA [124000]|510.00||||510.00|382.5|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|510.00||||510.00|36.45|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|510.00||||510.00|107.1|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|510.00||||510.00|39.63|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|510.00||||510.00|331.5|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|AETNA [1015]|AETNA ACO WILCO [101532]|510.00||||510.00|57.79|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|||510.00||||510.00|153|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|510.00||||510.00|45.31|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|510.00||||510.00|45.14|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MULTIPLAN [1680]|IHC HS [168011]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|UMR [2035]|UMR OPTIONS [203501]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|HEALTHNET [1495]|HEALTHNET [149500]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|TRUSTMARK [2030]|STARMARK [203000]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|510.00||||510.00|38.28|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|510.00||||510.00|510|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|510.00||||510.00|24.38|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|510.00||||510.00|306|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|510.00||||510.00|255|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|510.00||||510.00|179.01|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|510.00||||510.00|255.51|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|510.00||||510.00|45.14|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|510.00||||510.00|217.26|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|510.00||||510.00|39.63|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|510.00||||510.00|459|510|24.38 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MULTIPLAN [1680]|HMA [168003]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|510.00||||510.00||| 30184238|EAP|0301 - LABORATORY-CHEMISTRY|HC RECEPTOR ASSAY ACETYCHOLINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|510.00||||510.00||| 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|357.00||||357.00|24.19|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|357.00||||357.00|178.5|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|357.00||||357.00|152.08|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|357.00||||357.00|24.19|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|357.00||||357.00|178.86|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|357.00||||357.00|125.31|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|AETNA [1015]|AETNA ACO WILCO [101532]|357.00||||357.00|34.76|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|357.00||||357.00|214.2|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|357.00||||357.00|23.82|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|357.00||||357.00|23.01|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|357.00||||357.00|22.43|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|TRUSTMARK [2030]|STARMARK [203000]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|357.00||||357.00|27.23|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MULTIPLAN [1680]|HMA [168003]|357.00||||357.00|32.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|357.00||||357.00|31.61|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|HEALTHNET [1495]|HEALTHNET [149500]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|UMR [2035]|UMR OPTIONS [203501]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|357.00||||357.00|32.11|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MULTIPLAN [1680]|IHC HS [168011]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|357.00||||357.00|23.09|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|357.00||||357.00|357|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|357.00||||357.00|74.97|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|357.00||||357.00|171.18|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|||357.00||||357.00|107.1|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|357.00||||357.00|21.91|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|357.00||||357.00|31.61|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|GEHA [1415]|GEHA [141500]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|357.00||||357.00|27.15|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|357.00||||357.00|27.15|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|CHAMPVA [1240]|CHAMP VA [124000]|357.00||||357.00|267.75|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|357.00||||357.00|23.82|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|357.00||||357.00|24.76|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|357.00||||357.00|14.66|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|357.00||||357.00|21.99|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|357.00||||357.00|232.05|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|CORESOURCE [1315]|CORESOURCE [131500]|357.00||||357.00|321.3|357|14.66 30184244|EAP|0301 - LABORATORY-CHEMISTRY|HC RENIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|357.00||||357.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|234.00||||234.00|22.79|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|GEHA [1415]|GEHA [141500]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|CORESOURCE [1315]|CORESOURCE [131500]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|CHAMPVA [1240]|CHAMP VA [124000]|234.00||||234.00|175.5|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234.00||||234.00|20.17|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234.00||||234.00|21.93|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234.00||||234.00|112.2|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|||234.00||||234.00|70.2|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234.00||||234.00|234|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|FMH BENEFIT SERVICES [1390]|FMH [139000]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|234.00||||234.00|25.07|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234.00||||234.00|24.98|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|FIRST HEALTH [1375]|QUALCHOICE [137513]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234.00||||234.00|49.14|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|UMR [2035]|UMR OPTIONS [203501]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MULTIPLAN [1680]|IHC HS [168011]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234.00||||234.00|152.1|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|AETNA [1015]|AETNA ACO WILCO [101532]|234.00||||234.00|31.99|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|234.00||||234.00|13.49|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234.00||||234.00|21.18|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|TRUSTMARK [2030]|STARMARK [203000]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234.00||||234.00|21.93|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234.00||||234.00|117|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234.00||||234.00|82.13|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|234.00||||234.00|99.68|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|HEALTHNET [1495]|HEALTHNET [149500]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234.00||||234.00|140.4|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|234.00||||234.00|117.23|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234.00||||234.00|24.98|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234.00||||234.00|210.6|234|13.49 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MULTIPLAN [1680]|HMA [168003]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234.00||||234.00||| 30184252|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B-2 (RIBOFLAVIN)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|234.00||||234.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147.00||||147.00|88.2|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147.00||||147.00|31.52|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147.00||||147.00|51.6|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|147.00||||147.00|62.62|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|147.00||||147.00|73.65|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147.00||||147.00|73.5|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147.00||||147.00|26.72|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|147.00||||147.00|17.02|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|AETNA [1015]|AETNA ACO WILCO [101532]|147.00||||147.00|40.35|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|HEALTHNET [1495]|HEALTHNET [149500]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147.00||||147.00|31.52|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|147.00||||147.00|31.63|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MULTIPLAN [1680]|IHC HS [168011]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|TRUSTMARK [2030]|STARMARK [203000]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|UMR [2035]|UMR OPTIONS [203501]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147.00||||147.00|27.66|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147.00||||147.00|147|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147.00||||147.00|30.87|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147.00||||147.00|70.49|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147.00||||147.00|95.55|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147.00||||147.00|27.66|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147.00||||147.00|25.44|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|147.00||||147.00|28.75|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|GEHA [1415]|GEHA [141500]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|CORESOURCE [1315]|CORESOURCE [131500]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|CHAMPVA [1240]|CHAMP VA [124000]|147.00||||147.00|110.25|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|||147.00||||147.00|44.1|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147.00||||147.00|132.3|147|17.02 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MULTIPLAN [1680]|HMA [168003]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147.00||||147.00||| 30184255|EAP|0301 - LABORATORY-CHEMISTRY|HC SELENIUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|147.00||||147.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1253.00||||1253.00|600.81|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1253.00||||1253.00|263.13|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|UMR [2035]|UMR OPTIONS [203501]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MULTIPLAN [1680]|IHC HS [168011]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|HEALTHNET [1495]|HEALTHNET [149500]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|TRUSTMARK [2030]|STARMARK [203000]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1253.00||||1253.00|38.37|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1253.00||||1253.00|38.25|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1253.00||||1253.00|32.41|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1253.00||||1253.00|20.66|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1253.00||||1253.00|1253|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1253.00||||1253.00|751.8|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1253.00||||1253.00|626.5|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1253.00||||1253.00|38.25|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1253.00||||1253.00|533.78|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1253.00||||1253.00|439.8|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1253.00||||1253.00|627.75|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1253.00||||1253.00|33.56|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|||1253.00||||1253.00|375.9|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|AETNA [1015]|AETNA ACO WILCO [101532]|1253.00||||1253.00|48.98|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1253.00||||1253.00|814.45|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1253.00||||1253.00|34.88|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|GEHA [1415]|GEHA [141500]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|CORESOURCE [1315]|CORESOURCE [131500]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|CHAMPVA [1240]|CHAMP VA [124000]|1253.00||||1253.00|939.75|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1253.00||||1253.00|30.87|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1253.00||||1253.00|1127.7|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1253.00||||1253.00|33.56|1253|20.66 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MULTIPLAN [1680]|HMA [168003]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1253.00||||1253.00||| 30184260|EAP|0301 - LABORATORY-CHEMISTRY|HC SEROTONIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1253.00||||1253.00||| 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|268.00||||268.00|94.07|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|268.00||||268.00|23.9|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|268.00||||268.00|134.27|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|268.00||||268.00|114.17|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|268.00||||268.00|26.83|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|268.00||||268.00|134|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|268.00||||268.00|22.82|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|268.00||||268.00|23.55|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|268.00||||268.00|23.9|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|268.00||||268.00|22.74|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|HEALTHNET [1495]|HEALTHNET [149500]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|268.00||||268.00|31.24|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|268.00||||268.00|26.83|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|268.00||||268.00|26.93|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|268.00||||268.00|22.16|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MULTIPLAN [1680]|IHC HS [168011]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MULTIPLAN [1680]|HMA [168003]|268.00||||268.00|32.6|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|TRUSTMARK [2030]|STARMARK [203000]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|UMR [2035]|UMR OPTIONS [203501]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|268.00||||268.00|31.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|AETNA [1015]|AETNA ACO WILCO [101532]|268.00||||268.00|34.35|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|268.00||||268.00|56.28|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|268.00||||268.00|14.49|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|268.00||||268.00|268|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|268.00||||268.00|160.8|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|268.00||||268.00|128.51|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|||268.00||||268.00|80.4|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|CORESOURCE [1315]|CORESOURCE [131500]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|268.00||||268.00|24.48|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|GEHA [1415]|GEHA [141500]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|CHAMPVA [1240]|CHAMP VA [124000]|268.00||||268.00|201|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|268.00||||268.00|21.66|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|268.00||||268.00|241.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|268.00||||268.00|23.55|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|268.00||||268.00|31.24|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|268.00||||268.00|21.73|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|268.00||||268.00|174.2|268|14.49 30184270|EAP|0301 - LABORATORY-CHEMISTRY|HC SEX HORMONE BINDING GLOBULIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|268.00||||268.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|CHAMPVA [1240]|CHAMP VA [124000]|405.00||||405.00|303.75|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|GEHA [1415]|GEHA [141500]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|405.00||||405.00|28.4|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|CORESOURCE [1315]|CORESOURCE [131500]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|405.00||||405.00|25.12|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|405.00||||405.00|27.32|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|||405.00||||405.00|121.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|405.00||||405.00|263.25|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|405.00||||405.00|194.2|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|405.00||||405.00|405|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|UMR [2035]|UMR OPTIONS [203501]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|405.00||||405.00|29.06|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|FIRST HEALTH [1375]|QUALCHOICE [137513]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|405.00||||405.00|31.23|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|FMH BENEFIT SERVICES [1390]|FMH [139000]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MULTIPLAN [1680]|IHC HS [168011]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|405.00||||405.00|85.05|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|HEALTHNET [1495]|HEALTHNET [149500]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|TRUSTMARK [2030]|STARMARK [203000]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|AETNA [1015]|AETNA ACO WILCO [101532]|405.00||||405.00|37.2|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|405.00||||405.00|15.69|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|405.00||||405.00|26.38|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|405.00||||405.00|27.32|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|405.00||||405.00|172.53|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|405.00||||405.00|142.16|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|405.00||||405.00|29.06|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|405.00||||405.00|202.91|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|405.00||||405.00|202.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|405.00||||405.00|243|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|405.00||||405.00|364.5|405|15.69 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MULTIPLAN [1680]|HMA [168003]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|405.00||||405.00||| 30184285|EAP|0301 - LABORATORY-CHEMISTRY|HC SILICA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|405.00||||405.00||| 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|270.00||||270.00|135.27|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|270.00||||270.00|5.29|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|270.00||||270.00|5.94|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|270.00||||270.00|94.77|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|270.00||||270.00|115.02|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|270.00||||270.00|135|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|270.00||||270.00|162|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|270.00||||270.00|5.05|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|270.00||||270.00|5.29|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|270.00||||270.00|3.21|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|270.00||||270.00|7.6|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|TRUSTMARK [2030]|STARMARK [203000]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|270.00||||270.00|6.91|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MULTIPLAN [1680]|HMA [168003]|270.00||||270.00|7.22|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|270.00||||270.00|5.94|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MULTIPLAN [1680]|IHC HS [168011]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|270.00||||270.00|5.96|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|270.00||||270.00|4.91|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|UMR [2035]|UMR OPTIONS [203501]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|HEALTHNET [1495]|HEALTHNET [149500]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|270.00||||270.00|7.02|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|270.00||||270.00|5.03|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|270.00||||270.00|56.7|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|270.00||||270.00|5.21|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|270.00||||270.00|270|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|270.00||||270.00|129.47|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|270.00||||270.00|175.5|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|270.00||||270.00|5.21|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|270.00||||270.00|6.91|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|GEHA [1415]|GEHA [141500]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|CORESOURCE [1315]|CORESOURCE [131500]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|270.00||||270.00|5.42|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|CHAMPVA [1240]|CHAMP VA [124000]|270.00||||270.00|202.5|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|270.00||||270.00|4.79|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|270.00||||270.00|4.81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|270.00||||270.00|243|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|||270.00||||270.00|81|270|3.21 30184295|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|270.00||||270.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|CORESOURCE [1315]|CORESOURCE [131500]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|GEHA [1415]|GEHA [141500]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|238.00||||238.00|5.71|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|238.00||||238.00|147.56|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|CHAMPVA [1240]|CHAMP VA [124000]|238.00||||238.00|178.5|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|238.00||||238.00|5.05|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|238.00||||238.00|5.06|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|238.00||||238.00|5.49|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|238.00||||238.00|154.7|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|238.00||||238.00|114.12|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|238.00||||238.00|238|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|238.00||||238.00|49.98|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|238.00||||238.00|147.8|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|238.00||||238.00|6.28|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|238.00||||238.00|5.16|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|238.00||||238.00|6|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|FIRST HEALTH [1375]|QUALCHOICE [137513]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|238.00||||238.00|5.06|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|FMH BENEFIT SERVICES [1390]|FMH [139000]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|UMR [2035]|UMR OPTIONS [203501]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MULTIPLAN [1680]|HMA [168003]|238.00||||238.00|7.59|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MULTIPLAN [1680]|IHC HS [168011]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|238.00||||238.00|7.27|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|HEALTHNET [1495]|HEALTHNET [149500]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|TRUSTMARK [2030]|STARMARK [203000]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|||238.00||||238.00|71.4|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|AETNA [1015]|AETNA ACO WILCO [101532]|238.00||||238.00|7.68|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|238.00||||238.00|5.06|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|238.00||||238.00|3.24|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|238.00||||238.00|5.31|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|238.00||||238.00|142.8|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|238.00||||238.00|83.54|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|238.00||||238.00|5.06|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|238.00||||238.00|5.06|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|238.00||||238.00|101.39|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|238.00||||238.00|119.24|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|238.00||||238.00|6|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|238.00||||238.00|119|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|238.00||||238.00|5.49|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|238.00||||238.00|5.06|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|238.00||||238.00|5.3|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|238.00||||238.00|214.2|238|3.24 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|238.00||||238.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|238.00||||238.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|238.00||||238.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|238.00||||238.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|238.00||||238.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|238.00||||238.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|238.00||||238.00||| 30184300|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM URINE RANDOM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|238.00||||238.00||| 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78.00||||78.00|27.38|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|78.00||||78.00|39.08|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78.00||||78.00|5.35|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78.00||||78.00|6|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|78.00||||78.00|33.23|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78.00||||78.00|39|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78.00||||78.00|46.8|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78.00||||78.00|5.1|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78.00||||78.00|5.27|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78.00||||78.00|5.09|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|AETNA [1015]|AETNA ACO WILCO [101532]|78.00||||78.00|7.68|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|HEALTHNET [1495]|HEALTHNET [149500]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MULTIPLAN [1680]|HMA [168003]|78.00||||78.00|7.29|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|78.00||||78.00|6.99|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MULTIPLAN [1680]|IHC HS [168011]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78.00||||78.00|6|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|78.00||||78.00|6.03|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78.00||||78.00|4.96|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|TRUSTMARK [2030]|STARMARK [203000]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|UMR [2035]|UMR OPTIONS [203501]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78.00||||78.00|7.1|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78.00||||78.00|16.38|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78.00||||78.00|5.35|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78.00||||78.00|78|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78.00||||78.00|37.4|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|||78.00||||78.00|23.4|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78.00||||78.00|4.84|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|78.00||||78.00|5.48|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|GEHA [1415]|GEHA [141500]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|CORESOURCE [1315]|CORESOURCE [131500]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|CHAMPVA [1240]|CHAMP VA [124000]|78.00||||78.00|58.5|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|78.00||||78.00|3.24|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|78.00||||78.00|6.99|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78.00||||78.00|70.2|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78.00||||78.00|50.7|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|78.00||||78.00|4.86|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78.00||||78.00|5.27|78|3.24 30184302|EAP|0301 - LABORATORY-CHEMISTRY|HC SODIUM OTHER SOURCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|78.00||||78.00||| 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|GEHA [1415]|GEHA [141500]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|360.00||||360.00|23.94|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|CORESOURCE [1315]|CORESOURCE [131500]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|CHAMPVA [1240]|CHAMP VA [124000]|360.00||||360.00|270|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|360.00||||360.00|21.18|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|360.00||||360.00|23.03|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|||360.00||||360.00|108|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|360.00||||360.00|172.62|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|360.00||||360.00|360|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|360.00||||360.00|31.04|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|360.00||||360.00|21.69|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|UMR [2035]|UMR OPTIONS [203501]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|360.00||||360.00|26.33|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|360.00||||360.00|26.25|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MULTIPLAN [1680]|IHC HS [168011]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MULTIPLAN [1680]|HMA [168003]|360.00||||360.00|31.89|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|360.00||||360.00|30.56|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|360.00||||360.00|75.6|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|HEALTHNET [1495]|HEALTHNET [149500]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|TRUSTMARK [2030]|STARMARK [203000]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|AETNA [1015]|AETNA ACO WILCO [101532]|360.00||||360.00|33.61|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|360.00||||360.00|234|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|360.00||||360.00|14.18|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|360.00||||360.00|22.24|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|360.00||||360.00|23.03|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|360.00||||360.00|180.36|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|360.00||||360.00|126.36|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|360.00||||360.00|30.56|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|360.00||||360.00|23.39|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|360.00||||360.00|26.25|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|360.00||||360.00|153.36|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|360.00||||360.00|216|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|360.00||||360.00|180|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|360.00||||360.00|22.32|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|360.00||||360.00|23.39|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|360.00||||360.00|21.26|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|360.00||||360.00|324|360|14.18 30184305|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOMEDIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|360.00||||360.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297.00||||297.00|22.56|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297.00||||297.00|104.25|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|297.00||||297.00|126.52|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297.00||||297.00|148.5|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297.00||||297.00|178.2|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297.00||||297.00|19.12|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|297.00||||297.00|12.19|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|AETNA [1015]|AETNA ACO WILCO [101532]|297.00||||297.00|28.88|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|TRUSTMARK [2030]|STARMARK [203000]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MULTIPLAN [1680]|IHC HS [168011]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297.00||||297.00|22.56|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|297.00||||297.00|22.64|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|UMR [2035]|UMR OPTIONS [203501]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|HEALTHNET [1495]|HEALTHNET [149500]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297.00||||297.00|62.37|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297.00||||297.00|297|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297.00||||297.00|142.41|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297.00||||297.00|193.05|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297.00||||297.00|19.8|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|297.00||||297.00|148.8|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|GEHA [1415]|GEHA [141500]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|297.00||||297.00|20.58|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|CORESOURCE [1315]|CORESOURCE [131500]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|CHAMPVA [1240]|CHAMP VA [124000]|297.00||||297.00|222.75|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297.00||||297.00|18.21|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297.00||||297.00|19.8|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|||297.00||||297.00|89.1|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297.00||||297.00|267.3|297|12.19 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|MULTIPLAN [1680]|HMA [168003]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297.00||||297.00||| 30184307|EAP|0301 - LABORATORY-CHEMISTRY|HC SOMATOSTATIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|297.00||||297.00||| 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|GEHA [1415]|GEHA [141500]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|263.00||||263.00|9.12|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|CORESOURCE [1315]|CORESOURCE [131500]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|263.00||||263.00|11.64|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|CHAMPVA [1240]|CHAMP VA [124000]|263.00||||263.00|197.25|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263.00||||263.00|8.07|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263.00||||263.00|8.77|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263.00||||263.00|126.11|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263.00||||263.00|263|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263.00||||263.00|8.26|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263.00||||263.00|8.63|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|263.00||||263.00|10.03|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MULTIPLAN [1680]|IHC HS [168011]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|263.00||||263.00|11.64|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MULTIPLAN [1680]|HMA [168003]|263.00||||263.00|12.15|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263.00||||263.00|55.23|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263.00||||263.00|11.83|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|HEALTHNET [1495]|HEALTHNET [149500]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|TRUSTMARK [2030]|STARMARK [203000]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|UMR [2035]|UMR OPTIONS [203501]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|AETNA [1015]|AETNA ACO WILCO [101532]|263.00||||263.00|11.52|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|||263.00||||263.00|78.9|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263.00||||263.00|170.95|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|263.00||||263.00|4.86|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263.00||||263.00|8.91|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263.00||||263.00|157.8|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|263.00||||263.00|131.76|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263.00||||263.00|8.91|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|263.00||||263.00|112.04|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263.00||||263.00|8.63|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263.00||||263.00|131.5|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263.00||||263.00|8.51|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263.00||||263.00|8.77|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263.00||||263.00|236.7|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263.00||||263.00|8.47|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263.00||||263.00|8.1|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263.00||||263.00|92.31|263|4.86 30184311|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECTROPHOTOMETRY ANALYTE NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|263.00||||263.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.00||||49.00|3.55|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.00||||49.00|24.55|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.00||||49.00|17.2|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.00||||49.00|20.87|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.00||||49.00|3.28|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.00||||49.00|24.5|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.00||||49.00|3.43|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|AETNA [1015]|AETNA ACO WILCO [101532]|49.00||||49.00|4.67|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|TRUSTMARK [2030]|STARMARK [203000]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|HEALTHNET [1495]|HEALTHNET [149500]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MULTIPLAN [1680]|IHC HS [168011]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.00||||49.00|3.28|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.00||||49.00|4.06|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|UMR [2035]|UMR OPTIONS [203501]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.00||||49.00|10.29|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.00||||49.00|1.97|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.00||||49.00|49|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.00||||49.00|29.4|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.00||||49.00|23.5|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|||49.00||||49.00|14.7|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.00||||49.00|3.69|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|GEHA [1415]|GEHA [141500]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|CORESOURCE [1315]|CORESOURCE [131500]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|CHAMPVA [1240]|CHAMP VA [124000]|49.00||||49.00|36.75|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.00||||49.00|3.55|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.00||||49.00|31.85|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.00||||49.00|44.1|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.00||||49.00|3.26|49|1.97 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MULTIPLAN [1680]|HMA [168003]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.00||||49.00||| 30184315|EAP|0301 - LABORATORY-CHEMISTRY|HC SPECIFIC GRAVITY NON URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.00||||49.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|CHAMPVA [1240]|CHAMP VA [124000]|96.00||||96.00|72|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|GEHA [1415]|GEHA [141500]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.00||||96.00|6.19|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|CORESOURCE [1315]|CORESOURCE [131500]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.00||||96.00|5.48|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.00||||96.00|5.96|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|||96.00||||96.00|28.8|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.00||||96.00|46.03|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.00||||96.00|96|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.00||||96.00|6.79|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.00||||96.00|6.82|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MULTIPLAN [1680]|IHC HS [168011]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.00||||96.00|20.16|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|UMR [2035]|UMR OPTIONS [203501]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|HEALTHNET [1495]|HEALTHNET [149500]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|TRUSTMARK [2030]|STARMARK [203000]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.00||||96.00|62.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|AETNA [1015]|AETNA ACO WILCO [101532]|96.00||||96.00|8.69|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.00||||96.00|3.67|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.00||||96.00|5.75|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.00||||96.00|5.96|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.00||||96.00|48|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.00||||96.00|40.9|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.00||||96.00|33.7|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.00||||96.00|48.1|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.00||||96.00|6.79|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.00||||96.00|57.6|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.00||||96.00|86.4|96|3.67 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MULTIPLAN [1680]|HMA [168003]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.00||||96.00||| 30184376|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUALITATIVE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.00||||96.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|189.00||||189.00|80.51|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|189.00||||189.00|14.23|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|189.00||||189.00|94.69|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|189.00||||189.00|66.34|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|189.00||||189.00|94.5|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|189.00||||189.00|113.4|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|189.00||||189.00|12.49|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|189.00||||189.00|7.69|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|AETNA [1015]|AETNA ACO WILCO [101532]|189.00||||189.00|18.22|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|TRUSTMARK [2030]|STARMARK [203000]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MULTIPLAN [1680]|IHC HS [168011]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|189.00||||189.00|14.23|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|189.00||||189.00|14.28|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|UMR [2035]|UMR OPTIONS [203501]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|HEALTHNET [1495]|HEALTHNET [149500]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|189.00||||189.00|39.69|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|189.00||||189.00|12.07|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|189.00||||189.00|189|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|189.00||||189.00|90.63|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|189.00||||189.00|122.85|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|CHAMPVA [1240]|CHAMP VA [124000]|189.00||||189.00|141.75|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|GEHA [1415]|GEHA [141500]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|189.00||||189.00|12.98|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|CORESOURCE [1315]|CORESOURCE [131500]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|189.00||||189.00|11.5|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|189.00||||189.00|12.49|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|||189.00||||189.00|56.7|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|189.00||||189.00|170.1|189|7.69 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MULTIPLAN [1680]|HMA [168003]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|189.00||||189.00||| 30184378|EAP|0301 - LABORATORY-CHEMISTRY|HC SUGARS SINGLE QUANT EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|189.00||||189.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|CORESOURCE [1315]|CORESOURCE [131500]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|GEHA [1415]|GEHA [141500]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.00||||96.00|6.18|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|CHAMPVA [1240]|CHAMP VA [124000]|96.00||||96.00|72|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.00||||96.00|5.47|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.00||||96.00|5.95|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|||96.00||||96.00|28.8|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.00||||96.00|62.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.00||||96.00|46.03|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.00||||96.00|96|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|UMR [2035]|UMR OPTIONS [203501]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.00||||96.00|6.81|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MULTIPLAN [1680]|IHC HS [168011]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.00||||96.00|5.86|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.00||||96.00|20.16|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|HEALTHNET [1495]|HEALTHNET [149500]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|TRUSTMARK [2030]|STARMARK [203000]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|AETNA [1015]|AETNA ACO WILCO [101532]|96.00||||96.00|7.81|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.00||||96.00|3.29|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.00||||96.00|57.6|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.00||||96.00|40.9|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.00||||96.00|33.7|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.00||||96.00|48.1|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.00||||96.00|5.86|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.00||||96.00|48|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.00||||96.00|5.95|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.00||||96.00|5.74|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.00||||96.00|86.4|96|3.29 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MULTIPLAN [1680]|HMA [168003]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.00||||96.00||| 30184392|EAP|0301 - LABORATORY-CHEMISTRY|HC SULFATE URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.00||||96.00||| 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|355.00||||355.00|124.61|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|355.00||||355.00|28.02|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|355.00||||355.00|177.86|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|355.00||||355.00|151.23|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|355.00||||355.00|31.45|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|355.00||||355.00|177.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|355.00||||355.00|26.74|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|355.00||||355.00|27.59|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|355.00||||355.00|26.65|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|HEALTHNET [1495]|HEALTHNET [149500]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MULTIPLAN [1680]|HMA [168003]|355.00||||355.00|38.21|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|355.00||||355.00|31.45|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|355.00||||355.00|31.55|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|355.00||||355.00|25.98|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|355.00||||355.00|36.62|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|TRUSTMARK [2030]|STARMARK [203000]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|UMR [2035]|UMR OPTIONS [203501]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|AETNA [1015]|AETNA ACO WILCO [101532]|355.00||||355.00|40.25|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MULTIPLAN [1680]|IHC HS [168011]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|355.00||||355.00|37.19|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|355.00||||355.00|74.55|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|355.00||||355.00|28.02|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|355.00||||355.00|16.98|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|355.00||||355.00|355|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|355.00||||355.00|170.22|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|355.00||||355.00|230.75|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|||355.00||||355.00|106.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|355.00||||355.00|213|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|355.00||||355.00|28.68|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|GEHA [1415]|GEHA [141500]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|CHAMPVA [1240]|CHAMP VA [124000]|355.00||||355.00|266.25|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|355.00||||355.00|25.38|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|355.00||||355.00|36.62|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|355.00||||355.00|25.47|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|355.00||||355.00|27.59|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|CORESOURCE [1315]|CORESOURCE [131500]|355.00||||355.00|319.5|355|16.98 30184402|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|355.00||||355.00||| 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|GEHA [1415]|GEHA [141500]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|544.00||||544.00|29.06|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|CORESOURCE [1315]|CORESOURCE [131500]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|544.00||||544.00|37.1|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|CHAMPVA [1240]|CHAMP VA [124000]|544.00||||544.00|408|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|544.00||||544.00|25.73|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|544.00||||544.00|27.96|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|||544.00||||544.00|163.2|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|544.00||||544.00|260.85|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|544.00||||544.00|544|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|544.00||||544.00|114.24|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|544.00||||544.00|37.68|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|UMR [2035]|UMR OPTIONS [203501]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|544.00||||544.00|31.87|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|544.00||||544.00|31.97|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|544.00||||544.00|26.33|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MULTIPLAN [1680]|IHC HS [168011]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MULTIPLAN [1680]|HMA [168003]|544.00||||544.00|38.72|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|544.00||||544.00|37.1|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|HEALTHNET [1495]|HEALTHNET [149500]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|TRUSTMARK [2030]|STARMARK [203000]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|AETNA [1015]|AETNA ACO WILCO [101532]|544.00||||544.00|40.79|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|544.00||||544.00|353.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|544.00||||544.00|17.21|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|544.00||||544.00|27.01|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|544.00||||544.00|28.39|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|544.00||||544.00|27.96|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|544.00||||544.00|31.87|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|544.00||||544.00|28.39|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|544.00||||544.00|272.54|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|544.00||||544.00|231.74|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|544.00||||544.00|190.94|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|544.00||||544.00|326.4|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|544.00||||544.00|27.1|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|544.00||||544.00|272|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|544.00||||544.00|25.81|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|544.00||||544.00|489.6|544|17.21 30184403|EAP|0301 - LABORATORY-CHEMISTRY|HC TESTOSTERONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|544.00||||544.00||| 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|354.00||||354.00|23.35|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|354.00||||354.00|26.21|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|354.00||||354.00|124.25|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|354.00||||354.00|150.8|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|354.00||||354.00|177.35|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|354.00||||354.00|177|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|354.00||||354.00|212.4|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|354.00||||354.00|22.29|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|354.00||||354.00|23.35|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|354.00||||354.00|14.15|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|AETNA [1015]|AETNA ACO WILCO [101532]|354.00||||354.00|33.56|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|354.00||||354.00|30.52|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|FIRST HEALTH [1375]|QUALCHOICE [137513]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|354.00||||354.00|26.21|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|354.00||||354.00|26.31|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|FMH BENEFIT SERVICES [1390]|FMH [139000]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|354.00||||354.00|21.65|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MULTIPLAN [1680]|HMA [168003]|354.00||||354.00|31.85|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|UMR [2035]|UMR OPTIONS [203501]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|HEALTHNET [1495]|HEALTHNET [149500]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|354.00||||354.00|31|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|354.00||||354.00|74.34|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|354.00||||354.00|22.22|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|TRUSTMARK [2030]|STARMARK [203000]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|354.00||||354.00|23.01|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|354.00||||354.00|354|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|354.00||||354.00|169.74|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|354.00||||354.00|230.1|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|354.00||||354.00|30.52|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|354.00||||354.00|21.23|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|354.00||||354.00|23.92|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|CORESOURCE [1315]|CORESOURCE [131500]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|CHAMPVA [1240]|CHAMP VA [124000]|354.00||||354.00|265.5|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|GEHA [1415]|GEHA [141500]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|354.00||||354.00|21.16|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|MULTIPLAN [1680]|IHC HS [168011]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|354.00||||354.00|23.01|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|||354.00||||354.00|106.2|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|354.00||||354.00|318.6|354|14.15 30184425|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN B1 (THIAMINE)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|354.00||||354.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|204.00||||204.00|71.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|GEHA [1415]|GEHA [141500]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|CORESOURCE [1315]|CORESOURCE [131500]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|CHAMPVA [1240]|CHAMP VA [124000]|204.00||||204.00|153|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|204.00||||204.00|11.59|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|204.00||||204.00|12.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|204.00||||204.00|132.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|204.00||||204.00|97.82|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|204.00||||204.00|204|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|UMR [2035]|UMR OPTIONS [203501]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|204.00||||204.00|14.41|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|204.00||||204.00|14.36|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|204.00||||204.00|42.84|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|||204.00||||204.00|61.2|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MULTIPLAN [1680]|IHC HS [168011]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|HEALTHNET [1495]|HEALTHNET [149500]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|TRUSTMARK [2030]|STARMARK [203000]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|AETNA [1015]|AETNA ACO WILCO [101532]|204.00||||204.00|18.39|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|204.00||||204.00|7.76|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|204.00||||204.00|13.1|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|204.00||||204.00|12.17|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|204.00||||204.00|183.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|204.00||||204.00|12.6|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|204.00||||204.00|122.4|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|204.00||||204.00|102|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|204.00||||204.00|102.2|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|204.00||||204.00|14.36|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|204.00||||204.00|86.9|204|7.76 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MULTIPLAN [1680]|HMA [168003]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|204.00||||204.00||| 30184430|EAP|0301 - LABORATORY-CHEMISTRY|HC THIOCYANATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|204.00||||204.00||| 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.00||||464.00|17.67|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.00||||464.00|232.46|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.00||||464.00|19.83|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.00||||464.00|162.86|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.00||||464.00|232|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.00||||464.00|16.86|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.00||||464.00|17.4|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.00||||464.00|17.67|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.00||||464.00|16.81|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|464.00||||464.00|10.7|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|TRUSTMARK [2030]|STARMARK [203000]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|HEALTHNET [1495]|HEALTHNET [149500]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.00||||464.00|23.09|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MULTIPLAN [1680]|HMA [168003]|464.00||||464.00|24.09|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MULTIPLAN [1680]|IHC HS [168011]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.00||||464.00|19.83|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.00||||464.00|19.89|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.00||||464.00|16.38|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|UMR [2035]|UMR OPTIONS [203501]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|AETNA [1015]|AETNA ACO WILCO [101532]|464.00||||464.00|25.38|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.00||||464.00|23.45|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.00||||464.00|97.44|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.00||||464.00|464|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.00||||464.00|278.4|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.00||||464.00|222.49|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.00||||464.00|301.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|||464.00||||464.00|139.2|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.00||||464.00|197.66|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.00||||464.00|17.4|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.00||||464.00|16.06|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.00||||464.00|16.01|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|CHAMPVA [1240]|CHAMP VA [124000]|464.00||||464.00|348|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.00||||464.00|23.09|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|CORESOURCE [1315]|CORESOURCE [131500]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.00||||464.00|18.09|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|GEHA [1415]|GEHA [141500]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.00||||464.00|417.6|464|10.7 30184432|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROGLOBULIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.00||||464.00||| 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|GEHA [1415]|GEHA [141500]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|162.00||||162.00|7.74|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|162.00||||162.00|121.5|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162.00||||162.00|6.85|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162.00||||162.00|7.45|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|||162.00||||162.00|48.6|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162.00||||162.00|105.3|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162.00||||162.00|77.68|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162.00||||162.00|162|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162.00||||162.00|34.02|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162.00||||162.00|10.03|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|UMR [2035]|UMR OPTIONS [203501]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162.00||||162.00|7.01|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|162.00||||162.00|8.52|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162.00||||162.00|8.48|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MULTIPLAN [1680]|IHC HS [168011]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MULTIPLAN [1680]|HMA [168003]|162.00||||162.00|10.31|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|162.00||||162.00|9.88|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|TRUSTMARK [2030]|STARMARK [203000]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|162.00||||162.00|10.85|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|162.00||||162.00|4.58|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162.00||||162.00|7.19|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|162.00||||162.00|9.88|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162.00||||162.00|7.56|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162.00||||162.00|7.45|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162.00||||162.00|7.21|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162.00||||162.00|97.2|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162.00||||162.00|81|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162.00||||162.00|8.48|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162.00||||162.00|56.86|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|162.00||||162.00|69.01|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|162.00||||162.00|81.16|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162.00||||162.00|6.87|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162.00||||162.00|145.8|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162.00||||162.00|7.56|162|4.58 30184436|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|162.00||||162.00||| 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|333.00||||333.00|9.92|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|333.00||||333.00|11.13|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|333.00||||333.00|141.86|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|333.00||||333.00|166.83|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|333.00||||333.00|166.5|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|333.00||||333.00|199.8|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|333.00||||333.00|9.47|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|333.00||||333.00|9.92|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|333.00||||333.00|6.01|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|AETNA [1015]|AETNA ACO WILCO [101532]|333.00||||333.00|14.26|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|HEALTHNET [1495]|HEALTHNET [149500]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|333.00||||333.00|12.97|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MULTIPLAN [1680]|HMA [168003]|333.00||||333.00|13.53|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MULTIPLAN [1680]|IHC HS [168011]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|333.00||||333.00|11.13|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|333.00||||333.00|11.17|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|333.00||||333.00|9.2|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|TRUSTMARK [2030]|STARMARK [203000]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|UMR [2035]|UMR OPTIONS [203501]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|333.00||||333.00|9.44|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|333.00||||333.00|13.17|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|333.00||||333.00|69.93|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|333.00||||333.00|9.77|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|333.00||||333.00|333|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|333.00||||333.00|116.88|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|333.00||||333.00|159.67|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|333.00||||333.00|216.45|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|||333.00||||333.00|99.9|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|333.00||||333.00|9.77|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|333.00||||333.00|9.02|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|333.00||||333.00|8.99|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|CHAMPVA [1240]|CHAMP VA [124000]|333.00||||333.00|249.75|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|333.00||||333.00|12.97|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|CORESOURCE [1315]|CORESOURCE [131500]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|333.00||||333.00|10.15|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|GEHA [1415]|GEHA [141500]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|333.00||||333.00|299.7|333|6.01 30184439|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE (T-4) FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|333.00||||333.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|GEHA [1415]|GEHA [141500]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|CORESOURCE [1315]|CORESOURCE [131500]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|CHAMPVA [1240]|CHAMP VA [124000]|193.00||||193.00|144.75|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|193.00||||193.00|14.73|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|193.00||||193.00|16.01|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|193.00||||193.00|125.45|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|193.00||||193.00|92.54|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|193.00||||193.00|193|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|193.00||||193.00|40.53|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|193.00||||193.00|18.3|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|193.00||||193.00|18.25|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|UMR [2035]|UMR OPTIONS [203501]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MULTIPLAN [1680]|IHC HS [168011]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|HEALTHNET [1495]|HEALTHNET [149500]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|TRUSTMARK [2030]|STARMARK [203000]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|||193.00||||193.00|57.9|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|AETNA [1015]|AETNA ACO WILCO [101532]|193.00||||193.00|23.37|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|193.00||||193.00|9.86|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|193.00||||193.00|15.47|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|193.00||||193.00|16.64|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|193.00||||193.00|16.01|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|193.00||||193.00|115.8|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|193.00||||193.00|96.5|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|193.00||||193.00|96.69|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|193.00||||193.00|67.74|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|193.00||||193.00|82.22|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|193.00||||193.00|18.25|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|193.00||||193.00|173.7|193|9.86 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MULTIPLAN [1680]|HMA [168003]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|193.00||||193.00||| 30184442|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROXINE BINDING GLOBULIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|193.00||||193.00||| 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|339.00||||339.00|18.48|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|339.00||||339.00|144.41|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|339.00||||339.00|20.75|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|339.00||||339.00|118.99|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|339.00||||339.00|169.5|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|339.00||||339.00|203.4|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|339.00||||339.00|17.64|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|339.00||||339.00|18.2|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|339.00||||339.00|17.58|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|339.00||||339.00|11.2|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|AETNA [1015]|AETNA ACO WILCO [101532]|339.00||||339.00|26.56|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|TRUSTMARK [2030]|STARMARK [203000]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|HEALTHNET [1495]|HEALTHNET [149500]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|339.00||||339.00|24.15|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MULTIPLAN [1680]|HMA [168003]|339.00||||339.00|25.2|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MULTIPLAN [1680]|IHC HS [168011]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|FMH BENEFIT SERVICES [1390]|FMH [139000]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|FIRST HEALTH [1375]|QUALCHOICE [137513]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|339.00||||339.00|20.75|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|339.00||||339.00|20.81|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|339.00||||339.00|17.14|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|UMR [2035]|UMR OPTIONS [203501]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|339.00||||339.00|24.53|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|339.00||||339.00|71.19|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|339.00||||339.00|18.48|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|339.00||||339.00|339|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|339.00||||339.00|162.55|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|339.00||||339.00|220.35|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|||339.00||||339.00|101.7|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|339.00||||339.00|169.84|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|339.00||||339.00|18.2|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|339.00||||339.00|16.8|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|339.00||||339.00|16.74|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|CHAMPVA [1240]|CHAMP VA [124000]|339.00||||339.00|254.25|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|339.00||||339.00|24.15|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|CORESOURCE [1315]|CORESOURCE [131500]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|339.00||||339.00|18.92|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|GEHA [1415]|GEHA [141500]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|339.00||||339.00|305.1|339|11.2 30184443|EAP|0301 - LABORATORY-CHEMISTRY|HC TSH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|339.00||||339.00||| 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|GEHA [1415]|GEHA [141500]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|585.00||||585.00|57.28|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|CORESOURCE [1315]|CORESOURCE [131500]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|CHAMPVA [1240]|CHAMP VA [124000]|585.00||||585.00|438.75|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|585.00||||585.00|50.69|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|585.00||||585.00|55.11|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|||585.00||||585.00|175.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|585.00||||585.00|280.51|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|585.00||||585.00|585|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|585.00||||585.00|122.85|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|585.00||||585.00|74.26|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|UMR [2035]|UMR OPTIONS [203501]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|585.00||||585.00|51.88|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|585.00||||585.00|63.01|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|585.00||||585.00|62.78|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|FIRST HEALTH [1375]|QUALCHOICE [137513]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|FMH BENEFIT SERVICES [1390]|FMH [139000]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MULTIPLAN [1680]|IHC HS [168011]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|585.00||||585.00|73.12|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MULTIPLAN [1680]|HMA [168003]|585.00||||585.00|76.29|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|HEALTHNET [1495]|HEALTHNET [149500]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|TRUSTMARK [2030]|STARMARK [203000]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|585.00||||585.00|380.25|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|AETNA [1015]|AETNA ACO WILCO [101532]|585.00||||585.00|80.38|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|585.00||||585.00|33.91|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|585.00||||585.00|53.23|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|585.00||||585.00|73.12|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|585.00||||585.00|55.95|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|585.00||||585.00|55.11|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|585.00||||585.00|53.4|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|585.00||||585.00|351|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|585.00||||585.00|292.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|585.00||||585.00|62.78|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|585.00||||585.00|205.34|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|585.00||||585.00|249.21|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|585.00||||585.00|293.09|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|585.00||||585.00|50.86|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|585.00||||585.00|526.5|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|585.00||||585.00|55.95|585|33.91 30184445|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID STIM IMMUNOGLOB (TSI)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|585.00||||585.00||| 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|204.00||||204.00|15.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|204.00||||204.00|17.51|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|204.00||||204.00|102.2|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|204.00||||204.00|71.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|204.00||||204.00|102|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|204.00||||204.00|122.4|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|204.00||||204.00|14.89|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|204.00||||204.00|15.36|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|204.00||||204.00|15.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|204.00||||204.00|14.84|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|204.00||||204.00|9.45|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|AETNA [1015]|COVENTRY HEALTHCARE [101502]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|AETNA [1015]|AETNA ACO WILCO [101532]|204.00||||204.00|22.4|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|HEALTHNET [1495]|HEALTHNET [149500]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MULTIPLAN [1680]|IHC HS [168011]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|204.00||||204.00|20.39|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|FMH BENEFIT SERVICES [1390]|FMH [139000]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|FIRST HEALTH [1375]|QUALCHOICE [137513]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MULTIPLAN [1680]|HMA [168003]|204.00||||204.00|21.27|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|TRUSTMARK [2030]|STARMARK [203000]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|204.00||||204.00|17.51|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|204.00||||204.00|17.57|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|204.00||||204.00|14.46|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|UMR [2035]|UMR OPTIONS [203501]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|204.00||||204.00|20.7|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|204.00||||204.00|42.84|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|204.00||||204.00|204|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|204.00||||204.00|97.82|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|204.00||||204.00|132.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|204.00||||204.00|86.9|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|||204.00||||204.00|61.2|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|204.00||||204.00|15.36|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|204.00||||204.00|14.18|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|204.00||||204.00|14.14|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|CHAMPVA [1240]|CHAMP VA [124000]|204.00||||204.00|153|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|204.00||||204.00|20.39|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|CORESOURCE [1315]|CORESOURCE [131500]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|204.00||||204.00|15.96|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|GEHA [1415]|GEHA [141500]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|204.00||||204.00|183.6|204|9.45 30184446|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN E|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|204.00||||204.00||| 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|GEHA [1415]|GEHA [141500]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|325.00||||325.00|5.83|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|CORESOURCE [1315]|CORESOURCE [131500]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|325.00||||325.00|7.45|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|CHAMPVA [1240]|CHAMP VA [124000]|325.00||||325.00|243.75|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|325.00||||325.00|5.17|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|325.00||||325.00|5.61|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|325.00||||325.00|211.25|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|325.00||||325.00|155.84|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|325.00||||325.00|325|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|325.00||||325.00|7.56|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|325.00||||325.00|5.28|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|325.00||||325.00|6.41|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|325.00||||325.00|6.39|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|FIRST HEALTH [1375]|QUALCHOICE [137513]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|UMR [2035]|UMR OPTIONS [203501]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|FMH BENEFIT SERVICES [1390]|FMH [139000]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|325.00||||325.00|68.25|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MULTIPLAN [1680]|HMA [168003]|325.00||||325.00|7.77|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MULTIPLAN [1680]|IHC HS [168011]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|325.00||||325.00|7.45|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|HEALTHNET [1495]|HEALTHNET [149500]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|TRUSTMARK [2030]|STARMARK [203000]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|||325.00||||325.00|97.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|AETNA [1015]|AETNA ACO WILCO [101532]|325.00||||325.00|8.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|325.00||||325.00|3.45|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|325.00||||325.00|5.42|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|325.00||||325.00|5.7|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|325.00||||325.00|5.61|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|325.00||||325.00|5.44|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|325.00||||325.00|195|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|325.00||||325.00|162.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|325.00||||325.00|6.39|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|325.00||||325.00|162.83|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|325.00||||325.00|114.08|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|325.00||||325.00|138.45|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|325.00||||325.00|5.18|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|325.00||||325.00|292.5|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|325.00||||325.00|5.7|325|3.45 30184450|EAP|0301 - LABORATORY-CHEMISTRY|HC AST/SGOT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|325.00||||325.00||| 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235.00||||235.00|5.83|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|235.00||||235.00|100.11|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|235.00||||235.00|117.74|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235.00||||235.00|6.54|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235.00||||235.00|82.49|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235.00||||235.00|117.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235.00||||235.00|5.57|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235.00||||235.00|5.74|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235.00||||235.00|5.54|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|AETNA [1015]|AETNA ACO WILCO [101532]|235.00||||235.00|8.38|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|TRUSTMARK [2030]|STARMARK [203000]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|HEALTHNET [1495]|HEALTHNET [149500]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|235.00||||235.00|7.62|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MULTIPLAN [1680]|HMA [168003]|235.00||||235.00|7.95|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MULTIPLAN [1680]|IHC HS [168011]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|FMH BENEFIT SERVICES [1390]|FMH [139000]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|FIRST HEALTH [1375]|QUALCHOICE [137513]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235.00||||235.00|6.54|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|235.00||||235.00|6.56|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235.00||||235.00|5.41|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|UMR [2035]|UMR OPTIONS [203501]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|235.00||||235.00|3.53|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235.00||||235.00|7.74|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235.00||||235.00|49.35|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235.00||||235.00|5.83|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235.00||||235.00|235|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235.00||||235.00|141|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235.00||||235.00|112.68|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235.00||||235.00|152.75|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|||235.00||||235.00|70.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235.00||||235.00|5.74|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235.00||||235.00|5.3|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235.00||||235.00|5.28|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|CHAMPVA [1240]|CHAMP VA [124000]|235.00||||235.00|176.25|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|235.00||||235.00|7.62|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|CORESOURCE [1315]|CORESOURCE [131500]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|235.00||||235.00|5.97|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|GEHA [1415]|GEHA [141500]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235.00||||235.00|211.5|235|3.53 30184460|EAP|0301 - LABORATORY-CHEMISTRY|HC ALT/SGPT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|235.00||||235.00||| 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|GEHA [1415]|GEHA [141500]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|246.00||||246.00|14.36|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|CORESOURCE [1315]|CORESOURCE [131500]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|CHAMPVA [1240]|CHAMP VA [124000]|246.00||||246.00|184.5|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|246.00||||246.00|12.71|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|246.00||||246.00|13.82|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|||246.00||||246.00|73.8|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|246.00||||246.00|117.96|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|246.00||||246.00|246|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|246.00||||246.00|51.66|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|246.00||||246.00|18.63|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|UMR [2035]|UMR OPTIONS [203501]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|246.00||||246.00|13.02|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|246.00||||246.00|15.8|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|246.00||||246.00|15.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MULTIPLAN [1680]|IHC HS [168011]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MULTIPLAN [1680]|HMA [168003]|246.00||||246.00|19.14|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|246.00||||246.00|18.34|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|HEALTHNET [1495]|HEALTHNET [149500]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|TRUSTMARK [2030]|STARMARK [203000]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|246.00||||246.00|159.9|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|AETNA [1015]|AETNA ACO WILCO [101532]|246.00||||246.00|20.17|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|246.00||||246.00|8.51|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|246.00||||246.00|13.35|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|246.00||||246.00|18.34|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|246.00||||246.00|14.04|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|246.00||||246.00|13.82|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|246.00||||246.00|13.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|246.00||||246.00|147.6|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|246.00||||246.00|123|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|246.00||||246.00|15.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|246.00||||246.00|86.35|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|246.00||||246.00|104.8|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|246.00||||246.00|123.25|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|246.00||||246.00|12.76|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|246.00||||246.00|221.4|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|246.00||||246.00|14.04|246|8.51 30184466|EAP|0301 - LABORATORY-CHEMISTRY|HC TRANSFERRIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|246.00||||246.00||| 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230.00||||230.00|6.31|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230.00||||230.00|7.09|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230.00||||230.00|97.98|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230.00||||230.00|115.23|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230.00||||230.00|115|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230.00||||230.00|138|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230.00||||230.00|6.03|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230.00||||230.00|6.22|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230.00||||230.00|6.31|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230.00||||230.00|3.83|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|AETNA [1015]|AETNA ACO WILCO [101532]|230.00||||230.00|9.07|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|TRUSTMARK [2030]|STARMARK [203000]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|HEALTHNET [1495]|HEALTHNET [149500]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230.00||||230.00|8.25|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MULTIPLAN [1680]|HMA [168003]|230.00||||230.00|8.61|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MULTIPLAN [1680]|IHC HS [168011]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230.00||||230.00|7.09|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230.00||||230.00|7.11|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230.00||||230.00|5.85|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|UMR [2035]|UMR OPTIONS [203501]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230.00||||230.00|6.01|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230.00||||230.00|8.38|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230.00||||230.00|48.3|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230.00||||230.00|230|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230.00||||230.00|110.29|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230.00||||230.00|149.5|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230.00||||230.00|80.73|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|||230.00||||230.00|69|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230.00||||230.00|6.22|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230.00||||230.00|5.74|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230.00||||230.00|5.73|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|CHAMPVA [1240]|CHAMP VA [124000]|230.00||||230.00|172.5|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230.00||||230.00|8.25|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|CORESOURCE [1315]|CORESOURCE [131500]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230.00||||230.00|6.46|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|GEHA [1415]|GEHA [141500]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230.00||||230.00|207|230|3.83 30184478|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIGLYCERIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230.00||||230.00||| 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|GEHA [1415]|GEHA [141500]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|CORESOURCE [1315]|CORESOURCE [131500]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|110.00||||110.00|9.3|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|CHAMPVA [1240]|CHAMP VA [124000]|110.00||||110.00|82.5|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110.00||||110.00|6.44|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110.00||||110.00|7.01|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|||110.00||||110.00|33|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110.00||||110.00|71.5|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110.00||||110.00|52.75|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110.00||||110.00|110|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110.00||||110.00|9.45|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110.00||||110.00|6.6|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|110.00||||110.00|8.01|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110.00||||110.00|7.98|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|FIRST HEALTH [1375]|QUALCHOICE [137513]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|UMR [2035]|UMR OPTIONS [203501]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|FMH BENEFIT SERVICES [1390]|FMH [139000]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110.00||||110.00|23.1|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MULTIPLAN [1680]|HMA [168003]|110.00||||110.00|9.71|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MULTIPLAN [1680]|IHC HS [168011]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|110.00||||110.00|9.3|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|HEALTHNET [1495]|HEALTHNET [149500]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|TRUSTMARK [2030]|STARMARK [203000]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|AETNA [1015]|AETNA ACO WILCO [101532]|110.00||||110.00|10.21|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|110.00||||110.00|4.31|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110.00||||110.00|6.77|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110.00||||110.00|7.12|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|110.00||||110.00|7.29|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110.00||||110.00|7.01|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110.00||||110.00|6.79|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110.00||||110.00|66|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110.00||||110.00|55|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|110.00||||110.00|55.11|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110.00||||110.00|38.61|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|110.00||||110.00|46.86|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110.00||||110.00|7.98|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110.00||||110.00|6.47|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110.00||||110.00|99|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110.00||||110.00|7.12|110|4.31 30184479|EAP|0301 - LABORATORY-CHEMISTRY|HC THYROID HORMONE UPTAKE/RATIO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|110.00||||110.00||| 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|239.00||||239.00|15.6|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|239.00||||239.00|101.81|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|239.00||||239.00|17.51|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|239.00||||239.00|83.89|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|239.00||||239.00|119.5|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|239.00||||239.00|14.89|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|239.00||||239.00|15.36|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|239.00||||239.00|14.84|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|239.00||||239.00|9.45|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|239.00||||239.00|22.4|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|TRUSTMARK [2030]|STARMARK [203000]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MULTIPLAN [1680]|IHC HS [168011]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|239.00||||239.00|20.39|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MULTIPLAN [1680]|HMA [168003]|239.00||||239.00|21.27|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|239.00||||239.00|17.51|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|239.00||||239.00|17.57|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|239.00||||239.00|14.46|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|UMR [2035]|UMR OPTIONS [203501]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|239.00||||239.00|20.7|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|239.00||||239.00|50.19|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|239.00||||239.00|15.6|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|239.00||||239.00|239|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|239.00||||239.00|143.4|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|239.00||||239.00|114.6|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|239.00||||239.00|155.35|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|||239.00||||239.00|71.7|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|239.00||||239.00|119.74|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|239.00||||239.00|15.36|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|239.00||||239.00|14.18|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|239.00||||239.00|14.14|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|239.00||||239.00|179.25|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|239.00||||239.00|20.39|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|239.00||||239.00|15.96|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|GEHA [1415]|GEHA [141500]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|239.00||||239.00|215.1|239|9.45 30184480|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|239.00||||239.00||| 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|GEHA [1415]|GEHA [141500]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|406.00||||406.00|19.07|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|CORESOURCE [1315]|CORESOURCE [131500]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|406.00||||406.00|24.35|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|CHAMPVA [1240]|CHAMP VA [124000]|406.00||||406.00|304.5|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|406.00||||406.00|16.88|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|406.00||||406.00|18.35|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|||406.00||||406.00|121.8|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.00||||406.00|194.68|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|406.00||||406.00|406|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|406.00||||406.00|85.26|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|406.00||||406.00|24.73|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|UMR [2035]|UMR OPTIONS [203501]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|406.00||||406.00|17.28|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|406.00||||406.00|20.98|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.00||||406.00|20.92|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|406.00||||406.00|24.35|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MULTIPLAN [1680]|HMA [168003]|406.00||||406.00|25.41|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MULTIPLAN [1680]|IHC HS [168011]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|HEALTHNET [1495]|HEALTHNET [149500]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|TRUSTMARK [2030]|STARMARK [203000]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|406.00||||406.00|263.9|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|AETNA [1015]|AETNA ACO WILCO [101532]|406.00||||406.00|26.77|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|406.00||||406.00|11.29|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|406.00||||406.00|17.72|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|406.00||||406.00|18.63|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|406.00||||406.00|18.35|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|406.00||||406.00|17.79|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|406.00||||406.00|243.6|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.00||||406.00|203|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|406.00||||406.00|20.92|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|406.00||||406.00|142.51|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|406.00||||406.00|172.96|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|406.00||||406.00|203.41|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|406.00||||406.00|16.94|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|406.00||||406.00|365.4|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|406.00||||406.00|18.63|406|11.29 30184481|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|406.00||||406.00||| 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|181.00||||181.00|17.34|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|181.00||||181.00|19.46|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|181.00||||181.00|90.68|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|181.00||||181.00|77.11|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|181.00||||181.00|63.53|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|181.00||||181.00|90.5|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|181.00||||181.00|108.6|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|181.00||||181.00|16.55|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|181.00||||181.00|17.34|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|181.00||||181.00|10.51|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|AETNA [1015]|AETNA ACO WILCO [101532]|181.00||||181.00|24.91|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|TRUSTMARK [2030]|STARMARK [203000]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|HEALTHNET [1495]|HEALTHNET [149500]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MULTIPLAN [1680]|HMA [168003]|181.00||||181.00|23.64|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|181.00||||181.00|22.66|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|FMH BENEFIT SERVICES [1390]|FMH [139000]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|FIRST HEALTH [1375]|QUALCHOICE [137513]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MULTIPLAN [1680]|IHC HS [168011]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|181.00||||181.00|19.46|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|181.00||||181.00|19.52|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|181.00||||181.00|16.08|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|UMR [2035]|UMR OPTIONS [203501]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|181.00||||181.00|16.49|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|181.00||||181.00|23.01|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|181.00||||181.00|38.01|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|181.00||||181.00|17.07|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|181.00||||181.00|181|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|181.00||||181.00|86.79|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|181.00||||181.00|117.65|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|||181.00||||181.00|54.3|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|181.00||||181.00|17.07|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|181.00||||181.00|15.76|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|181.00||||181.00|15.71|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|CHAMPVA [1240]|CHAMP VA [124000]|181.00||||181.00|135.75|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|181.00||||181.00|22.66|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|CORESOURCE [1315]|CORESOURCE [131500]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|181.00||||181.00|17.74|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|GEHA [1415]|GEHA [141500]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|181.00||||181.00|162.9|181|10.51 30184482|EAP|0301 - LABORATORY-CHEMISTRY|HC TRIIODOTHYRONINE (T-3) REVERS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|181.00||||181.00||| 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|GEHA [1415]|GEHA [141500]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|CORESOURCE [1315]|CORESOURCE [131500]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|254.00||||254.00|17.93|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|CHAMPVA [1240]|CHAMP VA [124000]|254.00||||254.00|190.5|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254.00||||254.00|12.42|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254.00||||254.00|13.51|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254.00||||254.00|165.1|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254.00||||254.00|121.79|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254.00||||254.00|254|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254.00||||254.00|18.21|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|UMR [2035]|UMR OPTIONS [203501]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254.00||||254.00|12.72|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|254.00||||254.00|15.45|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254.00||||254.00|53.34|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MULTIPLAN [1680]|IHC HS [168011]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|254.00||||254.00|17.93|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MULTIPLAN [1680]|HMA [168003]|254.00||||254.00|18.71|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|HEALTHNET [1495]|HEALTHNET [149500]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|TRUSTMARK [2030]|STARMARK [203000]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|||254.00||||254.00|76.2|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|AETNA [1015]|AETNA ACO WILCO [101532]|254.00||||254.00|17.74|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|254.00||||254.00|7.48|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254.00||||254.00|13.04|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254.00||||254.00|13.72|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|254.00||||254.00|14.04|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254.00||||254.00|13.51|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254.00||||254.00|13.09|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254.00||||254.00|152.4|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254.00||||254.00|127|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|254.00||||254.00|127.25|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|254.00||||254.00|108.2|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254.00||||254.00|89.15|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254.00||||254.00|12.47|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254.00||||254.00|228.6|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254.00||||254.00|13.72|254|7.48 30184484|EAP|0301 - LABORATORY-CHEMISTRY|HC TROPONIN QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|254.00||||254.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|77.96|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|12.84|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|64.23|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|11.51|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|11.12|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|183.00||||183.00|6.94|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|AETNA [1015]|AETNA ACO WILCO [101532]|183.00||||183.00|16.44|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|12.84|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|13.16|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|183|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183.00||||183.00|109.8|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183.00||||183.00|87.75|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|||183.00||||183.00|54.9|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|91.68|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|11.51|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|10.59|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|CHAMPVA [1240]|CHAMP VA [124000]|183.00||||183.00|137.25|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|11.96|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|GEHA [1415]|GEHA [141500]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|183|6.94 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|MULTIPLAN [1680]|HMA [168003]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00||| 30184510|EAP|0301 - LABORATORY-CHEMISTRY|HC TYROSINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00||| 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|GEHA [1415]|GEHA [141500]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|216.00||||216.00|4.45|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|CORESOURCE [1315]|CORESOURCE [131500]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|CHAMPVA [1240]|CHAMP VA [124000]|216.00||||216.00|162|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216.00||||216.00|3.93|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216.00||||216.00|4.28|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|||216.00||||216.00|64.8|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|216.00||||216.00|4.88|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216.00||||216.00|140.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216.00||||216.00|103.57|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216.00||||216.00|216|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216.00||||216.00|45.36|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216.00||||216.00|5.77|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|UMR [2035]|UMR OPTIONS [203501]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216.00||||216.00|4.03|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|216.00||||216.00|4.9|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216.00||||216.00|4.88|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|FIRST HEALTH [1375]|QUALCHOICE [137513]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|FMH BENEFIT SERVICES [1390]|FMH [139000]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MULTIPLAN [1680]|HMA [168003]|216.00||||216.00|5.93|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|216.00||||216.00|5.68|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MULTIPLAN [1680]|IHC HS [168011]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|HEALTHNET [1495]|HEALTHNET [149500]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|TRUSTMARK [2030]|STARMARK [203000]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|AETNA [1015]|AETNA ACO WILCO [101532]|216.00||||216.00|6.25|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|216.00||||216.00|2.63|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216.00||||216.00|4.13|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|216.00||||216.00|5.68|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216.00||||216.00|4.35|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216.00||||216.00|4.28|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216.00||||216.00|4.15|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216.00||||216.00|129.6|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216.00||||216.00|108|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216.00||||216.00|4.88|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216.00||||216.00|75.82|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|216.00||||216.00|92.02|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|216.00||||216.00|108.22|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216.00||||216.00|3.95|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216.00||||216.00|194.4|216|2.63 30184520|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN BLD (BUN)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216.00||||216.00|4.35|216|2.63 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|148.00||||148.00|5.86|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|148.00||||148.00|63.05|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|148.00||||148.00|74.15|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|148.00||||148.00|74|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148.00||||148.00|88.8|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|148.00||||148.00|3.34|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|AETNA [1015]|AETNA ACO WILCO [101532]|148.00||||148.00|7.91|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|HEALTHNET [1495]|HEALTHNET [149500]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MULTIPLAN [1680]|IHC HS [168011]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|148.00||||148.00|5.86|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|148.00||||148.00|6.89|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|TRUSTMARK [2030]|STARMARK [203000]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|UMR [2035]|UMR OPTIONS [203501]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|148.00||||148.00|5.82|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|148.00||||148.00|31.08|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|148.00||||148.00|6.03|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|148.00||||148.00|148|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148.00||||148.00|70.97|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|148.00||||148.00|96.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|||148.00||||148.00|44.4|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|148.00||||148.00|6.03|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|148.00||||148.00|51.95|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|148.00||||148.00|5.54|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|CHAMPVA [1240]|CHAMP VA [124000]|148.00||||148.00|111|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|CORESOURCE [1315]|CORESOURCE [131500]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|148.00||||148.00|6.27|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|GEHA [1415]|GEHA [141500]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|148.00||||148.00|133.2|148|3.34 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MULTIPLAN [1680]|HMA [168003]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|148.00||||148.00||| 30184540|EAP|0301 - LABORATORY-CHEMISTRY|HC UREA NITROGEN URINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|148.00||||148.00||| 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|GEHA [1415]|GEHA [141500]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|CORESOURCE [1315]|CORESOURCE [131500]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|225.00||||225.00|6.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|CHAMPVA [1240]|CHAMP VA [124000]|225.00||||225.00|168.75|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225.00||||225.00|4.51|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225.00||||225.00|4.9|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225.00||||225.00|146.25|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225.00||||225.00|107.89|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225.00||||225.00|225|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225.00||||225.00|47.25|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225.00||||225.00|6.6|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225.00||||225.00|4.61|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|225.00||||225.00|5.6|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225.00||||225.00|5.58|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|FIRST HEALTH [1375]|QUALCHOICE [137513]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|UMR [2035]|UMR OPTIONS [203501]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|FMH BENEFIT SERVICES [1390]|FMH [139000]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MULTIPLAN [1680]|HMA [168003]|225.00||||225.00|6.78|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|225.00||||225.00|6.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MULTIPLAN [1680]|IHC HS [168011]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|HEALTHNET [1495]|HEALTHNET [149500]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|TRUSTMARK [2030]|STARMARK [203000]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|||225.00||||225.00|67.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|AETNA [1015]|AETNA ACO WILCO [101532]|225.00||||225.00|7.15|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|225.00||||225.00|3.01|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225.00||||225.00|4.74|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225.00||||225.00|4.97|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225.00||||225.00|4.9|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225.00||||225.00|4.75|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225.00||||225.00|135|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|225.00||||225.00|5.09|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225.00||||225.00|112.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|225.00||||225.00|112.73|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225.00||||225.00|78.98|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|225.00||||225.00|95.85|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225.00||||225.00|5.58|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225.00||||225.00|4.52|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225.00||||225.00|202.5|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225.00||||225.00|4.97|225|3.01 30184550|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID BLD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|225.00||||225.00||| 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|252.00||||252.00|5.59|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|252.00||||252.00|107.35|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|252.00||||252.00|5.86|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|252.00||||252.00|88.45|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|252.00||||252.00|126|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|252.00||||252.00|151.2|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|252.00||||252.00|5.33|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|252.00||||252.00|5.51|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|252.00||||252.00|5.33|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|252.00||||252.00|3.16|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|AETNA [1015]|AETNA ACO WILCO [101532]|252.00||||252.00|7.49|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|TRUSTMARK [2030]|STARMARK [203000]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|HEALTHNET [1495]|HEALTHNET [149500]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|252.00||||252.00|7.3|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MULTIPLAN [1680]|HMA [168003]|252.00||||252.00|7.62|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MULTIPLAN [1680]|IHC HS [168011]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|252.00||||252.00|5.86|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|252.00||||252.00|6.3|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|252.00||||252.00|5.18|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|UMR [2035]|UMR OPTIONS [203501]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|252.00||||252.00|7.42|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|252.00||||252.00|52.92|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|252.00||||252.00|5.59|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|252.00||||252.00|252|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|252.00||||252.00|120.83|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|252.00||||252.00|163.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|||252.00||||252.00|75.6|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|252.00||||252.00|126.25|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|252.00||||252.00|5.51|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|252.00||||252.00|5.08|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|252.00||||252.00|5.07|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|CHAMPVA [1240]|CHAMP VA [124000]|252.00||||252.00|189|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|252.00||||252.00|7.3|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|CORESOURCE [1315]|CORESOURCE [131500]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|252.00||||252.00|5.73|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|GEHA [1415]|GEHA [141500]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|252.00||||252.00|226.8|252|3.16 30184560|EAP|0301 - LABORATORY-CHEMISTRY|HC URIC ACID OTHER SOURCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|252.00||||252.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|GEHA [1415]|GEHA [141500]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|362.00||||362.00|17.45|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|CORESOURCE [1315]|CORESOURCE [131500]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|CHAMPVA [1240]|CHAMP VA [124000]|362.00||||362.00|271.5|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|362.00||||362.00|15.45|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|362.00||||362.00|16.79|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|||362.00||||362.00|108.6|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|362.00||||362.00|173.58|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|362.00||||362.00|362|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|362.00||||362.00|76.02|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|UMR [2035]|UMR OPTIONS [203501]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|362.00||||362.00|19.2|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|362.00||||362.00|19.13|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|MULTIPLAN [1680]|IHC HS [168011]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|HEALTHNET [1495]|HEALTHNET [149500]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|TRUSTMARK [2030]|STARMARK [203000]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|362.00||||362.00|235.3|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|AETNA [1015]|AETNA ACO WILCO [101532]|362.00||||362.00|24.49|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|362.00||||362.00|10.33|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|362.00||||362.00|16.22|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|362.00||||362.00|16.79|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|362.00||||362.00|217.2|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|362.00||||362.00|181|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|362.00||||362.00|19.13|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|362.00||||362.00|127.06|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|362.00||||362.00|154.21|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|362.00||||362.00|181.36|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|362.00||||362.00|325.8|362|10.33 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|MULTIPLAN [1680]|HMA [168003]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA) URINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|362.00||||362.00||| 30184585|EAP|0301 - LABORATORY-CHEMISTRY|HC VANILLYMANDELIC ACID(VMA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|362.00||||362.00||| 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|440.00||||440.00|38.86|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|440.00||||440.00|43.62|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|440.00||||440.00|220.44|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|440.00||||440.00|154.44|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|440.00||||440.00|220|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|440.00||||440.00|264|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|440.00||||440.00|37.1|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|440.00||||440.00|38.86|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|440.00||||440.00|36.97|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|440.00||||440.00|23.56|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|AETNA [1015]|AETNA ACO WILCO [101532]|440.00||||440.00|55.84|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|HEALTHNET [1495]|HEALTHNET [149500]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MULTIPLAN [1680]|HMA [168003]|440.00||||440.00|53|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MULTIPLAN [1680]|IHC HS [168011]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|FIRST HEALTH [1375]|QUALCHOICE [137513]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|440.00||||440.00|50.79|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|440.00||||440.00|43.62|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|440.00||||440.00|43.77|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|TRUSTMARK [2030]|STARMARK [203000]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|440.00||||440.00|36.04|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|UMR [2035]|UMR OPTIONS [203501]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|440.00||||440.00|51.58|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|440.00||||440.00|92.4|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|440.00||||440.00|38.28|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|440.00||||440.00|440|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|440.00||||440.00|210.98|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|440.00||||440.00|286|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|440.00||||440.00|187.44|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|||440.00||||440.00|132|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|440.00||||440.00|38.28|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|440.00||||440.00|35.33|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|440.00||||440.00|35.2|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|CHAMPVA [1240]|CHAMP VA [124000]|440.00||||440.00|330|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|440.00||||440.00|50.79|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|CORESOURCE [1315]|CORESOURCE [131500]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|440.00||||440.00|39.79|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|GEHA [1415]|GEHA [141500]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|440.00||||440.00|396|440|23.56 30184586|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOACTIVE INTEST PEPTIDE(VIP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|440.00||||440.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|GEHA [1415]|GEHA [141500]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|441.00||||441.00|38.22|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|CORESOURCE [1315]|CORESOURCE [131500]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|441.00||||441.00|273.42|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|CHAMPVA [1240]|CHAMP VA [124000]|441.00||||441.00|330.75|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|441.00||||441.00|33.82|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|441.00||||441.00|33.94|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|441.00||||441.00|36.77|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|441.00||||441.00|286.65|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|441.00||||441.00|211.46|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|441.00||||441.00|441|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|441.00||||441.00|273.86|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|441.00||||441.00|34.62|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|441.00||||441.00|42.04|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|441.00||||441.00|41.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|FIRST HEALTH [1375]|QUALCHOICE [137513]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|441.00||||441.00|33.94|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|FMH BENEFIT SERVICES [1390]|FMH [139000]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|UMR [2035]|UMR OPTIONS [203501]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|441.00||||441.00|92.61|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MULTIPLAN [1680]|HMA [168003]|441.00||||441.00|50.91|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|441.00||||441.00|48.79|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MULTIPLAN [1680]|IHC HS [168011]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|HEALTHNET [1495]|HEALTHNET [149500]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|TRUSTMARK [2030]|STARMARK [203000]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|AETNA [1015]|AETNA ACO WILCO [101532]|441.00||||441.00|53.64|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|441.00||||441.00|33.94|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|||441.00||||441.00|132.3|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|441.00||||441.00|22.63|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|441.00||||441.00|35.51|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|441.00||||441.00|33.94|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|441.00||||441.00|36.77|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|441.00||||441.00|35.64|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|441.00||||441.00|264.6|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|441.00||||441.00|220.5|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|441.00||||441.00|41.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|441.00||||441.00|220.94|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|441.00||||441.00|154.79|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|441.00||||441.00|187.87|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|441.00||||441.00|33.94|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|441.00||||441.00|33.94|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|441.00||||441.00|396.9|441|22.63 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|441.00||||441.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|441.00||||441.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|441.00||||441.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|441.00||||441.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|441.00||||441.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|441.00||||441.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|441.00||||441.00||| 30184588|EAP|0301 - LABORATORY-CHEMISTRY|HC VASOPRESSIN (ADH)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|441.00||||441.00||| 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|241.00||||241.00|12.77|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|241.00||||241.00|120.74|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|241.00||||241.00|102.67|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|241.00||||241.00|14.33|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|241.00||||241.00|84.59|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|241.00||||241.00|120.5|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|241.00||||241.00|12.19|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|241.00||||241.00|12.57|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|241.00||||241.00|12.15|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|AETNA [1015]|AETNA ACO WILCO [101532]|241.00||||241.00|18.35|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|TRUSTMARK [2030]|STARMARK [203000]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|HEALTHNET [1495]|HEALTHNET [149500]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MULTIPLAN [1680]|HMA [168003]|241.00||||241.00|17.42|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MULTIPLAN [1680]|IHC HS [168011]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|241.00||||241.00|16.69|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|FMH BENEFIT SERVICES [1390]|FMH [139000]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|FIRST HEALTH [1375]|QUALCHOICE [137513]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|241.00||||241.00|14.33|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|241.00||||241.00|14.37|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|241.00||||241.00|11.84|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|UMR [2035]|UMR OPTIONS [203501]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|241.00||||241.00|7.74|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|241.00||||241.00|16.95|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|241.00||||241.00|50.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|241.00||||241.00|12.77|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|241.00||||241.00|241|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|241.00||||241.00|144.6|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|241.00||||241.00|115.56|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|241.00||||241.00|156.65|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|||241.00||||241.00|72.3|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|241.00||||241.00|12.57|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|241.00||||241.00|11.61|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|241.00||||241.00|11.57|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|CHAMPVA [1240]|CHAMP VA [124000]|241.00||||241.00|180.75|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|241.00||||241.00|16.69|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|CORESOURCE [1315]|CORESOURCE [131500]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|241.00||||241.00|13.06|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|GEHA [1415]|GEHA [141500]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|241.00||||241.00|216.9|241|7.74 30184590|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN A (RETINOL)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|241.00||||241.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|GEHA [1415]|GEHA [141500]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|200.00||||200.00|19.22|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|CORESOURCE [1315]|CORESOURCE [131500]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|CHAMPVA [1240]|CHAMP VA [124000]|200.00||||200.00|150|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200.00||||200.00|17|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200.00||||200.00|18.49|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|||200.00||||200.00|60|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200.00||||200.00|95.9|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200.00||||200.00|200|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200.00||||200.00|42|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|UMR [2035]|UMR OPTIONS [203501]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|200.00||||200.00|21.14|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200.00||||200.00|17.06|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MULTIPLAN [1680]|IHC HS [168011]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|HEALTHNET [1495]|HEALTHNET [149500]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|TRUSTMARK [2030]|STARMARK [203000]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200.00||||200.00|130|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|AETNA [1015]|AETNA ACO WILCO [101532]|200.00||||200.00|24.27|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|200.00||||200.00|10.24|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200.00||||200.00|17.86|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200.00||||200.00|18.49|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200.00||||200.00|120|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200.00||||200.00|100|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200.00||||200.00|17.06|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200.00||||200.00|70.2|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|200.00||||200.00|85.2|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|200.00||||200.00|100.2|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200.00||||200.00|180|200|10.24 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MULTIPLAN [1680]|HMA [168003]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200.00||||200.00||| 30184591|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200.00||||200.00||| 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173.00||||173.00|15.09|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173.00||||173.00|16.94|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|173.00||||173.00|73.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|173.00||||173.00|86.67|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173.00||||173.00|86.5|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173.00||||173.00|103.8|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173.00||||173.00|14.41|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173.00||||173.00|14.87|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173.00||||173.00|15.09|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|173.00||||173.00|9.14|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|TRUSTMARK [2030]|STARMARK [203000]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|HEALTHNET [1495]|HEALTHNET [149500]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|173.00||||173.00|19.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MULTIPLAN [1680]|IHC HS [168011]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MULTIPLAN [1680]|HMA [168003]|173.00||||173.00|20.58|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|FMH BENEFIT SERVICES [1390]|FMH [139000]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|FIRST HEALTH [1375]|QUALCHOICE [137513]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173.00||||173.00|16.94|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|173.00||||173.00|17|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173.00||||173.00|13.99|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|AETNA [1015]|AETNA ACO WILCO [101532]|173.00||||173.00|21.67|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|UMR [2035]|UMR OPTIONS [203501]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173.00||||173.00|20.03|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173.00||||173.00|36.33|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173.00||||173.00|14.36|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173.00||||173.00|173|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173.00||||173.00|82.95|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173.00||||173.00|112.45|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173.00||||173.00|60.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|||173.00||||173.00|51.9|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173.00||||173.00|14.87|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173.00||||173.00|13.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173.00||||173.00|13.68|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|CHAMPVA [1240]|CHAMP VA [124000]|173.00||||173.00|129.75|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|173.00||||173.00|19.72|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|CORESOURCE [1315]|CORESOURCE [131500]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|173.00||||173.00|15.46|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|GEHA [1415]|GEHA [141500]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173.00||||173.00|155.7|173|9.14 30184597|EAP|0301 - LABORATORY-CHEMISTRY|HC VITAMIN K|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|173.00||||173.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|GEHA [1415]|GEHA [141500]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|CORESOURCE [1315]|CORESOURCE [131500]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|CHAMPVA [1240]|CHAMP VA [124000]|291.00||||291.00|218.25|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|291.00||||291.00|17.05|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|291.00||||291.00|18.53|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|||291.00||||291.00|87.3|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|291.00||||291.00|189.15|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|291.00||||291.00|139.53|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|291.00||||291.00|291|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|291.00||||291.00|21.18|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|291.00||||291.00|19.85|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|FIRST HEALTH [1375]|QUALCHOICE [137513]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|UMR [2035]|UMR OPTIONS [203501]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|FMH BENEFIT SERVICES [1390]|FMH [139000]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|291.00||||291.00|61.11|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MULTIPLAN [1680]|IHC HS [168011]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|HEALTHNET [1495]|HEALTHNET [149500]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|AETNA [1015]|AETNA ACO WILCO [101532]|291.00||||291.00|25.41|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|TRUSTMARK [2030]|STARMARK [203000]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|291.00||||291.00|10.72|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|291.00||||291.00|17.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|291.00||||291.00|19.26|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|291.00||||291.00|18.53|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|291.00||||291.00|174.6|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|291.00||||291.00|145.5|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|291.00||||291.00|145.79|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|291.00||||291.00|102.14|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|291.00||||291.00|123.97|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|291.00||||291.00|19.85|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|291.00||||291.00|261.9|291|10.72 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MULTIPLAN [1680]|HMA [168003]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|291.00||||291.00||| 30184600|EAP|0301 - LABORATORY-CHEMISTRY|HC VOLATILES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|291.00||||291.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146.00||||146.00|13.51|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146.00||||146.00|7.9|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|TRUSTMARK [2030]|STARMARK [203000]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|HEALTHNET [1495]|HEALTHNET [149500]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MULTIPLAN [1680]|IHC HS [168011]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146.00||||146.00|14.63|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146.00||||146.00|16|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|UMR [2035]|UMR OPTIONS [203501]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146.00||||146.00|30.66|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146.00||||146.00|146|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146.00||||146.00|70.01|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146.00||||146.00|94.9|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|||146.00||||146.00|43.8|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|AETNA [1015]|AETNA ACO WILCO [101532]|146.00||||146.00|18.72|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146.00||||146.00|13.99|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146.00||||146.00|12.87|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|CHAMPVA [1240]|CHAMP VA [124000]|146.00||||146.00|109.5|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|CORESOURCE [1315]|CORESOURCE [131500]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146.00||||146.00|14.54|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|GEHA [1415]|GEHA [141500]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146.00||||146.00|73|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146.00||||146.00|73.15|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146.00||||146.00|13.99|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146.00||||146.00|51.25|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146.00||||146.00|14.63|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146.00||||146.00|62.2|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146.00||||146.00|87.6|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146.00||||146.00|131.4|146|7.9 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MULTIPLAN [1680]|HMA [168003]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146.00||||146.00||| 30184620|EAP|0301 - LABORATORY-CHEMISTRY|HC XYLOSE ABSORPTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146.00||||146.00||| 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232.00||||232.00|11.62|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232.00||||232.00|14.06|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232.00||||232.00|11.35|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|GEHA [1415]|GEHA [141500]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232.00||||232.00|139.2|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|232.00||||232.00|7.59|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232.00||||232.00|16.63|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232.00||||232.00|12.53|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MULTIPLAN [1680]|IHC HS [168011]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|232.00||||232.00|98.83|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|HEALTHNET [1495]|HEALTHNET [149500]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232.00||||232.00|81.43|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|AETNA [1015]|AETNA ACO WILCO [101532]|232.00||||232.00|18|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|UMR [2035]|UMR OPTIONS [203501]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232.00||||232.00|48.72|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232.00||||232.00|11.92|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|232.00||||232.00|16.37|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MULTIPLAN [1680]|HMA [168003]|232.00||||232.00|17.09|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232.00||||232.00|116|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|232.00||||232.00|16.37|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232.00||||232.00|12.34|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232.00||||232.00|232|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232.00||||232.00|14.06|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|||232.00||||232.00|69.6|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232.00||||232.00|150.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|TRUSTMARK [2030]|STARMARK [203000]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232.00||||232.00|12.34|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232.00||||232.00|111.24|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|232.00||||232.00|12.83|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|232.00||||232.00|11.39|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|FIRST HEALTH [1375]|QUALCHOICE [137513]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|FMH BENEFIT SERVICES [1390]|FMH [139000]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|CORESOURCE [1315]|CORESOURCE [131500]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|CHAMPVA [1240]|CHAMP VA [124000]|232.00||||232.00|174|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|232.00||||232.00|14.1|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232.00||||232.00|11.96|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232.00||||232.00|208.8|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232.00||||232.00|12.53|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|232.00||||232.00|116.23|232|7.59 30184630|EAP|0301 - LABORATORY-CHEMISTRY|HC ZINC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|232.00||||232.00||| 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MULTIPLAN [1680]|IHC HS [168011]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|268.00||||268.00|25.7|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|AETNA [1015]|AETNA ACO WILCO [101532]|268.00||||268.00|32.91|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|268.00||||268.00|56.28|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|UMR [2035]|UMR OPTIONS [203501]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MULTIPLAN [1680]|HMA [168003]|268.00||||268.00|31.22|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|268.00||||268.00|22.54|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|268.00||||268.00|160.8|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|268.00||||268.00|29.92|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|268.00||||268.00|128.51|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|268.00||||268.00|174.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|268.00||||268.00|30.38|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|268.00||||268.00|25.77|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|268.00||||268.00|23.43|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|268.00||||268.00|94.07|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|CORESOURCE [1315]|CORESOURCE [131500]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|CHAMPVA [1240]|CHAMP VA [124000]|268.00||||268.00|201|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|268.00||||268.00|21.23|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|TRUSTMARK [2030]|STARMARK [203000]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|268.00||||268.00|20.74|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|HEALTHNET [1495]|HEALTHNET [149500]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|268.00||||268.00|268|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|268.00||||268.00|29.92|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|268.00||||268.00|114.17|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|268.00||||268.00|134|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|||268.00||||268.00|80.4|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|268.00||||268.00|25.7|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|268.00||||268.00|21.85|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|268.00||||268.00|22.54|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|268.00||||268.00|21.77|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|268.00||||268.00|22.89|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|268.00||||268.00|134.27|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|268.00||||268.00|13.88|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|GEHA [1415]|GEHA [141500]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|268.00||||268.00|22.89|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|268.00||||268.00|20.81|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|268.00||||268.00|241.2|268|13.88 30184681|EAP|0301 - LABORATORY-CHEMISTRY|HC C-PEPTIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|268.00||||268.00||| 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MULTIPLAN [1680]|HMA [168003]|351.00||||351.00|22.58|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|351.00||||351.00|16.95|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351.00||||351.00|15|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|||351.00||||351.00|105.3|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|CHAMPVA [1240]|CHAMP VA [124000]|351.00||||351.00|263.25|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351.00||||351.00|73.71|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351.00||||351.00|16.31|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|351.00||||351.00|21.64|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|UMR [2035]|UMR OPTIONS [203501]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351.00||||351.00|351|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351.00||||351.00|228.15|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351.00||||351.00|21.97|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|HEALTHNET [1495]|HEALTHNET [149500]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|351.00||||351.00|18.65|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351.00||||351.00|16.56|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|351.00||||351.00|21.64|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|CORESOURCE [1315]|CORESOURCE [131500]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351.00||||351.00|18.59|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351.00||||351.00|15.75|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351.00||||351.00|168.3|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351.00||||351.00|15.8|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|TRUSTMARK [2030]|STARMARK [203000]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|351.00||||351.00|149.53|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351.00||||351.00|210.6|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351.00||||351.00|15.35|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351.00||||351.00|16.56|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351.00||||351.00|175.5|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351.00||||351.00|123.2|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351.00||||351.00|16.31|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351.00||||351.00|15.05|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|351.00||||351.00|175.85|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|GEHA [1415]|GEHA [141500]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|351.00||||351.00|10.04|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|MULTIPLAN [1680]|IHC HS [168011]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351.00||||351.00|18.59|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|AETNA [1015]|AETNA ACO WILCO [101532]|351.00||||351.00|23.8|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351.00||||351.00|315.9|351|10.04 30184702|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|351.00||||351.00||| 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|283.00||||283.00|10.81|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|283.00||||283.00|10.98|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|283.00||||283.00|59.43|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MULTIPLAN [1680]|IHC HS [168011]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|283.00||||283.00|9.32|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|CHAMPVA [1240]|CHAMP VA [124000]|283.00||||283.00|212.25|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|UMR [2035]|UMR OPTIONS [203501]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MULTIPLAN [1680]|HMA [168003]|283.00||||283.00|11.28|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|283.00||||283.00|8.15|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|283.00||||283.00|283|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|283.00||||283.00|7.49|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|283.00||||283.00|8.47|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|283.00||||283.00|10.81|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|CORESOURCE [1315]|CORESOURCE [131500]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|||283.00||||283.00|84.9|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|283.00||||283.00|183.95|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|283.00||||283.00|9.29|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|GEHA [1415]|GEHA [141500]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|283.00||||283.00|135.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|283.00||||283.00|7.67|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|283.00||||283.00|99.33|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|283.00||||283.00|8.27|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|283.00||||283.00|141.5|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|283.00||||283.00|141.78|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|283.00||||283.00|7.9|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|283.00||||283.00|169.8|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|283.00||||283.00|9.29|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|283.00||||283.00|5.02|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|HEALTHNET [1495]|HEALTHNET [149500]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|283.00||||283.00|8.15|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|283.00||||283.00|8.27|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|TRUSTMARK [2030]|STARMARK [203000]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|283.00||||283.00|120.56|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|283.00||||283.00|7.87|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|283.00||||283.00|254.7|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|283.00||||283.00|7.52|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|AETNA [1015]|AETNA ACO WILCO [101532]|283.00||||283.00|11.89|283|5.02 30184703|EAP|0301 - LABORATORY-CHEMISTRY|HC HCG QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|283.00||||283.00||| 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263.00||||263.00|55.23|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|263.00||||263.00|20.25|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|263.00||||263.00|22.27|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|263.00||||263.00|25.85|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|CORESOURCE [1315]|CORESOURCE [131500]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263.00||||263.00|170.95|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263.00||||263.00|19.48|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263.00||||263.00|263|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263.00||||263.00|17.92|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|UMR [2035]|UMR OPTIONS [203501]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263.00||||263.00|26.25|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|HEALTHNET [1495]|HEALTHNET [149500]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263.00||||263.00|18.34|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|FMH BENEFIT SERVICES [1390]|FMH [139000]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MULTIPLAN [1680]|HMA [168003]|263.00||||263.00|26.97|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263.00||||263.00|22.19|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|||263.00||||263.00|78.9|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|AETNA [1015]|AETNA ACO WILCO [101532]|263.00||||263.00|28.4|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263.00||||263.00|131.5|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MULTIPLAN [1680]|IHC HS [168011]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|GEHA [1415]|GEHA [141500]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|263.00||||263.00|25.85|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263.00||||263.00|157.8|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263.00||||263.00|19.48|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|FIRST HEALTH [1375]|QUALCHOICE [137513]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263.00||||263.00|19.78|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263.00||||263.00|22.19|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263.00||||263.00|92.31|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|263.00||||263.00|112.04|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263.00||||263.00|126.11|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|263.00||||263.00|131.76|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|263.00||||263.00|11.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263.00||||263.00|19.78|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263.00||||263.00|18.82|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263.00||||263.00|18.88|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|TRUSTMARK [2030]|STARMARK [203000]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|CHAMPVA [1240]|CHAMP VA [124000]|263.00||||263.00|197.25|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263.00||||263.00|17.98|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263.00||||263.00|236.7|263|11.98 30185598|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEXAGONAL PHOSPHOLIPID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|263.00||||263.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94.00||||94.00|56.4|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94.00||||94.00|8.62|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94.00||||94.00|47|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94.00||||94.00|32.99|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|94.00||||94.00|40.04|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|94.00||||94.00|47.09|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|94.00||||94.00|4.66|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|HEALTHNET [1495]|HEALTHNET [149500]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|94.00||||94.00|8.65|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|AETNA [1015]|AETNA ACO WILCO [101532]|94.00||||94.00|11.04|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|UMR [2035]|UMR OPTIONS [203501]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94.00||||94.00|8.62|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|TRUSTMARK [2030]|STARMARK [203000]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94.00||||94.00|7.3|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MULTIPLAN [1680]|IHC HS [168011]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94.00||||94.00|19.74|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94.00||||94.00|94|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|||94.00||||94.00|28.2|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94.00||||94.00|6.95|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94.00||||94.00|7.56|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|CHAMPVA [1240]|CHAMP VA [124000]|94.00||||94.00|70.5|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|GEHA [1415]|GEHA [141500]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94.00||||94.00|45.07|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|CORESOURCE [1315]|CORESOURCE [131500]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94.00||||94.00|7.56|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94.00||||94.00|84.6|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94.00||||94.00|61.1|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|94.00||||94.00|7.86|94|4.66 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|MULTIPLAN [1680]|HMA [168003]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94.00||||94.00||| 30186000|EAP|0301 - LABORATORY-CHEMISTRY|HC AGGLUT FEBRILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94.00||||94.00||| 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101.00||||101.00|7.8|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|101.00||||101.00|8.8|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|GEHA [1415]|GEHA [141500]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|CORESOURCE [1315]|CORESOURCE [131500]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|CHAMPVA [1240]|CHAMP VA [124000]|101.00||||101.00|75.75|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|101.00||||101.00|9.69|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101.00||||101.00|11.42|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101.00||||101.00|48.43|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|UMR [2035]|UMR OPTIONS [203501]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101.00||||101.00|65.65|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101.00||||101.00|101|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101.00||||101.00|21.21|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101.00||||101.00|7.98|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MULTIPLAN [1680]|HMA [168003]|101.00||||101.00|11.73|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|101.00||||101.00|11.24|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|AETNA [1015]|AETNA ACO WILCO [101532]|101.00||||101.00|11.12|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|||101.00||||101.00|30.3|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|HEALTHNET [1495]|HEALTHNET [149500]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101.00||||101.00|50.5|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|101.00||||101.00|11.24|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101.00||||101.00|8.6|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101.00||||101.00|8.21|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MULTIPLAN [1680]|IHC HS [168011]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|101.00||||101.00|4.69|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101.00||||101.00|8.47|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101.00||||101.00|8.47|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101.00||||101.00|60.6|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|101.00||||101.00|50.6|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101.00||||101.00|35.45|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101.00||||101.00|8.6|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101.00||||101.00|8.19|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|TRUSTMARK [2030]|STARMARK [203000]|101.00||||101.00|90.9|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|101.00||||101.00|43.03|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101.00||||101.00|7.82|101|4.69 30186001|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLERGEN SPEC IGG EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|101.00||||101.00||| 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|UMR [2035]|UMR OPTIONS [203501]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82.00||||82.00|5.21|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82.00||||82.00|17.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|CHAMPVA [1240]|CHAMP VA [124000]|82.00||||82.00|61.5|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82.00||||82.00|5.88|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|CORESOURCE [1315]|CORESOURCE [131500]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82.00||||82.00|82|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|GEHA [1415]|GEHA [141500]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82.00||||82.00|5.66|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82.00||||82.00|7.62|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82.00||||82.00|53.3|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82.00||||82.00|39.32|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82.00||||82.00|7.5|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|||82.00||||82.00|24.6|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82.00||||82.00|5.74|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82.00||||82.00|41.08|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82.00||||82.00|28.78|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82.00||||82.00|6.44|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82.00||||82.00|34.93|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82.00||||82.00|5.66|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82.00||||82.00|49.2|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|AETNA [1015]|AETNA ACO WILCO [101532]|82.00||||82.00|8.25|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82.00||||82.00|5.74|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82.00||||82.00|3.48|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82.00||||82.00|5.48|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82.00||||82.00|5.47|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|HEALTHNET [1495]|HEALTHNET [149500]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MULTIPLAN [1680]|IHC HS [168011]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82.00||||82.00|7.5|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MULTIPLAN [1680]|HMA [168003]|82.00||||82.00|7.83|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82.00||||82.00|41|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82.00||||82.00|6.44|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|TRUSTMARK [2030]|STARMARK [203000]|82.00||||82.00|73.8|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82.00||||82.00|6.48|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82.00||||82.00|5.22|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82.00||||82.00|5.32|82|3.48 30186003|EAP|0301 - LABORATORY-CHEMISTRY|HC ALLERGEN SPEC IGE QN/SEMI-QN EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82.00||||82.00||| 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|577.00||||577.00|15|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|CHAMPVA [1240]|CHAMP VA [124000]|577.00||||577.00|432.75|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|CORESOURCE [1315]|CORESOURCE [131500]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|577.00||||577.00|16.95|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|577.00||||577.00|21.64|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|577.00||||577.00|21.97|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|577.00||||577.00|16.31|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|||577.00||||577.00|173.1|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|577.00||||577.00|276.67|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|577.00||||577.00|577|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|UMR [2035]|UMR OPTIONS [203501]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|577.00||||577.00|18.65|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MULTIPLAN [1680]|IHC HS [168011]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|FIRST HEALTH [1375]|QUALCHOICE [137513]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|577.00||||577.00|18.59|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|FMH BENEFIT SERVICES [1390]|FMH [139000]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|577.00||||577.00|375.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MULTIPLAN [1680]|HMA [168003]|577.00||||577.00|22.58|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|577.00||||577.00|121.17|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|GEHA [1415]|GEHA [141500]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|577.00||||577.00|21.64|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|577.00||||577.00|288.5|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|577.00||||577.00|346.2|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|577.00||||577.00|16.31|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|577.00||||577.00|16.56|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|577.00||||577.00|15.75|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|577.00||||577.00|15.8|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|577.00||||577.00|10.04|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|577.00||||577.00|202.53|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|577.00||||577.00|245.8|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|577.00||||577.00|18.59|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|AETNA [1015]|AETNA ACO WILCO [101532]|577.00||||577.00|23.8|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|577.00||||577.00|16.56|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|HEALTHNET [1495]|HEALTHNET [149500]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|577.00||||577.00|15.35|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|TRUSTMARK [2030]|STARMARK [203000]|577.00||||577.00|519.3|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|577.00||||577.00|15.05|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|577.00||||577.00|289.08|577|10.04 30186021|EAP|0301 - LABORATORY-CHEMISTRY|HC AB ID LEUKOCYTES ANTIBODIES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|577.00||||577.00||| 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|507.00||||507.00|19.29|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|FMH BENEFIT SERVICES [1390]|FMH [139000]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|507.00||||507.00|22.68|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|507.00||||507.00|20.21|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|507.00||||507.00|20.21|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|507.00||||507.00|304.2|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|507.00||||507.00|19.91|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|507.00||||507.00|12.25|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|TRUSTMARK [2030]|STARMARK [203000]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|AETNA [1015]|AETNA ACO WILCO [101532]|507.00||||507.00|29.03|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|507.00||||507.00|26.41|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|507.00||||507.00|215.98|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|507.00||||507.00|177.96|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MULTIPLAN [1680]|IHC HS [168011]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|UMR [2035]|UMR OPTIONS [203501]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|FIRST HEALTH [1375]|QUALCHOICE [137513]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|507.00||||507.00|22.76|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|507.00||||507.00|22.68|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|507.00||||507.00|18.74|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MULTIPLAN [1680]|HMA [168003]|507.00||||507.00|27.56|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|HEALTHNET [1495]|HEALTHNET [149500]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|507.00||||507.00|253.5|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|507.00||||507.00|26.82|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|507.00||||507.00|254.01|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|507.00||||507.00|19.23|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|507.00||||507.00|329.55|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|507.00||||507.00|19.91|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|507.00||||507.00|18.37|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|507.00||||507.00|507|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|507.00||||507.00|18.31|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|CHAMPVA [1240]|CHAMP VA [124000]|507.00||||507.00|380.25|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|507.00||||507.00|243.11|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|507.00||||507.00|20.69|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|507.00||||507.00|106.47|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|GEHA [1415]|GEHA [141500]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|CORESOURCE [1315]|CORESOURCE [131500]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|||507.00||||507.00|152.1|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|507.00||||507.00|26.41|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|507.00||||507.00|456.3|507|12.25 30186022|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|507.00||||507.00||| 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|397.00||||397.00|12.41|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|CHAMPVA [1240]|CHAMP VA [124000]|397.00||||397.00|297.75|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|CORESOURCE [1315]|CORESOURCE [131500]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|GEHA [1415]|GEHA [141500]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|397.00||||397.00|14.03|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|397.00||||397.00|17.91|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|||397.00||||397.00|119.1|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|397.00||||397.00|18.19|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|397.00||||397.00|258.05|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|397.00||||397.00|397|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|397.00||||397.00|83.37|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|397.00||||397.00|13.5|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|UMR [2035]|UMR OPTIONS [203501]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MULTIPLAN [1680]|HMA [168003]|397.00||||397.00|18.69|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MULTIPLAN [1680]|IHC HS [168011]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|397.00||||397.00|15.43|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|FMH BENEFIT SERVICES [1390]|FMH [139000]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|397.00||||397.00|15.38|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|397.00||||397.00|17.91|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|397.00||||397.00|12.71|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|HEALTHNET [1495]|HEALTHNET [149500]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|AETNA [1015]|AETNA ACO WILCO [101532]|397.00||||397.00|19.69|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|397.00||||397.00|190.36|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|397.00||||397.00|13.71|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|397.00||||397.00|198.9|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|397.00||||397.00|169.12|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|TRUSTMARK [2030]|STARMARK [203000]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|397.00||||397.00|15.38|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|397.00||||397.00|198.5|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|397.00||||397.00|8.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|397.00||||397.00|13.71|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|397.00||||397.00|13.08|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|397.00||||397.00|238.2|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|397.00||||397.00|13.03|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|397.00||||397.00|139.35|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|397.00||||397.00|13.5|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|FIRST HEALTH [1375]|QUALCHOICE [137513]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|397.00||||397.00|12.46|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|397.00||||397.00|357.3|397|8.3 30186023|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ID PLATELET ASSOC IGG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|397.00||||397.00||| 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|238.00||||238.00|13.3|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|238.00||||238.00|83.54|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|238.00||||238.00|14.92|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|238.00||||238.00|119.24|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|238.00||||238.00|101.39|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|238.00||||238.00|142.8|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|238.00||||238.00|12.65|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MULTIPLAN [1680]|IHC HS [168011]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|UMR [2035]|UMR OPTIONS [203501]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MULTIPLAN [1680]|HMA [168003]|238.00||||238.00|18.14|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|238.00||||238.00|8.06|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|238.00||||238.00|13.3|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|238.00||||238.00|12.69|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|238.00||||238.00|14.92|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|TRUSTMARK [2030]|STARMARK [203000]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|HEALTHNET [1495]|HEALTHNET [149500]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|238.00||||238.00|13.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|238.00||||238.00|14.97|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|238.00||||238.00|12.33|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|AETNA [1015]|AETNA ACO WILCO [101532]|238.00||||238.00|19.11|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|238.00||||238.00|49.98|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|238.00||||238.00|114.12|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|||238.00||||238.00|71.4|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|238.00||||238.00|238|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|238.00||||238.00|13.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|238.00||||238.00|12.09|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|238.00||||238.00|154.7|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|238.00||||238.00|12.05|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|238.00||||238.00|17.38|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|CHAMPVA [1240]|CHAMP VA [124000]|238.00||||238.00|178.5|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|238.00||||238.00|13.61|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|GEHA [1415]|GEHA [141500]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|238.00||||238.00|17.65|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|238.00||||238.00|119|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|CORESOURCE [1315]|CORESOURCE [131500]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|238.00||||238.00|17.38|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|238.00||||238.00|214.2|238|8.06 30186038|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|238.00||||238.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|GEHA [1415]|GEHA [141500]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|CORESOURCE [1315]|CORESOURCE [131500]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|218.00||||218.00|151.77|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|CHAMPVA [1240]|CHAMP VA [124000]|218.00||||218.00|163.5|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|218.00||||218.00|171.51|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|||218.00||||218.00|65.4|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|218.00||||218.00|104.53|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|218.00||||218.00|45.78|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|UMR [2035]|UMR OPTIONS [203501]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|218.00||||218.00|93.74|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MULTIPLAN [1680]|IHC HS [168011]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|218.00||||218.00|165.01|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|218.00||||218.00|218|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|218.00||||218.00|188.66|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|218.00||||218.00|130.8|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|218.00||||218.00|165.01|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|TRUSTMARK [2030]|STARMARK [203000]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|218.00||||218.00|218|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|218.00||||218.00|93.74|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|218.00||||218.00|76.52|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|218.00||||218.00|86.84|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|218.00||||218.00|92.87|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|218.00||||218.00|159.37|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|218.00||||218.00|141.7|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|HEALTHNET [1495]|HEALTHNET [149500]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|218.00||||218.00|196.2|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|218.00||||218.00|109.22|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|AETNA [1015]|AETNA ACO WILCO [101532]|218.00||||218.00|135.5|218|45.78 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MULTIPLAN [1680]|HMA [168003]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|218.00||||218.00||| 30186890|EAP|0300 - LABORATORY-GENERAL|HC BLD PROCESSING AUTOLOGOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|218.00||||218.00||| 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|64.5|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00|24.07|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00|24.07|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|96.89|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|10.3|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|114.7|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|64.5|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00|31.45|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00|32.82|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00|22.97|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|100.32|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00|22.32|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|41.04|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00|31.94|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|100.32|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00|21.88|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|92.28|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|||150.00||||150.00|45|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00|31.45|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|104.27|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|10.3 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00||| 30186999|EAP|0301 - LABORATORY-CHEMISTRY|HC UNLISTED TRANSFUSION MEDICINE PROCEDURE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|GEHA [1415]|GEHA [141500]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84.00||||84.00|5.32|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84.00||||84.00|6.79|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|CHAMPVA [1240]|CHAMP VA [124000]|84.00||||84.00|63|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84.00||||84.00|6.89|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84.00||||84.00|54.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84.00||||84.00|84|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84.00||||84.00|40.28|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84.00||||84.00|5.12|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|UMR [2035]|UMR OPTIONS [203501]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MULTIPLAN [1680]|IHC HS [168011]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84.00||||84.00|5.85|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84.00||||84.00|6.79|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84.00||||84.00|5.83|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|||84.00||||84.00|25.2|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84.00||||84.00|4.81|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84.00||||84.00|17.64|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MULTIPLAN [1680]|HMA [168003]|84.00||||84.00|7.08|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|HEALTHNET [1495]|HEALTHNET [149500]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|TRUSTMARK [2030]|STARMARK [203000]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84.00||||84.00|5.19|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84.00||||84.00|4.96|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84.00||||84.00|50.4|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84.00||||84.00|42|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84.00||||84.00|35.78|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84.00||||84.00|42.08|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|CORESOURCE [1315]|CORESOURCE [131500]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84.00||||84.00|29.48|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84.00||||84.00|4.94|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84.00||||84.00|5.12|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84.00||||84.00|3.15|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84.00||||84.00|5.19|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84.00||||84.00|4.71|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|AETNA [1015]|AETNA ACO WILCO [101532]|84.00||||84.00|7.47|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84.00||||84.00|4.72|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84.00||||84.00|75.6|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84.00||||84.00|5.83|84|3.15 30189050|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84.00||||84.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|GEHA [1415]|GEHA [141500]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|187.00||||187.00|6.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|CORESOURCE [1315]|CORESOURCE [131500]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|187.00||||187.00|115.94|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|187.00||||187.00|5.6|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|187.00||||187.00|6.8|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|187.00||||187.00|65.64|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|187.00||||187.00|79.66|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|187.00||||187.00|93.5|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|187.00||||187.00|112.2|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|187.00||||187.00|5.88|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|187.00||||187.00|3.67|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|187.00||||187.00|5.6|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|AETNA [1015]|AETNA ACO WILCO [101532]|187.00||||187.00|8.7|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|HEALTHNET [1495]|HEALTHNET [149500]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MULTIPLAN [1680]|IHC HS [168011]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MULTIPLAN [1680]|HMA [168003]|187.00||||187.00|8.4|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|187.00||||187.00|8.05|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|FMH BENEFIT SERVICES [1390]|FMH [139000]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|187.00||||187.00|5.6|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|187.00||||187.00|6.06|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|187.00||||187.00|5.6|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|TRUSTMARK [2030]|STARMARK [203000]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|FIRST HEALTH [1375]|QUALCHOICE [137513]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|187.00||||187.00|6.8|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|187.00||||187.00|6.93|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|187.00||||187.00|5.71|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|187.00||||187.00|116.13|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|187.00||||187.00|39.27|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|187.00||||187.00|187|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|187.00||||187.00|89.67|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|187.00||||187.00|93.69|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|187.00||||187.00|121.55|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|||187.00||||187.00|56.1|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|187.00||||187.00|6.06|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|187.00||||187.00|5.6|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|187.00||||187.00|5.86|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|187.00||||187.00|5.6|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|187.00||||187.00|5.58|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|UMR [2035]|UMR OPTIONS [203501]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|187.00||||187.00|168.3|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|CHAMPVA [1240]|CHAMP VA [124000]|187.00||||187.00|140.25|187|3.67 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|187.00||||187.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|187.00||||187.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|187.00||||187.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|187.00||||187.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|187.00||||187.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|187.00||||187.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|187.00||||187.00||| 30189051|EAP|0301 - LABORATORY-CHEMISTRY|HC CELL CNT BODY FLUID W/DIFF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|187.00||||187.00||| 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|105.00||||105.00|4.8|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|CORESOURCE [1315]|CORESOURCE [131500]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|105.00||||105.00|6.14|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105.00||||105.00|4.25|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|||105.00||||105.00|31.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105.00||||105.00|68.25|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105.00||||105.00|105|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105.00||||105.00|6.23|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105.00||||105.00|22.05|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|UMR [2035]|UMR OPTIONS [203501]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105.00||||105.00|50.35|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105.00||||105.00|4.62|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|105.00||||105.00|5.28|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105.00||||105.00|5.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105.00||||105.00|4.36|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MULTIPLAN [1680]|IHC HS [168011]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MULTIPLAN [1680]|HMA [168003]|105.00||||105.00|6.41|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|105.00||||105.00|6.14|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|AETNA [1015]|AETNA ACO WILCO [101532]|105.00||||105.00|6.75|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|105.00||||105.00|2.85|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105.00||||105.00|4.48|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105.00||||105.00|63|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105.00||||105.00|4.62|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105.00||||105.00|52.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|CHAMPVA [1240]|CHAMP VA [124000]|105.00||||105.00|78.75|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105.00||||105.00|5.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105.00||||105.00|4.7|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|105.00||||105.00|52.61|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|105.00||||105.00|44.73|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105.00||||105.00|36.86|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105.00||||105.00|4.46|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|GEHA [1415]|GEHA [141500]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105.00||||105.00|4.7|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|TRUSTMARK [2030]|STARMARK [203000]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|HEALTHNET [1495]|HEALTHNET [149500]|105.00||||105.00|94.5|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|105.00||||105.00|4.27|105|2.85 30189055|EAP|0301 - LABORATORY-CHEMISTRY|HC LEUKOCYT ASSESS WBC FECAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|105.00||||105.00||| 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.00||||123.00|8.06|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123.00||||123.00|61.62|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123.00||||123.00|52.4|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.00||||123.00|43.17|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.00||||123.00|7.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.00||||123.00|7.94|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.00||||123.00|7.67|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123.00||||123.00|4.77|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|TRUSTMARK [2030]|STARMARK [203000]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|AETNA [1015]|AETNA ACO WILCO [101532]|123.00||||123.00|11.31|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MULTIPLAN [1680]|IHC HS [168011]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123.00||||123.00|10.54|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.00||||123.00|8.06|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.00||||123.00|73.8|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.00||||123.00|8.83|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MULTIPLAN [1680]|HMA [168003]|123.00||||123.00|11|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|HEALTHNET [1495]|HEALTHNET [149500]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123.00||||123.00|9.07|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.00||||123.00|7.48|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.00||||123.00|10.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.00||||123.00|123|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.00||||123.00|79.95|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.00||||123.00|7.94|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.00||||123.00|7.31|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.00||||123.00|8.83|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.00||||123.00|58.98|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|CHAMPVA [1240]|CHAMP VA [124000]|123.00||||123.00|92.25|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123.00||||123.00|10.54|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|CORESOURCE [1315]|CORESOURCE [131500]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123.00||||123.00|8.25|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.00||||123.00|61.5|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|||123.00||||123.00|36.9|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.00||||123.00|7.33|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|GEHA [1415]|GEHA [141500]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|UMR [2035]|UMR OPTIONS [203501]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.00||||123.00|110.7|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.00||||123.00|25.83|123|4.77 30189060|EAP|0300 - LABORATORY-GENERAL|HC CRYSTAL ID LIGHT MICROSCOPY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123.00||||123.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|GEHA [1415]|GEHA [141500]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.00||||52.00|6.52|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|CORESOURCE [1315]|CORESOURCE [131500]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|CHAMPVA [1240]|CHAMP VA [124000]|52.00||||52.00|39|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.00||||52.00|5.77|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.00||||52.00|6.27|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|||52.00||||52.00|15.6|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.00||||52.00|24.93|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.00||||52.00|52|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.00||||52.00|10.92|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|UMR [2035]|UMR OPTIONS [203501]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.00||||52.00|7.17|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.00||||52.00|5.86|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MULTIPLAN [1680]|IHC HS [168011]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.00||||52.00|33.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|HEALTHNET [1495]|HEALTHNET [149500]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|TRUSTMARK [2030]|STARMARK [203000]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.00||||52.00|31.2|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.00||||52.00|6.27|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.00||||52.00|26|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.00||||52.00|22.15|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.00||||52.00|6.06|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.00||||52.00|26.05|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.00||||52.00|5.86|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.00||||52.00|18.25|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.00||||52.00|46.8|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.00||||52.00|3.47|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|AETNA [1015]|AETNA ACO WILCO [101532]|52.00||||52.00|8.23|52|3.47 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MULTIPLAN [1680]|HMA [168003]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.00||||52.00||| 30189190|EAP|0301 - LABORATORY-CHEMISTRY|HC SMEAR NASAL EOSINOPHILS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.00||||52.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|||10.00||||10.00|3|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|||10.00||||10.00|3|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 30264|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CITALOPRAM 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|GEHA [1415]|GEHA [141500]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|159.00||||159.00|20.18|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|CORESOURCE [1315]|CORESOURCE [131500]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|CHAMPVA [1240]|CHAMP VA [124000]|159.00||||159.00|119.25|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|159.00||||159.00|19.42|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|||159.00||||159.00|47.7|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|159.00||||159.00|103.35|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|159.00||||159.00|159|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|159.00||||159.00|26.18|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|UMR [2035]|UMR OPTIONS [203501]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|159.00||||159.00|18.29|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|159.00||||159.00|22.2|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|159.00||||159.00|22.14|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|159.00||||159.00|76.24|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|159.00||||159.00|33.39|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|HEALTHNET [1495]|HEALTHNET [149500]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MULTIPLAN [1680]|IHC HS [168011]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|TRUSTMARK [2030]|STARMARK [203000]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|159.00||||159.00|19.42|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|159.00||||159.00|95.4|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|159.00||||159.00|18.83|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|159.00||||159.00|19.72|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|159.00||||159.00|22.14|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|159.00||||159.00|79.66|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|159.00||||159.00|55.81|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|159.00||||159.00|25.78|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|159.00||||159.00|67.73|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|AETNA [1015]|AETNA ACO WILCO [101532]|159.00||||159.00|28.35|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|159.00||||159.00|18.76|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|159.00||||159.00|79.5|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|159.00||||159.00|19.72|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|159.00||||159.00|143.1|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|159.00||||159.00|17.93|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MULTIPLAN [1680]|HMA [168003]|159.00||||159.00|26.9|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|159.00||||159.00|25.78|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|159.00||||159.00|11.96|159|11.96 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|159.00||||159.00||| 30286008|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ALLG SPEC IGE RECOMB/PURIFIED EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|159.00||||159.00||| 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|255.00||||255.00|12.28|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|255.00||||255.00|127.76|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|255.00||||255.00|13.78|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|255.00||||255.00|89.51|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|255.00||||255.00|108.63|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|255.00||||255.00|153|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|255.00||||255.00|11.68|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|255.00||||255.00|7.44|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|AETNA [1015]|AETNA ACO WILCO [101532]|255.00||||255.00|17.64|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|HEALTHNET [1495]|HEALTHNET [149500]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|255.00||||255.00|16.04|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MULTIPLAN [1680]|HMA [168003]|255.00||||255.00|16.74|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|FMH BENEFIT SERVICES [1390]|FMH [139000]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|255.00||||255.00|12.28|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|FIRST HEALTH [1375]|QUALCHOICE [137513]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|255.00||||255.00|12.09|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MULTIPLAN [1680]|IHC HS [168011]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|255.00||||255.00|13.82|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|255.00||||255.00|13.78|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|255.00||||255.00|127.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|255.00||||255.00|11.38|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|TRUSTMARK [2030]|STARMARK [203000]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|UMR [2035]|UMR OPTIONS [203501]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|255.00||||255.00|255|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|255.00||||255.00|122.27|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|255.00||||255.00|165.75|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|||255.00||||255.00|76.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|255.00||||255.00|11.12|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|255.00||||255.00|11.16|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|255.00||||255.00|11.72|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|CHAMPVA [1240]|CHAMP VA [124000]|255.00||||255.00|191.25|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|255.00||||255.00|16.04|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|CORESOURCE [1315]|CORESOURCE [131500]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|255.00||||255.00|12.57|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|255.00||||255.00|12.09|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|GEHA [1415]|GEHA [141500]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|255.00||||255.00|53.55|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|255.00||||255.00|16.29|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|255.00||||255.00|229.5|255|7.44 30286039|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTINUCLEAR AB (ANA)TITER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|255.00||||255.00||| 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|GEHA [1415]|GEHA [141500]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|173.00||||173.00|8.22|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|CORESOURCE [1315]|CORESOURCE [131500]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|173.00||||173.00|10.49|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|CHAMPVA [1240]|CHAMP VA [124000]|173.00||||173.00|129.75|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173.00||||173.00|7.28|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173.00||||173.00|7.91|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173.00||||173.00|82.95|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173.00||||173.00|173|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173.00||||173.00|36.33|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173.00||||173.00|10.66|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173.00||||173.00|112.45|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173.00||||173.00|7.45|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|173.00||||173.00|9.04|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173.00||||173.00|9.01|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|||173.00||||173.00|51.9|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|FIRST HEALTH [1375]|QUALCHOICE [137513]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|UMR [2035]|UMR OPTIONS [203501]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|FMH BENEFIT SERVICES [1390]|FMH [139000]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MULTIPLAN [1680]|IHC HS [168011]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|173.00||||173.00|10.49|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|HEALTHNET [1495]|HEALTHNET [149500]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|173.00||||173.00|4.87|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173.00||||173.00|8.03|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173.00||||173.00|103.8|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173.00||||173.00|7.67|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173.00||||173.00|86.5|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|173.00||||173.00|86.67|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173.00||||173.00|60.72|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173.00||||173.00|7.91|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173.00||||173.00|7.64|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173.00||||173.00|9.01|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|173.00||||173.00|73.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|TRUSTMARK [2030]|STARMARK [203000]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173.00||||173.00|8.03|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|AETNA [1015]|AETNA ACO WILCO [101532]|173.00||||173.00|11.54|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173.00||||173.00|155.7|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|173.00||||173.00|7.3|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|MULTIPLAN [1680]|HMA [168003]|173.00||||173.00|10.95|173|4.87 30286060|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O TITER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|173.00||||173.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|161.00||||161.00|80.66|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161.00||||161.00|56.51|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|161.00||||161.00|68.59|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161.00||||161.00|7.12|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161.00||||161.00|80.5|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161.00||||161.00|6.25|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|TRUSTMARK [2030]|STARMARK [203000]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|161.00||||161.00|3.85|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161.00||||161.00|6.04|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MULTIPLAN [1680]|IHC HS [168011]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161.00||||161.00|96.6|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|161.00||||161.00|7.15|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161.00||||161.00|7.12|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|161.00||||161.00|9.12|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|UMR [2035]|UMR OPTIONS [203501]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161.00||||161.00|33.81|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161.00||||161.00|77.2|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|||161.00||||161.00|48.3|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161.00||||161.00|6.25|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161.00||||161.00|5.75|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|161.00||||161.00|120.75|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161.00||||161.00|104.65|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|161.00||||161.00|6.5|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|GEHA [1415]|GEHA [141500]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161.00||||161.00|161|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161.00||||161.00|144.9|161|3.85 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MULTIPLAN [1680]|HMA [168003]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|161.00||||161.00||| 30286063|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTISTREPTOLYSIN O SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161.00||||161.00||| 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|GEHA [1415]|GEHA [141500]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146.00||||146.00|5.83|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|CORESOURCE [1315]|CORESOURCE [131500]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|CHAMPVA [1240]|CHAMP VA [124000]|146.00||||146.00|109.5|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146.00||||146.00|5.17|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146.00||||146.00|94.9|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146.00||||146.00|146|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146.00||||146.00|7.56|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146.00||||146.00|30.66|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|UMR [2035]|UMR OPTIONS [203501]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146.00||||146.00|5.28|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146.00||||146.00|5.61|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146.00||||146.00|6.41|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146.00||||146.00|6.39|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|||146.00||||146.00|43.8|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146.00||||146.00|70.01|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146.00||||146.00|7.45|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MULTIPLAN [1680]|IHC HS [168011]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|AETNA [1015]|AETNA ACO WILCO [101532]|146.00||||146.00|8.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146.00||||146.00|5.42|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146.00||||146.00|87.6|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146.00||||146.00|5.61|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146.00||||146.00|5.44|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146.00||||146.00|73|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146.00||||146.00|73.15|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146.00||||146.00|62.2|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146.00||||146.00|7.45|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146.00||||146.00|3.45|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146.00||||146.00|6.39|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146.00||||146.00|51.25|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|TRUSTMARK [2030]|STARMARK [203000]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146.00||||146.00|5.18|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146.00||||146.00|5.7|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|HEALTHNET [1495]|HEALTHNET [149500]|146.00||||146.00|131.4|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MULTIPLAN [1680]|HMA [168003]|146.00||||146.00|7.77|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146.00||||146.00|5.7|146|3.45 30286140|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146.00||||146.00||| 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162.00||||162.00|14.25|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162.00||||162.00|15.98|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162.00||||162.00|56.86|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|162.00||||162.00|69.01|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|162.00||||162.00|81.16|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162.00||||162.00|97.2|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162.00||||162.00|14.03|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162.00||||162.00|14.25|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|AETNA [1015]|AETNA ACO WILCO [101532]|162.00||||162.00|20.47|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|HEALTHNET [1495]|HEALTHNET [149500]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|TRUSTMARK [2030]|STARMARK [203000]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|162.00||||162.00|18.62|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MULTIPLAN [1680]|IHC HS [168011]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MULTIPLAN [1680]|HMA [168003]|162.00||||162.00|19.43|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|FMH BENEFIT SERVICES [1390]|FMH [139000]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162.00||||162.00|13.6|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|FIRST HEALTH [1375]|QUALCHOICE [137513]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|162.00||||162.00|16.04|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162.00||||162.00|15.98|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162.00||||162.00|81|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162.00||||162.00|13.21|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|UMR [2035]|UMR OPTIONS [203501]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162.00||||162.00|34.02|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162.00||||162.00|162|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162.00||||162.00|105.3|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|||162.00||||162.00|48.6|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162.00||||162.00|12.9|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|CHAMPVA [1240]|CHAMP VA [124000]|162.00||||162.00|121.5|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162.00||||162.00|14.03|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162.00||||162.00|13.54|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|162.00||||162.00|18.62|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162.00||||162.00|12.95|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|CORESOURCE [1315]|CORESOURCE [131500]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|162.00||||162.00|14.58|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|GEHA [1415]|GEHA [141500]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162.00||||162.00|77.68|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162.00||||162.00|18.91|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162.00||||162.00|145.8|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|162.00||||162.00|8.63|162|8.63 30286141|EAP|0302 - LABORATORY-IMMUNOLOGY|HC C-REACTIVE PROTEIN HI SENSITV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|162.00||||162.00||| 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|GEHA [1415]|GEHA [141500]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|CORESOURCE [1315]|CORESOURCE [131500]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|333.00||||333.00|36.59|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|CHAMPVA [1240]|CHAMP VA [124000]|333.00||||333.00|249.75|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|333.00||||333.00|25.36|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|333.00||||333.00|27.57|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|333.00||||333.00|159.67|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|333.00||||333.00|69.93|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|333.00||||333.00|37.16|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|333.00||||333.00|333|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|333.00||||333.00|25.96|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|333.00||||333.00|31.52|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|||333.00||||333.00|99.9|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|333.00||||333.00|31.42|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|333.00||||333.00|216.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|UMR [2035]|UMR OPTIONS [203501]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MULTIPLAN [1680]|HMA [168003]|333.00||||333.00|38.18|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MULTIPLAN [1680]|IHC HS [168011]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|333.00||||333.00|36.59|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|HEALTHNET [1495]|HEALTHNET [149500]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|AETNA [1015]|AETNA ACO WILCO [101532]|333.00||||333.00|40.23|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|333.00||||333.00|16.97|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|333.00||||333.00|27.57|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|333.00||||333.00|28|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|333.00||||333.00|199.8|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|333.00||||333.00|26.72|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|333.00||||333.00|166.5|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|333.00||||333.00|166.83|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|333.00||||333.00|31.42|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|333.00||||333.00|26.63|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|333.00||||333.00|116.88|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|333.00||||333.00|28.66|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|333.00||||333.00|141.86|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|333.00||||333.00|28|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|333.00||||333.00|25.45|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|TRUSTMARK [2030]|STARMARK [203000]|333.00||||333.00|299.7|333|16.97 30286146|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BETA 2 GLYCOPROTEIN I AB EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|333.00||||333.00||| 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|386.00||||386.00|28|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|386.00||||386.00|135.49|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|386.00||||386.00|193.39|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|386.00||||386.00|193|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|386.00||||386.00|27.57|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|TRUSTMARK [2030]|STARMARK [203000]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|AETNA [1015]|AETNA ACO WILCO [101532]|386.00||||386.00|40.23|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|386.00||||386.00|36.59|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|386.00||||386.00|16.97|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MULTIPLAN [1680]|IHC HS [168011]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MULTIPLAN [1680]|HMA [168003]|386.00||||386.00|38.18|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|386.00||||386.00|231.6|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|386.00||||386.00|31.52|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|386.00||||386.00|31.42|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|386.00||||386.00|28|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|HEALTHNET [1495]|HEALTHNET [149500]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|386.00||||386.00|25.96|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|UMR [2035]|UMR OPTIONS [203501]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|386.00||||386.00|386|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|386.00||||386.00|185.09|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|||386.00||||386.00|115.8|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|386.00||||386.00|26.63|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|386.00||||386.00|27.57|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|386.00||||386.00|25.36|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|386.00||||386.00|31.42|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|CHAMPVA [1240]|CHAMP VA [124000]|386.00||||386.00|289.5|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|386.00||||386.00|250.9|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|386.00||||386.00|36.59|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|386.00||||386.00|25.45|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|CORESOURCE [1315]|CORESOURCE [131500]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|386.00||||386.00|28.66|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|GEHA [1415]|GEHA [141500]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|386.00||||386.00|164.44|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|386.00||||386.00|81.06|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|386.00||||386.00|37.16|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|386.00||||386.00|26.72|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|386.00||||386.00|347.4|386|16.97 30286147|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CARDIOLIPIN IG CLASS EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|386.00||||386.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|GEHA [1415]|GEHA [141500]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|268.00||||268.00|18.11|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|CORESOURCE [1315]|CORESOURCE [131500]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|CHAMPVA [1240]|CHAMP VA [124000]|268.00||||268.00|201|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|268.00||||268.00|16.02|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|268.00||||268.00|174.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|268.00||||268.00|128.51|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|268.00||||268.00|268|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|UMR [2035]|UMR OPTIONS [203501]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|268.00||||268.00|17.42|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|268.00||||268.00|19.84|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|268.00||||268.00|19.91|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|FIRST HEALTH [1375]|QUALCHOICE [137513]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|||268.00||||268.00|80.4|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|268.00||||268.00|56.28|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|FMH BENEFIT SERVICES [1390]|FMH [139000]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|268.00||||268.00|16.82|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|268.00||||268.00|10.71|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|268.00||||268.00|17.42|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|268.00||||268.00|160.8|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|268.00||||268.00|134|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|268.00||||268.00|134.27|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|268.00||||268.00|19.84|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|268.00||||268.00|94.07|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|268.00||||268.00|114.17|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|TRUSTMARK [2030]|STARMARK [203000]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|AETNA [1015]|AETNA ACO WILCO [101532]|268.00||||268.00|25.39|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|HEALTHNET [1495]|HEALTHNET [149500]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MULTIPLAN [1680]|IHC HS [168011]|268.00||||268.00|241.2|268|10.71 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MULTIPLAN [1680]|HMA [168003]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|268.00||||268.00||| 30286148|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PHOSPOLIPID AB APTT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|268.00||||268.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|||95.00||||95.00|28.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00|8.74|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00|8.03|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00|9.08|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|9.95|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00|47.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00|8.74|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00|5.38|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00|8.44|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00|12.75|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00|9.99|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|9.95|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|5.38 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00||| 30286157|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COLD AGGLUTININ TITER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00||| 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|GEHA [1415]|GEHA [141500]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|CORESOURCE [1315]|CORESOURCE [131500]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|308.00||||308.00|17.25|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|CHAMPVA [1240]|CHAMP VA [124000]|308.00||||308.00|231|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|308.00||||308.00|13|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|308.00||||308.00|200.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|308.00||||308.00|147.69|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|308.00||||308.00|308|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|308.00||||308.00|64.68|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|308.00||||308.00|17.52|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|UMR [2035]|UMR OPTIONS [203501]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|308.00||||308.00|12.24|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|308.00||||308.00|14.81|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|308.00||||308.00|14.86|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|308.00||||308.00|17.25|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MULTIPLAN [1680]|IHC HS [168011]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MULTIPLAN [1680]|HMA [168003]|308.00||||308.00|18|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|HEALTHNET [1495]|HEALTHNET [149500]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|AETNA [1015]|AETNA ACO WILCO [101532]|308.00||||308.00|18.96|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|||308.00||||308.00|92.4|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|TRUSTMARK [2030]|STARMARK [203000]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|308.00||||308.00|11.96|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|308.00||||308.00|8|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|308.00||||308.00|12.56|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|308.00||||308.00|13.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|308.00||||308.00|13.51|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|308.00||||308.00|13|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|308.00||||308.00|184.8|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|308.00||||308.00|12.6|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|308.00||||308.00|154|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|308.00||||308.00|14.81|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|308.00||||308.00|131.21|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|308.00||||308.00|154.31|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|308.00||||308.00|108.11|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|308.00||||308.00|12|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|308.00||||308.00|13.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|308.00||||308.00|277.2|308|8 30286160|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT AG EACH COMPONENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|308.00||||308.00||| 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|240.00||||240.00|120.24|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|240.00||||240.00|102.24|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|240.00||||240.00|14.81|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|240.00||||240.00|120|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|240.00||||240.00|144|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|240.00||||240.00|13|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|240.00||||240.00|13.2|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|240.00||||240.00|12.56|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|240.00||||240.00|8|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|TRUSTMARK [2030]|STARMARK [203000]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MULTIPLAN [1680]|IHC HS [168011]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MULTIPLAN [1680]|HMA [168003]|240.00||||240.00|18|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|240.00||||240.00|17.25|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|240.00||||240.00|14.86|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|240.00||||240.00|14.81|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|HEALTHNET [1495]|HEALTHNET [149500]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|240.00||||240.00|12.24|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|UMR [2035]|UMR OPTIONS [203501]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|AETNA [1015]|AETNA ACO WILCO [101532]|240.00||||240.00|18.96|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|240.00||||240.00|17.52|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|240.00||||240.00|50.4|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|240.00||||240.00|240|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|240.00||||240.00|12.6|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|240.00||||240.00|115.08|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|240.00||||240.00|156|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|||240.00||||240.00|72|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|240.00||||240.00|84.24|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|240.00||||240.00|13|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|240.00||||240.00|13.2|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|240.00||||240.00|12|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|240.00||||240.00|11.96|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|CHAMPVA [1240]|CHAMP VA [124000]|240.00||||240.00|180|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|240.00||||240.00|17.25|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|CORESOURCE [1315]|CORESOURCE [131500]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|240.00||||240.00|13.51|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|GEHA [1415]|GEHA [141500]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|240.00||||240.00|216|240|8 30286161|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT FUNCTIONL ACTIVITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|240.00||||240.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|GEHA [1415]|GEHA [141500]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|325.00||||325.00|22.88|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|CORESOURCE [1315]|CORESOURCE [131500]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|CHAMPVA [1240]|CHAMP VA [124000]|325.00||||325.00|243.75|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|325.00||||325.00|20.25|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|325.00||||325.00|20.32|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|325.00||||325.00|22.01|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|||325.00||||325.00|97.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|325.00||||325.00|211.25|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|325.00||||325.00|155.84|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|325.00||||325.00|68.25|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|325.00||||325.00|201.83|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|UMR [2035]|UMR OPTIONS [203501]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|325.00||||325.00|20.73|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|325.00||||325.00|25.09|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|325.00||||325.00|25.16|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|325.00||||325.00|20.32|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|FIRST HEALTH [1375]|QUALCHOICE [137513]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|FMH BENEFIT SERVICES [1390]|FMH [139000]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MULTIPLAN [1680]|IHC HS [168011]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MULTIPLAN [1680]|HMA [168003]|325.00||||325.00|30.48|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|325.00||||325.00|325|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|325.00||||325.00|29.21|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|HEALTHNET [1495]|HEALTHNET [149500]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|AETNA [1015]|COVENTRY HEALTHCARE [101502]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|325.00||||325.00|20.32|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|AETNA [1015]|AETNA ACO WILCO [101532]|325.00||||325.00|32.12|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|TRUSTMARK [2030]|STARMARK [203000]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|325.00||||325.00|13.55|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|325.00||||325.00|21.26|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|325.00||||325.00|201.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|325.00||||325.00|20.32|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|325.00||||325.00|22.01|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|325.00||||325.00|195|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|325.00||||325.00|21.34|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|325.00||||325.00|162.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|325.00||||325.00|162.83|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|325.00||||325.00|138.45|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|325.00||||325.00|25.09|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|325.00||||325.00|114.08|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|325.00||||325.00|20.32|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|325.00||||325.00|20.32|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|325.00||||325.00|292.5|325|13.55 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|325.00||||325.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|325.00||||325.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|325.00||||325.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|325.00||||325.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|325.00||||325.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|325.00||||325.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|325.00||||325.00||| 30286162|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPLEMENT CH50|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|325.00||||325.00||| 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|259.00||||259.00|14.25|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|259.00||||259.00|15.98|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|259.00||||259.00|90.91|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|259.00||||259.00|110.33|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|259.00||||259.00|129.5|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|259.00||||259.00|13.6|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|259.00||||259.00|155.4|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|259.00||||259.00|14.03|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|259.00||||259.00|14.25|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|259.00||||259.00|8.63|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|TRUSTMARK [2030]|STARMARK [203000]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|HEALTHNET [1495]|HEALTHNET [149500]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MULTIPLAN [1680]|IHC HS [168011]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|259.00||||259.00|18.62|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|FMH BENEFIT SERVICES [1390]|FMH [139000]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MULTIPLAN [1680]|HMA [168003]|259.00||||259.00|19.43|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|FIRST HEALTH [1375]|QUALCHOICE [137513]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|259.00||||259.00|16.04|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|259.00||||259.00|15.98|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|259.00||||259.00|13.21|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|AETNA [1015]|AETNA ACO WILCO [101532]|259.00||||259.00|20.47|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|UMR [2035]|UMR OPTIONS [203501]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|259.00||||259.00|13.54|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|259.00||||259.00|18.91|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|259.00||||259.00|54.39|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|259.00||||259.00|259|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|259.00||||259.00|124.19|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|259.00||||259.00|168.35|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|||259.00||||259.00|77.7|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|259.00||||259.00|14.03|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|259.00||||259.00|129.76|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|259.00||||259.00|12.95|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|259.00||||259.00|12.9|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|CHAMPVA [1240]|CHAMP VA [124000]|259.00||||259.00|194.25|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|259.00||||259.00|18.62|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|CORESOURCE [1315]|CORESOURCE [131500]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|259.00||||259.00|14.58|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|GEHA [1415]|GEHA [141500]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|259.00||||259.00|233.1|259|8.63 30286200|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CCP ANTIBODY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|259.00||||259.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|GEHA [1415]|GEHA [141500]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|CORESOURCE [1315]|CORESOURCE [131500]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|CHAMPVA [1240]|CHAMP VA [124000]|178.00||||178.00|133.5|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|178.00||||178.00|13.21|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|178.00||||178.00|14.36|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|178.00||||178.00|115.7|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|178.00||||178.00|85.35|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|178.00||||178.00|178|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|178.00||||178.00|37.38|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|178.00||||178.00|16.35|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|178.00||||178.00|16.42|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|UMR [2035]|UMR OPTIONS [203501]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MULTIPLAN [1680]|IHC HS [168011]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|HEALTHNET [1495]|HEALTHNET [149500]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|||178.00||||178.00|53.4|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|AETNA [1015]|AETNA ACO WILCO [101532]|178.00||||178.00|20.93|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|TRUSTMARK [2030]|STARMARK [203000]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|178.00||||178.00|8.83|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|178.00||||178.00|13.87|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|178.00||||178.00|14.36|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|178.00||||178.00|106.8|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|178.00||||178.00|14.93|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|178.00||||178.00|89|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|178.00||||178.00|16.35|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|178.00||||178.00|62.48|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|178.00||||178.00|75.83|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|178.00||||178.00|89.18|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|178.00||||178.00|160.2|178|8.83 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MULTIPLAN [1680]|HMA [168003]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|178.00||||178.00||| 30286215|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DEOXYRIBONUCLEASE (DNA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|178.00||||178.00||| 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|272.00||||272.00|136.27|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|272.00||||272.00|95.47|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|272.00||||272.00|115.87|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|272.00||||272.00|136|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|272.00||||272.00|14.43|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|272.00||||272.00|163.2|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|272.00||||272.00|14.89|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|272.00||||272.00|14.38|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|272.00||||272.00|9.16|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|TRUSTMARK [2030]|STARMARK [203000]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|AETNA [1015]|AETNA ACO WILCO [101532]|272.00||||272.00|21.72|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|HEALTHNET [1495]|HEALTHNET [149500]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|272.00||||272.00|19.75|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MULTIPLAN [1680]|IHC HS [168011]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MULTIPLAN [1680]|HMA [168003]|272.00||||272.00|20.61|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|FMH BENEFIT SERVICES [1390]|FMH [139000]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|FIRST HEALTH [1375]|QUALCHOICE [137513]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|272.00||||272.00|17.02|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|272.00||||272.00|16.97|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|272.00||||272.00|14.01|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|AETNA [1015]|COVENTRY HEALTHCARE [101502]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|UMR [2035]|UMR OPTIONS [203501]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|272.00||||272.00|20.06|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|272.00||||272.00|15.11|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|272.00||||272.00|57.12|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|272.00||||272.00|272|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|272.00||||272.00|130.42|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|272.00||||272.00|176.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|||272.00||||272.00|81.6|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|272.00||||272.00|16.97|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|272.00||||272.00|14.89|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|272.00||||272.00|13.74|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|272.00||||272.00|13.7|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|272.00||||272.00|15.11|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|CHAMPVA [1240]|CHAMP VA [124000]|272.00||||272.00|204|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|272.00||||272.00|19.75|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|CORESOURCE [1315]|CORESOURCE [131500]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|272.00||||272.00|15.48|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|GEHA [1415]|GEHA [141500]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|272.00||||272.00|244.8|272|9.16 30286225|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DNA NATIVE/DOUBLE STRAND|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|272.00||||272.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|GEHA [1415]|GEHA [141500]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|162.00||||162.00|13.64|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|CORESOURCE [1315]|CORESOURCE [131500]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|CHAMPVA [1240]|CHAMP VA [124000]|162.00||||162.00|121.5|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162.00||||162.00|12.07|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162.00||||162.00|13.12|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|||162.00||||162.00|48.6|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162.00||||162.00|77.68|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162.00||||162.00|34.02|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|UMR [2035]|UMR OPTIONS [203501]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162.00||||162.00|14.95|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|162.00||||162.00|15|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|FIRST HEALTH [1375]|QUALCHOICE [137513]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|FMH BENEFIT SERVICES [1390]|FMH [139000]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MULTIPLAN [1680]|IHC HS [168011]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162.00||||162.00|162|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|HEALTHNET [1495]|HEALTHNET [149500]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162.00||||162.00|105.3|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|AETNA [1015]|AETNA ACO WILCO [101532]|162.00||||162.00|19.13|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|TRUSTMARK [2030]|STARMARK [203000]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|162.00||||162.00|8.07|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162.00||||162.00|12.67|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162.00||||162.00|13.12|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162.00||||162.00|97.2|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162.00||||162.00|81|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|162.00||||162.00|69.01|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|162.00||||162.00|81.16|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162.00||||162.00|14.95|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162.00||||162.00|56.86|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162.00||||162.00|145.8|162|8.07 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MULTIPLAN [1680]|HMA [168003]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162.00||||162.00||| 30286226|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LAB AB DNA SINGLE STRAND|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162.00||||162.00||| 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|399.00||||399.00|19.72|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|399.00||||399.00|199.9|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|399.00||||399.00|22.14|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|399.00||||399.00|140.05|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|399.00||||399.00|199.5|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|399.00||||399.00|18.83|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|399.00||||399.00|239.4|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|399.00||||399.00|19.42|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|399.00||||399.00|19.72|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|399.00||||399.00|18.76|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|399.00||||399.00|11.96|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|TRUSTMARK [2030]|STARMARK [203000]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|HEALTHNET [1495]|HEALTHNET [149500]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MULTIPLAN [1680]|IHC HS [168011]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MULTIPLAN [1680]|HMA [168003]|399.00||||399.00|26.9|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|FMH BENEFIT SERVICES [1390]|FMH [139000]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|FIRST HEALTH [1375]|QUALCHOICE [137513]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|399.00||||399.00|25.78|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|399.00||||399.00|22.2|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|399.00||||399.00|22.14|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|AETNA [1015]|AETNA ACO WILCO [101532]|399.00||||399.00|28.35|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|399.00||||399.00|18.29|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|UMR [2035]|UMR OPTIONS [203501]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|399.00||||399.00|26.18|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|399.00||||399.00|83.79|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|399.00||||399.00|399|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|399.00||||399.00|191.32|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|399.00||||399.00|259.35|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|399.00||||399.00|169.97|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|||399.00||||399.00|119.7|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|399.00||||399.00|19.42|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|399.00||||399.00|17.93|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|399.00||||399.00|17.87|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|CHAMPVA [1240]|CHAMP VA [124000]|399.00||||399.00|299.25|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|399.00||||399.00|25.78|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|CORESOURCE [1315]|CORESOURCE [131500]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|399.00||||399.00|20.18|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|GEHA [1415]|GEHA [141500]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|399.00||||399.00|359.1|399|11.96 30286235|EAP|0302 - LABORATORY-IMMUNOLOGY|HC EXTRACTABLE NUCLEAR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|399.00||||399.00||| 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|GEHA [1415]|GEHA [141500]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|293.00||||293.00|13.57|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|293.00||||293.00|17.32|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|293.00||||293.00|219.75|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|293.00||||293.00|13.06|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|293.00||||293.00|190.45|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|293.00||||293.00|140.49|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|293.00||||293.00|293|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|293.00||||293.00|61.53|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|293.00||||293.00|17.59|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|293.00||||293.00|12.29|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|293.00||||293.00|14.88|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|293.00||||293.00|14.94|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|UMR [2035]|UMR OPTIONS [203501]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MULTIPLAN [1680]|HMA [168003]|293.00||||293.00|18.08|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MULTIPLAN [1680]|IHC HS [168011]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|293.00||||293.00|17.32|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|293.00||||293.00|19.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|||293.00||||293.00|87.9|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|TRUSTMARK [2030]|STARMARK [203000]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|293.00||||293.00|12.02|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|293.00||||293.00|8.03|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|293.00||||293.00|12.62|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|293.00||||293.00|13.26|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|293.00||||293.00|13.06|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|293.00||||293.00|175.8|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|293.00||||293.00|12.65|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|293.00||||293.00|146.5|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|293.00||||293.00|146.79|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|293.00||||293.00|102.84|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|293.00||||293.00|14.88|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|293.00||||293.00|124.82|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|293.00||||293.00|12.05|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|293.00||||293.00|13.26|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|293.00||||293.00|263.7|293|8.03 30286255|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|293.00||||293.00||| 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|254.00||||254.00|108.2|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|254.00||||254.00|127.25|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254.00||||254.00|89.15|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254.00||||254.00|14.88|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254.00||||254.00|127|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254.00||||254.00|152.4|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254.00||||254.00|13.06|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254.00||||254.00|12.62|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|254.00||||254.00|8.03|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|TRUSTMARK [2030]|STARMARK [203000]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|AETNA [1015]|AETNA ACO WILCO [101532]|254.00||||254.00|19.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MULTIPLAN [1680]|IHC HS [168011]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MULTIPLAN [1680]|HMA [168003]|254.00||||254.00|18.08|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|254.00||||254.00|17.32|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|FMH BENEFIT SERVICES [1390]|FMH [139000]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|FIRST HEALTH [1375]|QUALCHOICE [137513]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|HEALTHNET [1495]|HEALTHNET [149500]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|254.00||||254.00|14.94|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254.00||||254.00|14.88|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254.00||||254.00|12.29|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|UMR [2035]|UMR OPTIONS [203501]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254.00||||254.00|17.59|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254.00||||254.00|13.26|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254.00||||254.00|53.34|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254.00||||254.00|254|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254.00||||254.00|12.65|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254.00||||254.00|121.79|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254.00||||254.00|165.1|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|||254.00||||254.00|76.2|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254.00||||254.00|13.06|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254.00||||254.00|13.26|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254.00||||254.00|12.05|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254.00||||254.00|12.02|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|CHAMPVA [1240]|CHAMP VA [124000]|254.00||||254.00|190.5|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|254.00||||254.00|17.32|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|CORESOURCE [1315]|CORESOURCE [131500]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|254.00||||254.00|13.57|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|GEHA [1415]|GEHA [141500]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254.00||||254.00|228.6|254|8.03 30286256|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FLUOR AB TITER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|254.00||||254.00||| 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|GEHA [1415]|GEHA [141500]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|361.00||||361.00|23.43|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|CORESOURCE [1315]|CORESOURCE [131500]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|361.00||||361.00|29.92|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|CHAMPVA [1240]|CHAMP VA [124000]|361.00||||361.00|270.75|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|361.00||||361.00|20.74|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|361.00||||361.00|22.54|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|||361.00||||361.00|108.3|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|361.00||||361.00|173.1|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|361.00||||361.00|75.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|361.00||||361.00|30.38|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|UMR [2035]|UMR OPTIONS [203501]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|361.00||||361.00|21.23|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|361.00||||361.00|25.7|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|361.00||||361.00|25.77|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|FIRST HEALTH [1375]|QUALCHOICE [137513]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|FMH BENEFIT SERVICES [1390]|FMH [139000]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MULTIPLAN [1680]|IHC HS [168011]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|361.00||||361.00|29.92|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|361.00||||361.00|361|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MULTIPLAN [1680]|HMA [168003]|361.00||||361.00|31.22|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|HEALTHNET [1495]|HEALTHNET [149500]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|AETNA [1015]|AETNA ACO WILCO [101532]|361.00||||361.00|32.91|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|361.00||||361.00|234.65|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|AETNA [1015]|COVENTRY HEALTHCARE [101502]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|TRUSTMARK [2030]|STARMARK [203000]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|361.00||||361.00|13.88|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|361.00||||361.00|21.77|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|361.00||||361.00|22.89|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|361.00||||361.00|22.54|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|361.00||||361.00|216.6|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|361.00||||361.00|21.85|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|361.00||||361.00|180.5|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|361.00||||361.00|153.79|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|361.00||||361.00|180.86|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|361.00||||361.00|25.7|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|361.00||||361.00|126.71|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|361.00||||361.00|20.81|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|361.00||||361.00|22.89|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|361.00||||361.00|324.9|361|13.88 30286300|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 15-3|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|361.00||||361.00||| 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|382.00||||382.00|22.89|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|382.00||||382.00|25.7|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|382.00||||382.00|134.08|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|382.00||||382.00|162.73|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|382.00||||382.00|191|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|382.00||||382.00|21.85|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|382.00||||382.00|229.2|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|382.00||||382.00|22.54|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|382.00||||382.00|22.89|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|382.00||||382.00|13.88|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|TRUSTMARK [2030]|STARMARK [203000]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|AETNA [1015]|AETNA ACO WILCO [101532]|382.00||||382.00|32.91|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|HEALTHNET [1495]|HEALTHNET [149500]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|382.00||||382.00|29.92|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MULTIPLAN [1680]|IHC HS [168011]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MULTIPLAN [1680]|HMA [168003]|382.00||||382.00|31.22|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|FMH BENEFIT SERVICES [1390]|FMH [139000]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|FIRST HEALTH [1375]|QUALCHOICE [137513]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|382.00||||382.00|25.77|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|382.00||||382.00|25.7|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|382.00||||382.00|21.23|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|AETNA [1015]|COVENTRY HEALTHCARE [101502]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|UMR [2035]|UMR OPTIONS [203501]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|382.00||||382.00|30.38|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|382.00||||382.00|80.22|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|382.00||||382.00|382|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|382.00||||382.00|21.77|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|382.00||||382.00|183.17|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|382.00||||382.00|248.3|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|382.00||||382.00|191.38|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|||382.00||||382.00|114.6|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|382.00||||382.00|22.54|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|382.00||||382.00|20.81|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|382.00||||382.00|20.74|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|CHAMPVA [1240]|CHAMP VA [124000]|382.00||||382.00|286.5|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|382.00||||382.00|29.92|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|CORESOURCE [1315]|CORESOURCE [131500]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|382.00||||382.00|23.43|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|GEHA [1415]|GEHA [141500]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|382.00||||382.00|343.8|382|13.88 30286301|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 19-9|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|382.00||||382.00||| 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|GEHA [1415]|GEHA [141500]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|CORESOURCE [1315]|CORESOURCE [131500]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|367.00||||367.00|29.92|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|CHAMPVA [1240]|CHAMP VA [124000]|367.00||||367.00|275.25|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|367.00||||367.00|22.54|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|||367.00||||367.00|110.1|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|367.00||||367.00|238.55|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|367.00||||367.00|175.98|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|367.00||||367.00|367|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|367.00||||367.00|77.07|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|367.00||||367.00|30.38|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|367.00||||367.00|21.23|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|367.00||||367.00|25.7|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|367.00||||367.00|25.77|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|FIRST HEALTH [1375]|QUALCHOICE [137513]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|UMR [2035]|UMR OPTIONS [203501]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|FMH BENEFIT SERVICES [1390]|FMH [139000]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MULTIPLAN [1680]|IHC HS [168011]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|367.00||||367.00|29.92|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MULTIPLAN [1680]|HMA [168003]|367.00||||367.00|31.22|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|HEALTHNET [1495]|HEALTHNET [149500]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|AETNA [1015]|AETNA ACO WILCO [101532]|367.00||||367.00|32.91|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|AETNA [1015]|COVENTRY HEALTHCARE [101502]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|TRUSTMARK [2030]|STARMARK [203000]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|367.00||||367.00|13.88|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|367.00||||367.00|20.74|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|367.00||||367.00|21.77|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|367.00||||367.00|22.89|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|367.00||||367.00|23.43|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|367.00||||367.00|22.54|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|367.00||||367.00|220.2|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|367.00||||367.00|21.85|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|367.00||||367.00|183.5|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|367.00||||367.00|183.87|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|367.00||||367.00|25.7|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|367.00||||367.00|128.82|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|367.00||||367.00|156.34|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|367.00||||367.00|20.81|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|367.00||||367.00|22.89|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|367.00||||367.00|330.3|367|13.88 30286304|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG CA 125|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|367.00||||367.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|391.00||||391.00|137.24|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|391.00||||391.00|195.89|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|391.00||||391.00|166.57|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|391.00||||391.00|195.5|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|391.00||||391.00|234.6|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|391.00||||391.00|22.54|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|391.00||||391.00|21.77|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|391.00||||391.00|13.88|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|TRUSTMARK [2030]|STARMARK [203000]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|AETNA [1015]|AETNA ACO WILCO [101532]|391.00||||391.00|32.91|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MULTIPLAN [1680]|IHC HS [168011]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|FMH BENEFIT SERVICES [1390]|FMH [139000]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|FIRST HEALTH [1375]|QUALCHOICE [137513]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|391.00||||391.00|25.77|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|391.00||||391.00|25.7|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|HEALTHNET [1495]|HEALTHNET [149500]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|UMR [2035]|UMR OPTIONS [203501]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|391.00||||391.00|82.11|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|391.00||||391.00|391|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.00||||391.00|187.48|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|391.00||||391.00|254.15|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|||391.00||||391.00|117.3|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|391.00||||391.00|25.7|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|391.00||||391.00|22.54|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|391.00||||391.00|20.74|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|CHAMPVA [1240]|CHAMP VA [124000]|391.00||||391.00|293.25|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|CORESOURCE [1315]|CORESOURCE [131500]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|391.00||||391.00|23.43|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|GEHA [1415]|GEHA [141500]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|391.00||||391.00|351.9|391|13.88 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MULTIPLAN [1680]|HMA [168003]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|391.00||||391.00||| 30286305|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HE4 HUMAN EPIDIDY PROTEIN 4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|391.00||||391.00||| 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|GEHA [1415]|GEHA [141500]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|272.00||||272.00|5.83|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|272.00||||272.00|7.45|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|272.00||||272.00|204|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|272.00||||272.00|5.17|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|272.00||||272.00|5.61|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|||272.00||||272.00|81.6|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|272.00||||272.00|176.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|272.00||||272.00|130.42|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|272.00||||272.00|272|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|272.00||||272.00|57.12|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|272.00||||272.00|7.56|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|UMR [2035]|UMR OPTIONS [203501]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|272.00||||272.00|5.28|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|272.00||||272.00|6.39|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|272.00||||272.00|6.41|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|272.00||||272.00|7.45|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MULTIPLAN [1680]|HMA [168003]|272.00||||272.00|7.77|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MULTIPLAN [1680]|IHC HS [168011]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|272.00||||272.00|8.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|TRUSTMARK [2030]|STARMARK [203000]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|272.00||||272.00|3.45|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|272.00||||272.00|5.42|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|272.00||||272.00|5.7|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|272.00||||272.00|5.61|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|272.00||||272.00|163.2|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|272.00||||272.00|5.44|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|272.00||||272.00|136|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|272.00||||272.00|115.87|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|272.00||||272.00|136.27|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|272.00||||272.00|6.39|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|272.00||||272.00|95.47|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|272.00||||272.00|5.18|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|272.00||||272.00|5.7|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|272.00||||272.00|244.8|272|3.45 30286308|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|272.00||||272.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|125.00||||125.00|7.98|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|125.00||||125.00|43.88|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|125.00||||125.00|53.25|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|125.00||||125.00|62.63|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|125.00||||125.00|62.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.00||||125.00|75|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|125.00||||125.00|7.01|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|125.00||||125.00|4.31|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|TRUSTMARK [2030]|STARMARK [203000]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|AETNA [1015]|AETNA ACO WILCO [101532]|125.00||||125.00|10.21|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|HEALTHNET [1495]|HEALTHNET [149500]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MULTIPLAN [1680]|IHC HS [168011]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|FMH BENEFIT SERVICES [1390]|FMH [139000]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|FIRST HEALTH [1375]|QUALCHOICE [137513]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|125.00||||125.00|8.01|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|125.00||||125.00|7.98|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|UMR [2035]|UMR OPTIONS [203501]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|125.00||||125.00|6.77|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|125.00||||125.00|26.25|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|125.00||||125.00|125|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.00||||125.00|59.94|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|125.00||||125.00|81.25|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|||125.00||||125.00|37.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|125.00||||125.00|7.01|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|125.00||||125.00|6.44|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|CHAMPVA [1240]|CHAMP VA [124000]|125.00||||125.00|93.75|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|CORESOURCE [1315]|CORESOURCE [131500]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|125.00||||125.00|7.29|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|GEHA [1415]|GEHA [141500]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|125.00||||125.00|112.5|125|4.31 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MULTIPLAN [1680]|HMA [168003]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|125.00||||125.00||| 30286309|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HETEROPHILE TITER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|125.00||||125.00||| 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|GEHA [1415]|GEHA [141500]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|CORESOURCE [1315]|CORESOURCE [131500]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|462.00||||462.00|29.92|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|CHAMPVA [1240]|CHAMP VA [124000]|462.00||||462.00|346.5|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|462.00||||462.00|22.54|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|462.00||||462.00|300.3|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|462.00||||462.00|221.53|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|462.00||||462.00|462|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|462.00||||462.00|97.02|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|462.00||||462.00|30.38|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|UMR [2035]|UMR OPTIONS [203501]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|462.00||||462.00|21.23|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|462.00||||462.00|25.7|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|462.00||||462.00|25.77|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|FIRST HEALTH [1375]|QUALCHOICE [137513]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|FMH BENEFIT SERVICES [1390]|FMH [139000]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MULTIPLAN [1680]|HMA [168003]|462.00||||462.00|31.22|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|462.00||||462.00|29.92|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MULTIPLAN [1680]|IHC HS [168011]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|HEALTHNET [1495]|HEALTHNET [149500]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|AETNA [1015]|AETNA ACO WILCO [101532]|462.00||||462.00|32.91|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|||462.00||||462.00|138.6|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|TRUSTMARK [2030]|STARMARK [203000]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|462.00||||462.00|13.88|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|462.00||||462.00|20.74|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|462.00||||462.00|21.77|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|462.00||||462.00|22.89|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|462.00||||462.00|23.43|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|462.00||||462.00|22.54|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|462.00||||462.00|277.2|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|462.00||||462.00|21.85|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|462.00||||462.00|231|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|462.00||||462.00|25.7|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|462.00||||462.00|196.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|462.00||||462.00|231.46|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|462.00||||462.00|162.16|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|462.00||||462.00|20.81|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|462.00||||462.00|22.89|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|462.00||||462.00|415.8|462|13.88 30286316|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO TUMOR AG OTHER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|462.00||||462.00||| 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|188.00||||188.00|94.19|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|188.00||||188.00|80.09|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|188.00||||188.00|18.5|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|188.00||||188.00|94|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|188.00||||188.00|112.8|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|188.00||||188.00|16.24|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|188.00||||188.00|16.49|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|188.00||||188.00|15.68|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|188.00||||188.00|9.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|TRUSTMARK [2030]|STARMARK [203000]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|188.00||||188.00|21.55|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MULTIPLAN [1680]|IHC HS [168011]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MULTIPLAN [1680]|HMA [168003]|188.00||||188.00|22.49|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|188.00||||188.00|18.56|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|188.00||||188.00|18.5|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|HEALTHNET [1495]|HEALTHNET [149500]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|188.00||||188.00|15.29|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|UMR [2035]|UMR OPTIONS [203501]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|AETNA [1015]|AETNA ACO WILCO [101532]|188.00||||188.00|23.69|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|188.00||||188.00|21.89|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|188.00||||188.00|39.48|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|188.00||||188.00|188|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|188.00||||188.00|15.74|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|188.00||||188.00|90.15|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|188.00||||188.00|122.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|||188.00||||188.00|56.4|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|188.00||||188.00|65.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|188.00||||188.00|16.24|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|188.00||||188.00|16.49|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|188.00||||188.00|14.99|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|188.00||||188.00|14.94|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|CHAMPVA [1240]|CHAMP VA [124000]|188.00||||188.00|141|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|188.00||||188.00|21.55|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|CORESOURCE [1315]|CORESOURCE [131500]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|188.00||||188.00|16.88|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|GEHA [1415]|GEHA [141500]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|188.00||||188.00|169.2|188|9.99 30286317|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNO ASSAY INFECT AGENT QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|188.00||||188.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|GEHA [1415]|GEHA [141500]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|301.00||||301.00|33.69|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|CORESOURCE [1315]|CORESOURCE [131500]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|CHAMPVA [1240]|CHAMP VA [124000]|301.00||||301.00|225.75|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|301.00||||301.00|29.81|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|301.00||||301.00|32.41|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|||301.00||||301.00|90.3|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|301.00||||301.00|195.65|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|301.00||||301.00|144.33|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|301.00||||301.00|63.21|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|UMR [2035]|UMR OPTIONS [203501]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|301.00||||301.00|29.92|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|301.00||||301.00|37.05|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MULTIPLAN [1680]|IHC HS [168011]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|301.00||||301.00|301|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|HEALTHNET [1495]|HEALTHNET [149500]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|AETNA [1015]|AETNA ACO WILCO [101532]|301.00||||301.00|42.56|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|TRUSTMARK [2030]|STARMARK [203000]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|301.00||||301.00|17.95|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|301.00||||301.00|31.3|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|301.00||||301.00|32.41|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|301.00||||301.00|180.6|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|301.00||||301.00|150.5|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|301.00||||301.00|128.23|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|301.00||||301.00|150.8|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|301.00||||301.00|29.92|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|301.00||||301.00|105.65|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|301.00||||301.00|270.9|301|17.95 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MULTIPLAN [1680]|HMA [168003]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|301.00||||301.00||| 30286320|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS SERUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|301.00||||301.00|27.61|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|301.00||||301.00|105.65|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|301.00||||301.00|128.23|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|301.00||||301.00|150.5|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|301.00||||301.00|180.6|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|301.00||||301.00|25.06|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|301.00||||301.00|14.91|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|TRUSTMARK [2030]|STARMARK [203000]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|AETNA [1015]|AETNA ACO WILCO [101532]|301.00||||301.00|35.35|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|HEALTHNET [1495]|HEALTHNET [149500]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|FMH BENEFIT SERVICES [1390]|FMH [139000]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MULTIPLAN [1680]|IHC HS [168011]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|FIRST HEALTH [1375]|QUALCHOICE [137513]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|301.00||||301.00|28.66|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|301.00||||301.00|27.61|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|UMR [2035]|UMR OPTIONS [203501]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|301.00||||301.00|24.2|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|301.00||||301.00|63.21|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|301.00||||301.00|301|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|301.00||||301.00|150.8|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|301.00||||301.00|144.33|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|301.00||||301.00|195.65|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|||301.00||||301.00|90.3|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|301.00||||301.00|25.06|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|301.00||||301.00|23.04|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|CHAMPVA [1240]|CHAMP VA [124000]|301.00||||301.00|225.75|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|CORESOURCE [1315]|CORESOURCE [131500]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|301.00||||301.00|26.05|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|GEHA [1415]|GEHA [141500]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|301.00||||301.00|270.9|301|14.91 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MULTIPLAN [1680]|HMA [168003]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|301.00||||301.00||| 30286325|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOELECTROPHORESIS URINE/CSF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|301.00||||301.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|GEHA [1415]|GEHA [141500]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|CORESOURCE [1315]|CORESOURCE [131500]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|189.00||||189.00|117.18|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|CHAMPVA [1240]|CHAMP VA [124000]|189.00||||189.00|141.75|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|189.00||||189.00|14|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|189.00||||189.00|14.05|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|189.00||||189.00|15.23|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|189.00||||189.00|122.85|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|189.00||||189.00|90.63|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|189.00||||189.00|189|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|189.00||||189.00|39.69|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|189.00||||189.00|117.37|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|189.00||||189.00|14.33|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|189.00||||189.00|17.34|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|189.00||||189.00|17.41|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|189.00||||189.00|14.05|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|UMR [2035]|UMR OPTIONS [203501]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MULTIPLAN [1680]|HMA [168003]|189.00||||189.00|21.08|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|189.00||||189.00|20.2|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MULTIPLAN [1680]|IHC HS [168011]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|HEALTHNET [1495]|HEALTHNET [149500]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|||189.00||||189.00|56.7|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|189.00||||189.00|14.05|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|AETNA [1015]|AETNA ACO WILCO [101532]|189.00||||189.00|22.2|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|TRUSTMARK [2030]|STARMARK [203000]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|189.00||||189.00|9.37|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|189.00||||189.00|14.7|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|189.00||||189.00|14.05|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|189.00||||189.00|15.83|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|189.00||||189.00|15.23|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|189.00||||189.00|113.4|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|189.00||||189.00|14.75|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|189.00||||189.00|94.5|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|189.00||||189.00|17.34|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|189.00||||189.00|94.69|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|189.00||||189.00|80.51|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|189.00||||189.00|66.34|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|189.00||||189.00|14.05|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|189.00||||189.00|14.05|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|189.00||||189.00|170.1|189|9.37 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|189.00||||189.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|189.00||||189.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|189.00||||189.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|189.00||||189.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|189.00||||189.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|189.00||||189.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|189.00||||189.00||| 30286329|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|189.00||||189.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|14.79|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|12.98|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|12.54|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|7.99|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|14.84|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|14.79|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00|18.93|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|||150.00||||150.00|45|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|12.98|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|11.94|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|13.49|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|7.99 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 30286331|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNODIFFUSION OUCHTERLONY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|GEHA [1415]|GEHA [141500]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|442.00||||442.00|27.45|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|CORESOURCE [1315]|CORESOURCE [131500]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|CHAMPVA [1240]|CHAMP VA [124000]|442.00||||442.00|331.5|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|442.00||||442.00|24.29|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|442.00||||442.00|26.41|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|||442.00||||442.00|132.6|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|442.00||||442.00|211.94|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|442.00||||442.00|92.82|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|UMR [2035]|UMR OPTIONS [203501]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|442.00||||442.00|30.09|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|442.00||||442.00|30.19|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MULTIPLAN [1680]|IHC HS [168011]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|HEALTHNET [1495]|HEALTHNET [149500]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|AETNA [1015]|AETNA ACO WILCO [101532]|442.00||||442.00|38.52|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|TRUSTMARK [2030]|STARMARK [203000]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|442.00||||442.00|442|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|442.00||||442.00|287.3|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|442.00||||442.00|16.25|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|442.00||||442.00|25.51|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|442.00||||442.00|26.41|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|442.00||||442.00|265.2|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|442.00||||442.00|221|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|442.00||||442.00|188.29|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|442.00||||442.00|221.44|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|442.00||||442.00|30.09|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|442.00||||442.00|155.14|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|442.00||||442.00|397.8|442|16.25 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MULTIPLAN [1680]|HMA [168003]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|442.00||||442.00||| 30286332|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNE COMPLEX ASSAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|442.00||||442.00||| 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|460.00||||460.00|24.57|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|460.00||||460.00|27.59|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|460.00||||460.00|161.46|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|460.00||||460.00|195.96|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|460.00||||460.00|230|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|460.00||||460.00|23.46|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|460.00||||460.00|276|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|460.00||||460.00|24.2|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|460.00||||460.00|24.57|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|460.00||||460.00|23.38|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|460.00||||460.00|14.9|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|TRUSTMARK [2030]|STARMARK [203000]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|AETNA [1015]|AETNA ACO WILCO [101532]|460.00||||460.00|35.31|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|HEALTHNET [1495]|HEALTHNET [149500]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MULTIPLAN [1680]|HMA [168003]|460.00||||460.00|33.51|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MULTIPLAN [1680]|IHC HS [168011]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|460.00||||460.00|32.12|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|460.00||||460.00|27.67|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|460.00||||460.00|27.59|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|460.00||||460.00|22.79|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|UMR [2035]|UMR OPTIONS [203501]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|460.00||||460.00|32.62|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|460.00||||460.00|96.6|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|460.00||||460.00|460|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|460.00||||460.00|220.57|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|460.00||||460.00|299|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|460.00||||460.00|230.46|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|||460.00||||460.00|138|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|460.00||||460.00|24.2|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|460.00||||460.00|22.34|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|460.00||||460.00|22.26|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|CHAMPVA [1240]|CHAMP VA [124000]|460.00||||460.00|345|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|460.00||||460.00|32.12|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|CORESOURCE [1315]|CORESOURCE [131500]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|460.00||||460.00|25.15|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|GEHA [1415]|GEHA [141500]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|460.00||||460.00|414|460|14.9 30286334|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFIX ELECTROPHOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|460.00||||460.00||| 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|GEHA [1415]|GEHA [141500]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|623.00||||623.00|33.05|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|CORESOURCE [1315]|CORESOURCE [131500]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|623.00||||623.00|42.19|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|CHAMPVA [1240]|CHAMP VA [124000]|623.00||||623.00|467.25|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|623.00||||623.00|31.8|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|623.00||||623.00|404.95|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|623.00||||623.00|298.73|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|623.00||||623.00|623|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|623.00||||623.00|130.83|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|623.00||||623.00|42.85|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|623.00||||623.00|29.94|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|623.00||||623.00|36.23|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|623.00||||623.00|36.36|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|FIRST HEALTH [1375]|QUALCHOICE [137513]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|UMR [2035]|UMR OPTIONS [203501]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|FMH BENEFIT SERVICES [1390]|FMH [139000]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MULTIPLAN [1680]|IHC HS [168011]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|623.00||||623.00|42.19|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MULTIPLAN [1680]|HMA [168003]|623.00||||623.00|44.03|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|HEALTHNET [1495]|HEALTHNET [149500]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|AETNA [1015]|AETNA ACO WILCO [101532]|623.00||||623.00|46.38|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|||623.00||||623.00|186.9|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|TRUSTMARK [2030]|STARMARK [203000]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|623.00||||623.00|19.57|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|623.00||||623.00|30.71|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|623.00||||623.00|32.29|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|623.00||||623.00|29.25|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|623.00||||623.00|31.8|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|623.00||||623.00|373.8|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|623.00||||623.00|30.82|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|623.00||||623.00|311.5|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|623.00||||623.00|36.23|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|623.00||||623.00|265.4|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|623.00||||623.00|312.12|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|623.00||||623.00|218.67|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|623.00||||623.00|29.35|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|623.00||||623.00|32.29|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|623.00||||623.00|560.7|623|19.57 30286335|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOFX ELECTROPHR FLD W/CON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|623.00||||623.00||| 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|333.00||||333.00|166.83|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|333.00||||333.00|116.88|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|333.00||||333.00|141.86|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|333.00||||333.00|19.24|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|333.00||||333.00|166.5|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|333.00||||333.00|199.8|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|333.00||||333.00|16.89|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|333.00||||333.00|16.31|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|TRUSTMARK [2030]|STARMARK [203000]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|AETNA [1015]|AETNA ACO WILCO [101532]|333.00||||333.00|24.64|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|AETNA [1015]|COVENTRY HEALTHCARE [101502]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|333.00||||333.00|22.41|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MULTIPLAN [1680]|HMA [168003]|333.00||||333.00|23.39|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MULTIPLAN [1680]|IHC HS [168011]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|FMH BENEFIT SERVICES [1390]|FMH [139000]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|FIRST HEALTH [1375]|QUALCHOICE [137513]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|HEALTHNET [1495]|HEALTHNET [149500]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|333.00||||333.00|19.31|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|333.00||||333.00|19.24|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|333.00||||333.00|15.9|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|UMR [2035]|UMR OPTIONS [203501]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|333.00||||333.00|10.39|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|333.00||||333.00|22.76|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|333.00||||333.00|17.15|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|333.00||||333.00|69.93|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|333.00||||333.00|333|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|333.00||||333.00|16.37|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|333.00||||333.00|159.67|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|333.00||||333.00|216.45|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|||333.00||||333.00|99.9|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|333.00||||333.00|16.89|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|333.00||||333.00|17.15|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|333.00||||333.00|15.59|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|333.00||||333.00|15.53|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|CHAMPVA [1240]|CHAMP VA [124000]|333.00||||333.00|249.75|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|333.00||||333.00|22.41|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|CORESOURCE [1315]|CORESOURCE [131500]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|333.00||||333.00|17.56|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|GEHA [1415]|GEHA [141500]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|333.00||||333.00|299.7|333|10.39 30286336|EAP|0302 - LABORATORY-IMMUNOLOGY|HC INHIBIN A|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|333.00||||333.00||| 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|GEHA [1415]|GEHA [141500]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|321.00||||321.00|24.11|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|CORESOURCE [1315]|CORESOURCE [131500]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|CHAMPVA [1240]|CHAMP VA [124000]|321.00||||321.00|240.75|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|321.00||||321.00|21.34|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|321.00||||321.00|23.2|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|||321.00||||321.00|96.3|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|321.00||||321.00|153.92|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|321.00||||321.00|67.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|321.00||||321.00|31.26|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|UMR [2035]|UMR OPTIONS [203501]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|321.00||||321.00|21.84|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|321.00||||321.00|26.43|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|321.00||||321.00|26.52|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|321.00||||321.00|30.78|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MULTIPLAN [1680]|HMA [168003]|321.00||||321.00|32.12|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|321.00||||321.00|321|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MULTIPLAN [1680]|IHC HS [168011]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|HEALTHNET [1495]|HEALTHNET [149500]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|AETNA [1015]|AETNA ACO WILCO [101532]|321.00||||321.00|33.84|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|321.00||||321.00|208.65|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|TRUSTMARK [2030]|STARMARK [203000]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|321.00||||321.00|14.27|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|321.00||||321.00|22.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|321.00||||321.00|23.55|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|321.00||||321.00|23.2|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|321.00||||321.00|192.6|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|321.00||||321.00|22.48|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|321.00||||321.00|160.5|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|321.00||||321.00|160.82|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|321.00||||321.00|30.78|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|321.00||||321.00|136.75|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|321.00||||321.00|26.43|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|321.00||||321.00|112.67|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|321.00||||321.00|21.41|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|321.00||||321.00|23.55|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|321.00||||321.00|288.9|321|14.27 30286337|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSULIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|321.00||||321.00||| 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|352.00||||352.00|16.59|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|352.00||||352.00|18.61|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|352.00||||352.00|123.55|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|352.00||||352.00|149.95|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|352.00||||352.00|176|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|352.00||||352.00|15.83|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|352.00||||352.00|211.2|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|352.00||||352.00|16.34|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|352.00||||352.00|16.59|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|352.00||||352.00|10.05|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|TRUSTMARK [2030]|STARMARK [203000]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|AETNA [1015]|AETNA ACO WILCO [101532]|352.00||||352.00|23.82|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|HEALTHNET [1495]|HEALTHNET [149500]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MULTIPLAN [1680]|IHC HS [168011]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MULTIPLAN [1680]|HMA [168003]|352.00||||352.00|22.62|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|352.00||||352.00|21.68|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|352.00||||352.00|18.68|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|352.00||||352.00|18.61|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|352.00||||352.00|15.38|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|UMR [2035]|UMR OPTIONS [203501]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|352.00||||352.00|15.78|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|352.00||||352.00|22.02|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|352.00||||352.00|73.92|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|352.00||||352.00|352|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|352.00||||352.00|168.78|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|352.00||||352.00|228.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|352.00||||352.00|176.35|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|||352.00||||352.00|105.6|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|352.00||||352.00|16.34|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|352.00||||352.00|15.08|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|352.00||||352.00|15.03|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|CHAMPVA [1240]|CHAMP VA [124000]|352.00||||352.00|264|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|352.00||||352.00|21.68|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|CORESOURCE [1315]|CORESOURCE [131500]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|352.00||||352.00|16.98|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|GEHA [1415]|GEHA [141500]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|352.00||||352.00|316.8|352|10.05 30286340|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INSTRINSIC FACTOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|352.00||||352.00||| 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|GEHA [1415]|GEHA [141500]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|CORESOURCE [1315]|CORESOURCE [131500]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|266.00||||266.00|33.88|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|CHAMPVA [1240]|CHAMP VA [124000]|266.00||||266.00|199.5|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|266.00||||266.00|25.54|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|||266.00||||266.00|79.8|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|266.00||||266.00|172.9|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|266.00||||266.00|127.55|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|266.00||||266.00|266|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|266.00||||266.00|55.86|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|266.00||||266.00|34.41|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|266.00||||266.00|24.04|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|266.00||||266.00|24.43|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|266.00||||266.00|29.2|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|UMR [2035]|UMR OPTIONS [203501]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MULTIPLAN [1680]|HMA [168003]|266.00||||266.00|35.36|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MULTIPLAN [1680]|IHC HS [168011]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|266.00||||266.00|33.88|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|HEALTHNET [1495]|HEALTHNET [149500]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|AETNA [1015]|AETNA ACO WILCO [101532]|266.00||||266.00|33.52|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|TRUSTMARK [2030]|STARMARK [203000]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|266.00||||266.00|23.49|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|266.00||||266.00|14.14|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|266.00||||266.00|24.67|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|266.00||||266.00|25.93|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|266.00||||266.00|26.55|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|266.00||||266.00|25.54|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|266.00||||266.00|159.6|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|266.00||||266.00|24.75|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|266.00||||266.00|133|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|266.00||||266.00|113.32|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|266.00||||266.00|93.37|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|266.00||||266.00|133.27|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|266.00||||266.00|24.43|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|266.00||||266.00|23.57|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|266.00||||266.00|25.93|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|266.00||||266.00|239.4|266|14.14 30286341|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ISLET CELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|266.00||||266.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|CHAMPVA [1240]|CHAMP VA [124000]|223.00||||223.00|167.25|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|CORESOURCE [1315]|CORESOURCE [131500]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|223.00||||223.00|14.03|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|GEHA [1415]|GEHA [141500]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|223.00||||223.00|13.5|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|223.00||||223.00|111.72|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|223.00||||223.00|8.3|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|223.00||||223.00|15.43|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|FIRST HEALTH [1375]|QUALCHOICE [137513]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|FMH BENEFIT SERVICES [1390]|FMH [139000]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|223.00||||223.00|12.41|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|223.00||||223.00|15.38|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|223.00||||223.00|15.38|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|HEALTHNET [1495]|HEALTHNET [149500]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|223.00||||223.00|106.93|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MULTIPLAN [1680]|IHC HS [168011]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|AETNA [1015]|AETNA ACO WILCO [101532]|223.00||||223.00|19.69|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|223.00||||223.00|13.5|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|223.00||||223.00|13.03|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|UMR [2035]|UMR OPTIONS [203501]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|223.00||||223.00|78.27|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|223.00||||223.00|46.83|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|||223.00||||223.00|66.9|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|223.00||||223.00|144.95|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|223.00||||223.00|223|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|223.00||||223.00|111.5|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|223.00||||223.00|95|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|TRUSTMARK [2030]|STARMARK [203000]|223.00||||223.00|200.7|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|223.00||||223.00|133.8|223|8.3 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MULTIPLAN [1680]|HMA [168003]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|223.00||||223.00||| 30286343|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LEUKO HISTAMINE RELEASE (LHR)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|223.00||||223.00||| 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|745.00||||745.00|153|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|GEHA [1415]|GEHA [141500]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|745.00||||745.00|149.45|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|CHAMPVA [1240]|CHAMP VA [124000]|745.00||||745.00|558.75|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|FMH BENEFIT SERVICES [1390]|FMH [139000]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|745.00||||745.00|135.39|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|745.00||||745.00|147.2|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|CORESOURCE [1315]|CORESOURCE [131500]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|745.00||||745.00|357.23|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|745.00||||745.00|90.58|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|AETNA [1015]|AETNA ACO WILCO [101532]|745.00||||745.00|214.73|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|745.00||||745.00|195.31|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|HEALTHNET [1495]|HEALTHNET [149500]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|745.00||||745.00|261.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|745.00||||745.00|198.36|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|745.00||||745.00|142.65|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|745.00||||745.00|167.73|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|745.00||||745.00|745|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|UMR [2035]|UMR OPTIONS [203501]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|745.00||||745.00|156.45|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|745.00||||745.00|484.25|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|745.00||||745.00|195.31|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|745.00||||745.00|142.17|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|745.00||||745.00|317.37|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|745.00||||745.00|372.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|TRUSTMARK [2030]|STARMARK [203000]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|745.00||||745.00|373.25|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|745.00||||745.00|147.2|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|||745.00||||745.00|223.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|745.00||||745.00|447|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|745.00||||745.00|138.58|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|745.00||||745.00|167.73|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MULTIPLAN [1680]|IHC HS [168011]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|745.00||||745.00|135.86|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MULTIPLAN [1680]|HMA [168003]|745.00||||745.00|203.79|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|FIRST HEALTH [1375]|QUALCHOICE [137513]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|745.00||||745.00|149.45|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|745.00||||745.00|168.3|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|745.00||||745.00|670.5|745|90.58 30286352|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CELL FUNCT ASSAY/STIM BIOMARK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|745.00||||745.00||| 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1395.00||||1395.00|594.27|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|CORESOURCE [1315]|CORESOURCE [131500]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1395.00||||1395.00|837|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1395.00||||1395.00|53.93|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1395.00||||1395.00|53.12|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MULTIPLAN [1680]|HMA [168003]|1395.00||||1395.00|73.55|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1395.00||||1395.00|698.9|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1395.00||||1395.00|51.31|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1395.00||||1395.00|51.48|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MULTIPLAN [1680]|IHC HS [168011]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|HEALTHNET [1495]|HEALTHNET [149500]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1395.00||||1395.00|489.65|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1395.00||||1395.00|60.53|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1395.00||||1395.00|71.58|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|UMR [2035]|UMR OPTIONS [203501]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1395.00||||1395.00|48.86|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|||1395.00||||1395.00|418.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1395.00||||1395.00|906.75|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1395.00||||1395.00|292.95|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1395.00||||1395.00|668.9|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1395.00||||1395.00|70.49|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|AETNA [1015]|AETNA ACO WILCO [101532]|1395.00||||1395.00|77.48|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|TRUSTMARK [2030]|STARMARK [203000]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1395.00||||1395.00|53.12|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1395.00||||1395.00|70.49|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|CHAMPVA [1240]|CHAMP VA [124000]|1395.00||||1395.00|1046.25|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1395.00||||1395.00|50.01|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1395.00||||1395.00|697.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1395.00||||1395.00|32.68|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1395.00||||1395.00|1395|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1395.00||||1395.00|53.93|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|GEHA [1415]|GEHA [141500]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1395.00||||1395.00|1255.5|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1395.00||||1395.00|60.53|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1395.00||||1395.00|60.73|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1395.00||||1395.00|55.21|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1395.00||||1395.00|49.03|1395|32.68 30286353|EAP|0302 - LABORATORY-IMMUNOLOGY|HC LYMPHOCYTE TRANSFORMATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1395.00||||1395.00||| 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126.00||||126.00|81.9|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.00||||126.00|60.42|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|UMR [2035]|UMR OPTIONS [203501]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126.00||||126.00|55.09|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126.00||||126.00|26.46|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126.00||||126.00|40.88|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126.00||||126.00|126|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126.00||||126.00|38.48|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|126.00||||126.00|54.24|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MULTIPLAN [1680]|IHC HS [168011]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|126.00||||126.00|46.74|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|HEALTHNET [1495]|HEALTHNET [149500]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|TRUSTMARK [2030]|STARMARK [203000]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126.00||||126.00|39.49|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|||126.00||||126.00|37.8|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126.00||||126.00|37.61|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|126.00||||126.00|25.15|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126.00||||126.00|44.23|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126.00||||126.00|46.58|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|126.00||||126.00|63.13|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126.00||||126.00|39.62|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|AETNA [1015]|AETNA ACO WILCO [101532]|126.00||||126.00|59.63|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.00||||126.00|75.6|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126.00||||126.00|46.58|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126.00||||126.00|40.88|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MULTIPLAN [1680]|HMA [168003]|126.00||||126.00|56.6|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126.00||||126.00|41.5|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|126.00||||126.00|53.68|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.00||||126.00|37.73|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126.00||||126.00|63|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126.00||||126.00|41.5|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|CORESOURCE [1315]|CORESOURCE [131500]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|126.00||||126.00|42.49|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|CHAMPVA [1240]|CHAMP VA [124000]|126.00||||126.00|94.5|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|126.00||||126.00|54.24|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|GEHA [1415]|GEHA [141500]|126.00||||126.00|113.4|126|25.15 30286355|EAP|0302 - LABORATORY-IMMUNOLOGY|HC B CELLS TOTAL COUNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|126.00||||126.00||| 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126.00||||126.00|40.88|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|126.00||||126.00|54.24|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126.00||||126.00|41.5|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126.00||||126.00|41.5|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126.00||||126.00|63|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126.00||||126.00|39.62|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126.00||||126.00|46.58|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.00||||126.00|75.6|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|126.00||||126.00|25.15|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|126.00||||126.00|53.68|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MULTIPLAN [1680]|IHC HS [168011]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126.00||||126.00|44.23|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|TRUSTMARK [2030]|STARMARK [203000]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126.00||||126.00|39.49|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|126.00||||126.00|46.74|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MULTIPLAN [1680]|HMA [168003]|126.00||||126.00|56.6|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|126.00||||126.00|63.13|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126.00||||126.00|26.46|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|126.00||||126.00|54.24|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|||126.00||||126.00|37.8|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|HEALTHNET [1495]|HEALTHNET [149500]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|AETNA [1015]|AETNA ACO WILCO [101532]|126.00||||126.00|59.63|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126.00||||126.00|46.58|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.00||||126.00|60.42|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126.00||||126.00|38.48|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|UMR [2035]|UMR OPTIONS [203501]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126.00||||126.00|81.9|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126.00||||126.00|126|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126.00||||126.00|55.09|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|GEHA [1415]|GEHA [141500]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|126.00||||126.00|42.49|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|CORESOURCE [1315]|CORESOURCE [131500]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126.00||||126.00|37.61|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126.00||||126.00|40.88|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126.00||||126.00|37.73|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126.00||||126.00|113.4|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|CHAMPVA [1240]|CHAMP VA [124000]|126.00||||126.00|94.5|126|25.15 30286357|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NK CELLS TOTAL COUNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|126.00||||126.00||| 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|126.00||||126.00|42.49|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|UMR [2035]|UMR OPTIONS [203501]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126.00||||126.00|26.46|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|126.00||||126.00|54.24|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126.00||||126.00|40.88|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126.00||||126.00|81.9|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|||126.00||||126.00|37.8|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126.00||||126.00|126|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126.00||||126.00|37.61|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|GEHA [1415]|GEHA [141500]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|126.00||||126.00|46.74|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.00||||126.00|60.42|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|126.00||||126.00|59.63|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|126.00||||126.00|94.5|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|126.00||||126.00|25.15|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126.00||||126.00|55.09|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126.00||||126.00|41.5|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126.00||||126.00|46.58|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126.00||||126.00|63|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126.00||||126.00|44.23|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.00||||126.00|75.6|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126.00||||126.00|40.88|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MULTIPLAN [1680]|IHC HS [168011]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126.00||||126.00|46.58|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|126.00||||126.00|63.13|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MULTIPLAN [1680]|HMA [168003]|126.00||||126.00|56.6|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126.00||||126.00|39.62|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|126.00||||126.00|54.24|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126.00||||126.00|38.48|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126.00||||126.00|39.49|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|TRUSTMARK [2030]|STARMARK [203000]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|126.00||||126.00|53.68|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.00||||126.00|37.73|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126.00||||126.00|113.4|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126.00||||126.00|41.5|126|25.15 30286359|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|126.00||||126.00||| 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|590.00||||590.00|354|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|590.00||||590.00|49.33|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|590.00||||590.00|58.01|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|590.00||||590.00|51.68|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|AETNA [1015]|AETNA ACO WILCO [101532]|590.00||||590.00|74.24|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MULTIPLAN [1680]|IHC HS [168011]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|590.00||||590.00|207.09|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|590.00||||590.00|58.01|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MULTIPLAN [1680]|HMA [168003]|590.00||||590.00|70.47|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|HEALTHNET [1495]|HEALTHNET [149500]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|590.00||||590.00|31.32|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|590.00||||590.00|251.34|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|590.00||||590.00|58.19|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|FMH BENEFIT SERVICES [1390]|FMH [139000]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|FIRST HEALTH [1375]|QUALCHOICE [137513]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|590.00||||590.00|590|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|590.00||||590.00|295.59|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|590.00||||590.00|282.91|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|590.00||||590.00|383.5|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|590.00||||590.00|295|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|590.00||||590.00|67.54|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|590.00||||590.00|123.9|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|CHAMPVA [1240]|CHAMP VA [124000]|590.00||||590.00|442.5|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|590.00||||590.00|49.16|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|TRUSTMARK [2030]|STARMARK [203000]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|590.00||||590.00|50.9|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|590.00||||590.00|46.81|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|590.00||||590.00|68.59|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|UMR [2035]|UMR OPTIONS [203501]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|590.00||||590.00|46.98|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|590.00||||590.00|50.9|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|590.00||||590.00|47.92|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|CORESOURCE [1315]|CORESOURCE [131500]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|GEHA [1415]|GEHA [141500]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|590.00||||590.00|67.54|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|||590.00||||590.00|177|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|590.00||||590.00|531|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|590.00||||590.00|51.68|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|590.00||||590.00|52.9|590|31.32 30286360|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 & CD8 W/RATIO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|590.00||||590.00||| 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|UMR [2035]|UMR OPTIONS [203501]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|437.00||||437.00|38.5|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MULTIPLAN [1680]|IHC HS [168011]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|437.00||||437.00|33.17|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|AETNA [1015]|AETNA ACO WILCO [101532]|437.00||||437.00|42.31|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|437.00||||437.00|33.06|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MULTIPLAN [1680]|HMA [168003]|437.00||||437.00|40.17|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|437.00||||437.00|17.85|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|437.00||||437.00|218.5|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|437.00||||437.00|29.01|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|437.00||||437.00|29.46|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|437.00||||437.00|218.94|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|437.00||||437.00|186.16|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|437.00||||437.00|437|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|437.00||||437.00|28.02|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|437.00||||437.00|33.06|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|437.00||||437.00|262.2|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|HEALTHNET [1495]|HEALTHNET [149500]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|437.00||||437.00|28.12|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|437.00||||437.00|39.1|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|437.00||||437.00|91.77|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|TRUSTMARK [2030]|STARMARK [203000]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|437.00||||437.00|27.32|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|437.00||||437.00|153.39|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|437.00||||437.00|29.46|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|437.00||||437.00|29.01|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|GEHA [1415]|GEHA [141500]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|437.00||||437.00|30.15|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|CHAMPVA [1240]|CHAMP VA [124000]|437.00||||437.00|327.75|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|437.00||||437.00|26.68|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|CORESOURCE [1315]|CORESOURCE [131500]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|437.00||||437.00|38.5|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|437.00||||437.00|26.78|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|437.00||||437.00|284.05|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|437.00||||437.00|209.54|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|||437.00||||437.00|131.1|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|437.00||||437.00|393.3|437|17.85 30286361|EAP|0302 - LABORATORY-IMMUNOLOGY|HC T CELLS CD4 CNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|437.00||||437.00||| 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205.00||||205.00|123|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|205.00||||205.00|87.33|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205.00||||205.00|16.01|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205.00||||205.00|71.96|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|205.00||||205.00|20.92|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205.00||||205.00|15.77|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|205.00||||205.00|9.7|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|23|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|HEALTHNET [1495]|HEALTHNET [149500]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MULTIPLAN [1680]|HMA [168003]|205.00||||205.00|21.83|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MULTIPLAN [1680]|IHC HS [168011]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|UMR [2035]|UMR OPTIONS [203501]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|TRUSTMARK [2030]|STARMARK [203000]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00|15.28|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00|14.84|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205.00||||205.00|102.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205.00||||205.00|16.01|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|205.00||||205.00|102.71|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205.00||||205.00|17.96|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205.00||||205.00|43.05|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|||205.00||||205.00|61.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|98.3|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205.00||||205.00|15.77|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|17.96|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|205.00||||205.00|18.03|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00|14.55|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205.00||||205.00|14.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205.00||||205.00|133.25|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00|153.75|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205.00||||205.00|15.23|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|205.00||||205.00|20.92|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|205.00||||205.00|16.39|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|GEHA [1415]|GEHA [141500]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205.00||||205.00|21.24|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205.00||||205.00|205|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|CORESOURCE [1315]|CORESOURCE [131500]|205.00||||205.00|184.5|205|9.7 30286376|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MICROSOMAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|205.00||||205.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|CORESOURCE [1315]|CORESOURCE [131500]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|93.00||||93.00|19.05|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|||93.00||||93.00|27.9|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93.00||||93.00|93|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93.00||||93.00|19.53|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|UMR [2035]|UMR OPTIONS [203501]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93.00||||93.00|60.45|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|93.00||||93.00|20.95|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93.00||||93.00|20.88|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|HEALTHNET [1495]|HEALTHNET [149500]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MULTIPLAN [1680]|IHC HS [168011]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|CHAMPVA [1240]|CHAMP VA [124000]|93.00||||93.00|69.75|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|GEHA [1415]|GEHA [141500]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|93.00||||93.00|11.27|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|93.00||||93.00|46.59|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|TRUSTMARK [2030]|STARMARK [203000]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|93.00||||93.00|39.62|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93.00||||93.00|17.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93.00||||93.00|18.33|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93.00||||93.00|18.33|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93.00||||93.00|44.59|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93.00||||93.00|55.8|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93.00||||93.00|46.5|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93.00||||93.00|32.64|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|AETNA [1015]|AETNA ACO WILCO [101532]|93.00||||93.00|26.72|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93.00||||93.00|20.88|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93.00||||93.00|83.7|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93.00||||93.00|16.86|93|11.27 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MULTIPLAN [1680]|HMA [168003]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93.00||||93.00||| 30286382|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NEUTRALIZATION VIRAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93.00||||93.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177.00||||177.00|62.13|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|177.00||||177.00|75.4|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177.00||||177.00|14.06|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177.00||||177.00|106.2|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|177.00||||177.00|8.17|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177.00||||177.00|14.24|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|AETNA [1015]|AETNA ACO WILCO [101532]|177.00||||177.00|19.35|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177.00||||177.00|14.74|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|HEALTHNET [1495]|HEALTHNET [149500]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MULTIPLAN [1680]|IHC HS [168011]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|FIRST HEALTH [1375]|QUALCHOICE [137513]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|UMR [2035]|UMR OPTIONS [203501]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177.00||||177.00|14.06|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177.00||||177.00|13.56|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|177.00||||177.00|88.68|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|TRUSTMARK [2030]|STARMARK [203000]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177.00||||177.00|84.87|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|||177.00||||177.00|53.1|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177.00||||177.00|115.05|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177.00||||177.00|14.74|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|177.00||||177.00|16.85|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177.00||||177.00|88.5|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|FMH BENEFIT SERVICES [1390]|FMH [139000]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177.00||||177.00|177|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|CHAMPVA [1240]|CHAMP VA [124000]|177.00||||177.00|132.75|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|GEHA [1415]|GEHA [141500]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|177.00||||177.00|15.32|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177.00||||177.00|37.17|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|CORESOURCE [1315]|CORESOURCE [131500]|177.00||||177.00|159.3|177|8.17 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MULTIPLAN [1680]|HMA [168003]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|177.00||||177.00||| 30286384|EAP|0302 - LABORATORY-IMMUNOLOGY|HC NITROBLUE TETRAZOLIUM DYE(NTD)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177.00||||177.00||| 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|167.00||||167.00|13|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|167.00||||167.00|16.59|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167.00||||167.00|167|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167.00||||167.00|12.51|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167.00||||167.00|108.55|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167.00||||167.00|16.85|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167.00||||167.00|35.07|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|GEHA [1415]|GEHA [141500]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|UMR [2035]|UMR OPTIONS [203501]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167.00||||167.00|11.51|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167.00||||167.00|11.77|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167.00||||167.00|12.58|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MULTIPLAN [1680]|IHC HS [168011]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|167.00||||167.00|16.59|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MULTIPLAN [1680]|HMA [168003]|167.00||||167.00|17.31|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|167.00||||167.00|14.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|167.00||||167.00|125.25|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167.00||||167.00|58.62|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167.00||||167.00|80.08|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|TRUSTMARK [2030]|STARMARK [203000]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167.00||||167.00|12.69|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|167.00||||167.00|16.42|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167.00||||167.00|12.12|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167.00||||167.00|100.2|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|||167.00||||167.00|50.1|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167.00||||167.00|12.08|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167.00||||167.00|83.5|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|167.00||||167.00|71.14|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167.00||||167.00|12.51|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|167.00||||167.00|83.67|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|167.00||||167.00|6.92|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167.00||||167.00|12.58|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167.00||||167.00|12.69|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167.00||||167.00|150.3|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167.00||||167.00|11.54|167|6.92 30286403|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTICLE AGGLUT SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|167.00||||167.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144.00||||144.00|86.4|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MULTIPLAN [1680]|IHC HS [168011]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|TRUSTMARK [2030]|STARMARK [203000]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|144.00||||144.00|72.14|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144.00||||144.00|11.53|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144.00||||144.00|13.13|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|HEALTHNET [1495]|HEALTHNET [149500]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|FMH BENEFIT SERVICES [1390]|FMH [139000]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|UMR [2035]|UMR OPTIONS [203501]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|FIRST HEALTH [1375]|QUALCHOICE [137513]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|144.00||||144.00|13.18|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144.00||||144.00|13.13|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144.00||||144.00|72|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144.00||||144.00|11.13|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144.00||||144.00|50.54|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144.00||||144.00|30.24|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144.00||||144.00|69.05|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|AETNA [1015]|AETNA ACO WILCO [101532]|144.00||||144.00|16.81|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|||144.00||||144.00|43.2|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144.00||||144.00|11.53|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|144.00||||144.00|7.09|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|144.00||||144.00|61.34|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144.00||||144.00|10.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144.00||||144.00|144|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144.00||||144.00|93.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|CHAMPVA [1240]|CHAMP VA [124000]|144.00||||144.00|108|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|GEHA [1415]|GEHA [141500]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|144.00||||144.00|11.98|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|CORESOURCE [1315]|CORESOURCE [131500]|144.00||||144.00|129.6|144|7.09 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MULTIPLAN [1680]|HMA [168003]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|144.00||||144.00||| 30286406|EAP|0302 - LABORATORY-IMMUNOLOGY|HC PARTCL AGGL TITER EA ANTIBODY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144.00||||144.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|CHAMPVA [1240]|CHAMP VA [124000]|146.00||||146.00|109.5|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|GEHA [1415]|GEHA [141500]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146.00||||146.00|6.91|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146.00||||146.00|6.12|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|||146.00||||146.00|43.8|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146.00||||146.00|146|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|CORESOURCE [1315]|CORESOURCE [131500]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|UMR [2035]|UMR OPTIONS [203501]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146.00||||146.00|94.9|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|AETNA [1015]|AETNA ACO WILCO [101532]|146.00||||146.00|8.96|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146.00||||146.00|7.61|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|HEALTHNET [1495]|HEALTHNET [149500]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MULTIPLAN [1680]|IHC HS [168011]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146.00||||146.00|70.01|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146.00||||146.00|30.66|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|TRUSTMARK [2030]|STARMARK [203000]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146.00||||146.00|62.2|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146.00||||146.00|6.43|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146.00||||146.00|3.78|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146.00||||146.00|7|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146.00||||146.00|6.65|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146.00||||146.00|6.65|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146.00||||146.00|87.6|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146.00||||146.00|73|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146.00||||146.00|73.15|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146.00||||146.00|51.25|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146.00||||146.00|7|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146.00||||146.00|131.4|146|3.78 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MULTIPLAN [1680]|HMA [168003]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146.00||||146.00||| 30286430|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146.00||||146.00||| 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161.00||||161.00|5.95|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161.00||||161.00|6.24|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161.00||||161.00|6.24|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MULTIPLAN [1680]|IHC HS [168011]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|161.00||||161.00|3.78|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161.00||||161.00|5.94|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|161.00||||161.00|68.59|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|161.00||||161.00|80.66|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|HEALTHNET [1495]|HEALTHNET [149500]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161.00||||161.00|80.5|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|161.00||||161.00|8.15|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MULTIPLAN [1680]|HMA [168003]|161.00||||161.00|8.51|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|UMR [2035]|UMR OPTIONS [203501]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161.00||||161.00|5.78|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161.00||||161.00|56.51|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161.00||||161.00|77.2|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|161.00||||161.00|7.02|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|||161.00||||161.00|48.3|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161.00||||161.00|33.81|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161.00||||161.00|104.65|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161.00||||161.00|7|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|AETNA [1015]|AETNA ACO WILCO [101532]|161.00||||161.00|8.96|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161.00||||161.00|6.14|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161.00||||161.00|8.28|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|TRUSTMARK [2030]|STARMARK [203000]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161.00||||161.00|5.67|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161.00||||161.00|5.65|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161.00||||161.00|161|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|CHAMPVA [1240]|CHAMP VA [124000]|161.00||||161.00|120.75|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|161.00||||161.00|8.15|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|161.00||||161.00|6.38|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161.00||||161.00|6.14|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|CORESOURCE [1315]|CORESOURCE [131500]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|GEHA [1415]|GEHA [141500]|161.00||||161.00|144.9|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161.00||||161.00|96.6|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161.00||||161.00|7|161|3.78 30286431|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RHEUMATOID FACTOR QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|161.00||||161.00||| 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|TRUSTMARK [2030]|STARMARK [203000]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|929.00||||929.00|41.32|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|929.00||||929.00|64.86|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|929.00||||929.00|68.18|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|929.00||||929.00|67.15|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|929.00||||929.00|557.4|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|929.00||||929.00|464.5|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|929.00||||929.00|465.43|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|AETNA [1015]|AETNA ACO WILCO [101532]|929.00||||929.00|97.96|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|929.00||||929.00|395.75|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|929.00||||929.00|76.52|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|929.00||||929.00|326.08|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|929.00||||929.00|65.08|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|929.00||||929.00|68.18|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|929.00||||929.00|69.79|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|929.00||||929.00|89.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|CHAMPVA [1240]|CHAMP VA [124000]|929.00||||929.00|696.75|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|929.00||||929.00|61.77|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|929.00||||929.00|67.15|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|||929.00||||929.00|278.7|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|929.00||||929.00|603.85|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|929.00||||929.00|445.46|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|929.00||||929.00|929|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|929.00||||929.00|195.09|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|CORESOURCE [1315]|CORESOURCE [131500]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|929.00||||929.00|90.49|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|GEHA [1415]|GEHA [141500]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|UMR [2035]|UMR OPTIONS [203501]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|929.00||||929.00|63.22|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|929.00||||929.00|76.52|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|929.00||||929.00|76.78|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|FMH BENEFIT SERVICES [1390]|FMH [139000]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|FIRST HEALTH [1375]|QUALCHOICE [137513]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MULTIPLAN [1680]|IHC HS [168011]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|929.00||||929.00|89.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|MULTIPLAN [1680]|HMA [168003]|929.00||||929.00|92.97|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|HEALTHNET [1495]|HEALTHNET [149500]|929.00||||929.00|836.1|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|929.00||||929.00|61.98|929|41.32 30286480|EAP|0302 - LABORATORY-IMMUNOLOGY|HC TB TEST CELL IMMUNITY MEASURE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|929.00||||929.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82.00||||82.00|34.93|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82.00||||82.00|41.08|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82.00||||82.00|9.35|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82.00||||82.00|9.03|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82.00||||82.00|49.2|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82.00||||82.00|35.26|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|TRUSTMARK [2030]|STARMARK [203000]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|AETNA [1015]|AETNA ACO WILCO [101532]|82.00||||82.00|11.5|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|HEALTHNET [1495]|HEALTHNET [149500]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MULTIPLAN [1680]|IHC HS [168011]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82.00||||82.00|35.26|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82.00||||82.00|17.22|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82.00||||82.00|41.04|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82.00||||82.00|28.78|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82.00||||82.00|10.3|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82.00||||82.00|82|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82.00||||82.00|39.32|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82.00||||82.00|53.3|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|||82.00||||82.00|24.6|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|UMR [2035]|UMR OPTIONS [203501]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82.00||||82.00|9.35|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82.00||||82.00|10.7|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82.00||||82.00|8.6|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|CHAMPVA [1240]|CHAMP VA [124000]|82.00||||82.00|61.5|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|CORESOURCE [1315]|CORESOURCE [131500]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|GEHA [1415]|GEHA [141500]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82.00||||82.00|73.8|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82.00||||82.00|9.72|82|8.6 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|MULTIPLAN [1680]|HMA [168003]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82.00||||82.00||| 30286580|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SKIN TEST TB INTRADERMAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82.00||||82.00||| 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|UMR [2035]|UMR OPTIONS [203501]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|214.00||||214.00|4.8|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|214.00||||214.00|6.14|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|214.00||||214.00|4.62|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|||214.00||||214.00|64.2|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|214.00||||214.00|139.1|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|214.00||||214.00|214|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|214.00||||214.00|6.23|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|214.00||||214.00|4.36|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|214.00||||214.00|5.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|214.00||||214.00|5.28|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|214.00||||214.00|6.14|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MULTIPLAN [1680]|HMA [168003]|214.00||||214.00|6.41|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|AETNA [1015]|AETNA ACO WILCO [101532]|214.00||||214.00|6.75|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|TRUSTMARK [2030]|STARMARK [203000]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|GEHA [1415]|GEHA [141500]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|214.00||||214.00|44.94|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|CHAMPVA [1240]|CHAMP VA [124000]|214.00||||214.00|160.5|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|214.00||||214.00|4.25|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|214.00||||214.00|102.61|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|214.00||||214.00|2.85|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|214.00||||214.00|4.46|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|HEALTHNET [1495]|HEALTHNET [149500]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|214.00||||214.00|4.7|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|214.00||||214.00|4.62|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MULTIPLAN [1680]|IHC HS [168011]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|214.00||||214.00|128.4|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|CORESOURCE [1315]|CORESOURCE [131500]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|214.00||||214.00|4.48|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|214.00||||214.00|107|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|214.00||||214.00|107.21|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|214.00||||214.00|91.16|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|214.00||||214.00|5.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|214.00||||214.00|75.11|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|214.00||||214.00|4.27|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|214.00||||214.00|192.6|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|214.00||||214.00|4.7|214|2.85 30286592|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS VDRL/RPR QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|214.00||||214.00||| 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|250.00||||250.00|125.25|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|250.00||||250.00|106.5|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250.00||||250.00|4.62|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250.00||||250.00|4.84|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250.00||||250.00|4.77|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250.00||||250.00|4.61|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|250.00||||250.00|2.93|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250.00||||250.00|87.75|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250.00||||250.00|150|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|AETNA [1015]|AETNA ACO WILCO [101532]|250.00||||250.00|6.96|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|HEALTHNET [1495]|HEALTHNET [149500]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250.00||||250.00|5.44|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|250.00||||250.00|6.33|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MULTIPLAN [1680]|IHC HS [168011]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|250.00||||250.00|5.46|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250.00||||250.00|5.44|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|UMR [2035]|UMR OPTIONS [203501]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250.00||||250.00|6.42|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MULTIPLAN [1680]|HMA [168003]|250.00||||250.00|6.6|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250.00||||250.00|250|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250.00||||250.00|4.84|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250.00||||250.00|119.88|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250.00||||250.00|52.5|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250.00||||250.00|162.5|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|TRUSTMARK [2030]|STARMARK [203000]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250.00||||250.00|125|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|||250.00||||250.00|75|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250.00||||250.00|4.77|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250.00||||250.00|4.49|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250.00||||250.00|4.4|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250.00||||250.00|4.39|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|CHAMPVA [1240]|CHAMP VA [124000]|250.00||||250.00|187.5|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|250.00||||250.00|6.33|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|CORESOURCE [1315]|CORESOURCE [131500]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|GEHA [1415]|GEHA [141500]|250.00||||250.00|225|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|250.00||||250.00|4.96|250|2.93 30286593|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SYPHILIS NON-TREP AB QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|250.00||||250.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|201.00||||201.00|11.46|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201.00||||201.00|10.14|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201.00||||201.00|11.03|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|||201.00||||201.00|60.3|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201.00||||201.00|130.65|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201.00||||201.00|201|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|CHAMPVA [1240]|CHAMP VA [124000]|201.00||||201.00|150.75|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201.00||||201.00|42.21|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|UMR [2035]|UMR OPTIONS [203501]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201.00||||201.00|12.56|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|201.00||||201.00|12.61|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|FMH BENEFIT SERVICES [1390]|FMH [139000]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|CORESOURCE [1315]|CORESOURCE [131500]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MULTIPLAN [1680]|IHC HS [168011]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|AETNA [1015]|AETNA ACO WILCO [101532]|201.00||||201.00|16.08|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|TRUSTMARK [2030]|STARMARK [203000]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|GEHA [1415]|GEHA [141500]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|201.00||||201.00|6.79|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201.00||||201.00|10.65|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201.00||||201.00|11.03|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201.00||||201.00|96.38|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201.00||||201.00|120.6|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|FIRST HEALTH [1375]|QUALCHOICE [137513]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201.00||||201.00|100.5|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|201.00||||201.00|85.63|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|201.00||||201.00|100.7|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201.00||||201.00|70.55|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201.00||||201.00|12.56|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|HEALTHNET [1495]|HEALTHNET [149500]|201.00||||201.00|180.9|201|6.79 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MULTIPLAN [1680]|HMA [168003]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201.00||||201.00||| 30286602|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ACTINOMYCES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|201.00||||201.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|13.47|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|8.58|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|20.34|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|15.89|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|15.89|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|13.95|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|||192.00||||192.00|57.6|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|13.95|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|12.83|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|14.5|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|15.95|192|8.58 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00||| 30286603|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ADENOVIRUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00||| 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|236.00||||236.00|16.95|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|236.00||||236.00|21.64|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|||236.00||||236.00|70.8|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236.00||||236.00|153.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|CHAMPVA [1240]|CHAMP VA [124000]|236.00||||236.00|177|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236.00||||236.00|236|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|GEHA [1415]|GEHA [141500]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|UMR [2035]|UMR OPTIONS [203501]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236.00||||236.00|18.59|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|236.00||||236.00|21.64|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MULTIPLAN [1680]|HMA [168003]|236.00||||236.00|22.58|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MULTIPLAN [1680]|IHC HS [168011]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|AETNA [1015]|AETNA ACO WILCO [101532]|236.00||||236.00|23.8|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236.00||||236.00|15.35|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|TRUSTMARK [2030]|STARMARK [203000]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236.00||||236.00|21.97|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|CORESOURCE [1315]|CORESOURCE [131500]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236.00||||236.00|49.56|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236.00||||236.00|15|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236.00||||236.00|113.16|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236.00||||236.00|16.31|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|236.00||||236.00|10.04|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|HEALTHNET [1495]|HEALTHNET [149500]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236.00||||236.00|15.75|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236.00||||236.00|16.56|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236.00||||236.00|16.31|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236.00||||236.00|141.6|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236.00||||236.00|15.8|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236.00||||236.00|118|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|236.00||||236.00|118.24|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236.00||||236.00|18.59|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236.00||||236.00|82.84|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|236.00||||236.00|100.54|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236.00||||236.00|15.05|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|236.00||||236.00|18.65|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236.00||||236.00|16.56|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236.00||||236.00|212.4|236|10.04 30286606|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ASPERGILLUS AB QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|236.00||||236.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132.00||||132.00|66.13|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132.00||||132.00|79.2|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132.00||||132.00|15.9|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.00||||132.00|66|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132.00||||132.00|13.96|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132.00||||132.00|13.48|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132.00||||132.00|56.23|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|HEALTHNET [1495]|HEALTHNET [149500]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MULTIPLAN [1680]|IHC HS [168011]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132.00||||132.00|15.9|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132.00||||132.00|15.96|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|UMR [2035]|UMR OPTIONS [203501]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132.00||||132.00|132|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|AETNA [1015]|AETNA ACO WILCO [101532]|132.00||||132.00|20.35|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|TRUSTMARK [2030]|STARMARK [203000]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132.00||||132.00|46.33|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132.00||||132.00|8.59|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132.00||||132.00|27.72|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.00||||132.00|63.29|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132.00||||132.00|85.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|||132.00||||132.00|39.6|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132.00||||132.00|13.96|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|FIRST HEALTH [1375]|QUALCHOICE [137513]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|FMH BENEFIT SERVICES [1390]|FMH [139000]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132.00||||132.00|12.84|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|CHAMPVA [1240]|CHAMP VA [124000]|132.00||||132.00|99|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|CORESOURCE [1315]|CORESOURCE [131500]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|GEHA [1415]|GEHA [141500]|132.00||||132.00|118.8|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132.00||||132.00|14.51|132|8.59 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MULTIPLAN [1680]|HMA [168003]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132.00||||132.00||| 30286609|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BACTERIUM NOT SPECIFIED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132.00||||132.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|GEHA [1415]|GEHA [141500]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|116.00||||116.00|11.46|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|CHAMPVA [1240]|CHAMP VA [124000]|116.00||||116.00|87|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116.00||||116.00|10.14|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116.00||||116.00|11.03|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|||116.00||||116.00|34.8|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116.00||||116.00|75.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116.00||||116.00|55.62|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116.00||||116.00|116|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|CORESOURCE [1315]|CORESOURCE [131500]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|UMR [2035]|UMR OPTIONS [203501]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116.00||||116.00|12.56|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|116.00||||116.00|12.61|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|FIRST HEALTH [1375]|QUALCHOICE [137513]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|FMH BENEFIT SERVICES [1390]|FMH [139000]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MULTIPLAN [1680]|IHC HS [168011]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|TRUSTMARK [2030]|STARMARK [203000]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116.00||||116.00|24.36|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|116.00||||116.00|6.79|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116.00||||116.00|10.65|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|HEALTHNET [1495]|HEALTHNET [149500]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116.00||||116.00|11.03|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116.00||||116.00|69.6|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116.00||||116.00|58|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116.00||||116.00|40.72|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|116.00||||116.00|58.12|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|116.00||||116.00|49.42|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116.00||||116.00|12.56|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|AETNA [1015]|AETNA ACO WILCO [101532]|116.00||||116.00|16.08|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116.00||||116.00|104.4|116|6.79 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MULTIPLAN [1680]|HMA [168003]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116.00||||116.00||| 30286611|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BARTONELLA AB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116.00||||116.00||| 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173.00||||173.00|14.19|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173.00||||173.00|15.93|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|173.00||||173.00|86.67|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|173.00||||173.00|73.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173.00||||173.00|13.55|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173.00||||173.00|13.98|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173.00||||173.00|14.19|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173.00||||173.00|13.5|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|173.00||||173.00|8.6|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173.00||||173.00|60.72|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|TRUSTMARK [2030]|STARMARK [203000]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|AETNA [1015]|AETNA ACO WILCO [101532]|173.00||||173.00|20.4|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|HEALTHNET [1495]|HEALTHNET [149500]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MULTIPLAN [1680]|IHC HS [168011]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|173.00||||173.00|18.55|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|FMH BENEFIT SERVICES [1390]|FMH [139000]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|FIRST HEALTH [1375]|QUALCHOICE [137513]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173.00||||173.00|15.93|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173.00||||173.00|13.16|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MULTIPLAN [1680]|HMA [168003]|173.00||||173.00|19.35|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173.00||||173.00|36.33|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173.00||||173.00|173|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173.00||||173.00|86.5|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173.00||||173.00|103.8|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173.00||||173.00|82.95|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173.00||||173.00|112.45|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|||173.00||||173.00|51.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173.00||||173.00|18.83|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|UMR [2035]|UMR OPTIONS [203501]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173.00||||173.00|13.98|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|173.00||||173.00|15.99|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173.00||||173.00|12.9|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173.00||||173.00|12.86|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|CHAMPVA [1240]|CHAMP VA [124000]|173.00||||173.00|129.75|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|173.00||||173.00|18.55|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|CORESOURCE [1315]|CORESOURCE [131500]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|GEHA [1415]|GEHA [141500]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173.00||||173.00|155.7|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|173.00||||173.00|14.53|173|8.6 30286612|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BLASTOMYCES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|173.00||||173.00||| 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|CORESOURCE [1315]|CORESOURCE [131500]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|521.00||||521.00|14.85|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|521.00||||521.00|18.96|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|521.00||||521.00|13.15|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|||521.00||||521.00|156.3|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|521.00||||521.00|338.65|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|521.00||||521.00|521|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|521.00||||521.00|19.26|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|UMR [2035]|UMR OPTIONS [203501]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|521.00||||521.00|16.28|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|521.00||||521.00|16.34|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|521.00||||521.00|18.96|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MULTIPLAN [1680]|IHC HS [168011]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MULTIPLAN [1680]|HMA [168003]|521.00||||521.00|19.79|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|521.00||||521.00|13.45|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|GEHA [1415]|GEHA [141500]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|521.00||||521.00|109.41|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|CHAMPVA [1240]|CHAMP VA [124000]|521.00||||521.00|390.75|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|TRUSTMARK [2030]|STARMARK [203000]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|521.00||||521.00|249.82|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|521.00||||521.00|14.29|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|521.00||||521.00|8.79|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|521.00||||521.00|13.81|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|HEALTHNET [1495]|HEALTHNET [149500]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|521.00||||521.00|14.51|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|521.00||||521.00|14.29|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|AETNA [1015]|AETNA ACO WILCO [101532]|521.00||||521.00|20.84|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|521.00||||521.00|312.6|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|521.00||||521.00|13.85|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|521.00||||521.00|260.5|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|521.00||||521.00|221.95|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|521.00||||521.00|182.87|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|521.00||||521.00|261.02|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|521.00||||521.00|16.28|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|521.00||||521.00|13.19|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|521.00||||521.00|468.9|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|521.00||||521.00|14.51|521|8.79 30286615|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORDETELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|521.00||||521.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195.00||||195.00|68.45|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|195.00||||195.00|83.07|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195.00||||195.00|97.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195.00||||195.00|117|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195.00||||195.00|16.21|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|AETNA [1015]|AETNA ACO WILCO [101532]|195.00||||195.00|24.48|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|HEALTHNET [1495]|HEALTHNET [149500]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195.00||||195.00|19.13|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MULTIPLAN [1680]|IHC HS [168011]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|195.00||||195.00|19.19|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195.00||||195.00|19.13|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|UMR [2035]|UMR OPTIONS [203501]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|195.00||||195.00|97.7|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|TRUSTMARK [2030]|STARMARK [203000]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195.00||||195.00|195|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|195.00||||195.00|10.33|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195.00||||195.00|93.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195.00||||195.00|16.78|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195.00||||195.00|40.95|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195.00||||195.00|126.75|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|||195.00||||195.00|58.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195.00||||195.00|16.78|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|FIRST HEALTH [1375]|QUALCHOICE [137513]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195.00||||195.00|15.44|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|CHAMPVA [1240]|CHAMP VA [124000]|195.00||||195.00|146.25|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|CORESOURCE [1315]|CORESOURCE [131500]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|FMH BENEFIT SERVICES [1390]|FMH [139000]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|GEHA [1415]|GEHA [141500]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|195.00||||195.00|17.44|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195.00||||195.00|175.5|195|10.33 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MULTIPLAN [1680]|HMA [168003]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195.00||||195.00||| 30286617|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE W/BLOT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|195.00||||195.00||| 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|292.00||||292.00|19.18|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|CHAMPVA [1240]|CHAMP VA [124000]|292.00||||292.00|219|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|292.00||||292.00|16.97|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|292.00||||292.00|18.45|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|||292.00||||292.00|87.6|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|292.00||||292.00|189.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|292.00||||292.00|292|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|CORESOURCE [1315]|CORESOURCE [131500]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|292.00||||292.00|61.32|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|UMR [2035]|UMR OPTIONS [203501]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|292.00||||292.00|17.37|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|292.00||||292.00|21.02|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|292.00||||292.00|21.1|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MULTIPLAN [1680]|IHC HS [168011]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|292.00||||292.00|24.48|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|HEALTHNET [1495]|HEALTHNET [149500]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|AETNA [1015]|AETNA ACO WILCO [101532]|292.00||||292.00|26.91|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|TRUSTMARK [2030]|STARMARK [203000]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|GEHA [1415]|GEHA [141500]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|292.00||||292.00|24.86|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|292.00||||292.00|24.48|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|292.00||||292.00|140.01|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|292.00||||292.00|11.35|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|292.00||||292.00|17.82|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|292.00||||292.00|18.73|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MULTIPLAN [1680]|HMA [168003]|292.00||||292.00|25.55|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|292.00||||292.00|18.45|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|292.00||||292.00|175.2|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|292.00||||292.00|17.88|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|292.00||||292.00|146|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|292.00||||292.00|21.02|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|292.00||||292.00|102.49|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|292.00||||292.00|124.39|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|292.00||||292.00|146.29|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|292.00||||292.00|17.03|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|292.00||||292.00|262.8|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|292.00||||292.00|18.73|292|11.35 30286618|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYME DISEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|292.00||||292.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74.00||||74.00|16.52|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74.00||||74.00|31.52|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74.00||||74.00|14.5|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74.00||||74.00|14|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74.00||||74.00|8.92|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|TRUSTMARK [2030]|STARMARK [203000]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74.00||||74.00|37|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|HEALTHNET [1495]|HEALTHNET [149500]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MULTIPLAN [1680]|IHC HS [168011]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74.00||||74.00|16.52|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74.00||||74.00|15.54|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|AETNA [1015]|AETNA ACO WILCO [101532]|74.00||||74.00|21.13|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74.00||||74.00|74|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74.00||||74.00|35.48|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74.00||||74.00|37.07|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74.00||||74.00|25.97|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74.00||||74.00|48.1|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|UMR [2035]|UMR OPTIONS [203501]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|||74.00||||74.00|22.2|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74.00||||74.00|14.5|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74.00||||74.00|16.58|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74.00||||74.00|13.34|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|CHAMPVA [1240]|CHAMP VA [124000]|74.00||||74.00|55.5|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74.00||||74.00|44.4|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|CORESOURCE [1315]|CORESOURCE [131500]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74.00||||74.00|15.07|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|GEHA [1415]|GEHA [141500]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74.00||||74.00|66.6|74|8.92 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MULTIPLAN [1680]|HMA [168003]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74.00||||74.00||| 30286619|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BORRELIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74.00||||74.00||| 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|CORESOURCE [1315]|CORESOURCE [131500]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.00||||128.00|12.84|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|||128.00||||128.00|38.4|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.00||||128.00|83.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.00||||128.00|61.38|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.00||||128.00|10.05|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.00||||128.00|128|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|GEHA [1415]|GEHA [141500]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|UMR [2035]|UMR OPTIONS [203501]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.00||||128.00|11.03|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.00||||128.00|9.11|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.00||||128.00|12.84|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MULTIPLAN [1680]|IHC HS [168011]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MULTIPLAN [1680]|HMA [168003]|128.00||||128.00|13.4|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.00||||128.00|8.9|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.00||||128.00|13.04|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.00||||128.00|26.88|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|AETNA [1015]|AETNA ACO WILCO [101532]|128.00||||128.00|14.11|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|TRUSTMARK [2030]|STARMARK [203000]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.00||||128.00|5.95|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.00||||128.00|9.34|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.00||||128.00|9.67|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.00||||128.00|9.82|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.00||||128.00|9.67|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|CHAMPVA [1240]|CHAMP VA [124000]|128.00||||128.00|96|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.00||||128.00|76.8|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.00||||128.00|9.38|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.00||||128.00|64|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.00||||128.00|11.06|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.00||||128.00|44.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.00||||128.00|64.13|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.00||||128.00|11.03|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.00||||128.00|54.53|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.00||||128.00|8.93|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|HEALTHNET [1495]|HEALTHNET [149500]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.00||||128.00|115.2|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.00||||128.00|9.82|128|5.95 30286622|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB BRUCELLA IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.00||||128.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|HEALTHNET [1495]|HEALTHNET [149500]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MULTIPLAN [1680]|IHC HS [168011]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|FIRST HEALTH [1375]|QUALCHOICE [137513]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|374.00||||374.00|16.25|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374.00||||374.00|16.2|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|UMR [2035]|UMR OPTIONS [203501]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374.00||||374.00|78.54|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374.00||||374.00|374|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374.00||||374.00|179.33|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374.00||||374.00|243.1|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|FMH BENEFIT SERVICES [1390]|FMH [139000]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374.00||||374.00|14.21|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374.00||||374.00|13.08|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|CHAMPVA [1240]|CHAMP VA [124000]|374.00||||374.00|280.5|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|||374.00||||374.00|112.2|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|CORESOURCE [1315]|CORESOURCE [131500]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|GEHA [1415]|GEHA [141500]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|374.00||||374.00|14.77|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|374.00||||374.00|187.37|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374.00||||374.00|16.2|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|374.00||||374.00|159.32|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374.00||||374.00|131.27|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374.00||||374.00|187|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374.00||||374.00|224.4|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374.00||||374.00|14.21|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374.00||||374.00|13.73|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|374.00||||374.00|8.75|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|TRUSTMARK [2030]|STARMARK [203000]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374.00||||374.00|336.6|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|AETNA [1015]|AETNA ACO WILCO [101532]|374.00||||374.00|20.74|374|8.75 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MULTIPLAN [1680]|HMA [168003]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374.00||||374.00||| 30286625|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CAMPYLOBACTER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374.00||||374.00||| 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|GEHA [1415]|GEHA [141500]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|182.00||||182.00|13.52|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|182.00||||182.00|17.27|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|CHAMPVA [1240]|CHAMP VA [124000]|182.00||||182.00|136.5|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.00||||182.00|11.97|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.00||||182.00|13.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|||182.00||||182.00|54.6|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.00||||182.00|118.3|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.00||||182.00|87.27|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.00||||182.00|182|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.00||||182.00|38.22|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.00||||182.00|17.53|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|UMR [2035]|UMR OPTIONS [203501]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.00||||182.00|12.25|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.00||||182.00|14.82|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|182.00||||182.00|14.87|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MULTIPLAN [1680]|IHC HS [168011]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MULTIPLAN [1680]|HMA [168003]|182.00||||182.00|18.02|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|182.00||||182.00|17.27|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|HEALTHNET [1495]|HEALTHNET [149500]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|AETNA [1015]|AETNA ACO WILCO [101532]|182.00||||182.00|18.97|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|TRUSTMARK [2030]|STARMARK [203000]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|182.00||||182.00|8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.00||||182.00|12.57|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|CORESOURCE [1315]|CORESOURCE [131500]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.00||||182.00|13.21|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.00||||182.00|13.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.00||||182.00|109.2|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.00||||182.00|12.61|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.00||||182.00|91|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|182.00||||182.00|77.53|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|182.00||||182.00|91.18|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.00||||182.00|14.82|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.00||||182.00|63.88|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.00||||182.00|12.01|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.00||||182.00|13.21|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.00||||182.00|163.8|182|8 30286628|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CANDIDA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|182.00||||182.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|159.00||||159.00|67.73|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|159.00||||159.00|55.81|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|159.00||||159.00|14.6|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|159.00||||159.00|79.5|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|159.00||||159.00|95.4|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|159.00||||159.00|12.81|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|159.00||||159.00|12.37|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|159.00||||159.00|7.88|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|TRUSTMARK [2030]|STARMARK [203000]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|AETNA [1015]|AETNA ACO WILCO [101532]|159.00||||159.00|18.69|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|HEALTHNET [1495]|HEALTHNET [149500]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MULTIPLAN [1680]|IHC HS [168011]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|159.00||||159.00|14.64|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|159.00||||159.00|14.6|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|UMR [2035]|UMR OPTIONS [203501]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|159.00||||159.00|33.39|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|159.00||||159.00|159|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|159.00||||159.00|76.24|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|159.00||||159.00|79.66|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|159.00||||159.00|103.35|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|||159.00||||159.00|47.7|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|159.00||||159.00|12.81|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|159.00||||159.00|11.78|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|CHAMPVA [1240]|CHAMP VA [124000]|159.00||||159.00|119.25|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|CORESOURCE [1315]|CORESOURCE [131500]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|159.00||||159.00|13.31|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|GEHA [1415]|GEHA [141500]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|159.00||||159.00|143.1|159|7.88 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|MULTIPLAN [1680]|HMA [168003]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|159.00||||159.00||| 30286631|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CHLAMYDIA AB QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|159.00||||159.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|171.00||||171.00|14.28|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|CORESOURCE [1315]|CORESOURCE [131500]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|171.00||||171.00|12.64|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|171.00||||171.00|13.74|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|||171.00||||171.00|51.3|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|171.00||||171.00|111.15|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|171.00||||171.00|171|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|UMR [2035]|UMR OPTIONS [203501]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|171.00||||171.00|15.66|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|171.00||||171.00|15.7|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MULTIPLAN [1680]|IHC HS [168011]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|171.00||||171.00|35.91|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|171.00||||171.00|81.99|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|HEALTHNET [1495]|HEALTHNET [149500]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|AETNA [1015]|AETNA ACO WILCO [101532]|171.00||||171.00|20.04|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|TRUSTMARK [2030]|STARMARK [203000]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|171.00||||171.00|8.45|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|171.00||||171.00|13.27|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|CHAMPVA [1240]|CHAMP VA [124000]|171.00||||171.00|128.25|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|171.00||||171.00|13.74|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|171.00||||171.00|102.6|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|GEHA [1415]|GEHA [141500]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|171.00||||171.00|85.5|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|171.00||||171.00|60.02|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|171.00||||171.00|85.67|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|171.00||||171.00|15.66|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|171.00||||171.00|72.85|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|171.00||||171.00|153.9|171|8.45 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MULTIPLAN [1680]|HMA [168003]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|171.00||||171.00||| 30286632|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CHLAMYDIA IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|171.00||||171.00||| 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|392.00||||392.00|12.62|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|392.00||||392.00|166.99|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|392.00||||392.00|196.39|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|392.00||||392.00|137.59|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|392.00||||392.00|12.04|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|392.00||||392.00|235.2|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|392.00||||392.00|12.62|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|392.00||||392.00|12.01|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|392.00||||392.00|7.65|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|AETNA [1015]|AETNA ACO WILCO [101532]|392.00||||392.00|18.13|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|HEALTHNET [1495]|HEALTHNET [149500]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MULTIPLAN [1680]|HMA [168003]|392.00||||392.00|17.21|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|392.00||||392.00|16.49|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MULTIPLAN [1680]|IHC HS [168011]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|FMH BENEFIT SERVICES [1390]|FMH [139000]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|FIRST HEALTH [1375]|QUALCHOICE [137513]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|392.00||||392.00|14.21|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|392.00||||392.00|14.17|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|392.00||||392.00|11.7|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|TRUSTMARK [2030]|STARMARK [203000]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|UMR [2035]|UMR OPTIONS [203501]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|392.00||||392.00|16.75|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|392.00||||392.00|82.32|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|392.00||||392.00|12.43|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|392.00||||392.00|392|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|392.00||||392.00|187.96|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|392.00||||392.00|254.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|392.00||||392.00|196|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|392.00||||392.00|14.17|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|||392.00||||392.00|117.6|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|392.00||||392.00|12.43|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|392.00||||392.00|11.47|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|392.00||||392.00|11.43|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|CHAMPVA [1240]|CHAMP VA [124000]|392.00||||392.00|294|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|392.00||||392.00|16.49|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|CORESOURCE [1315]|CORESOURCE [131500]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|392.00||||392.00|12.92|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|GEHA [1415]|GEHA [141500]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|392.00||||392.00|352.8|392|7.65 30286635|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COCCIDIOIDES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|392.00||||392.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|GEHA [1415]|GEHA [141500]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|165.00||||165.00|13.65|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|CORESOURCE [1315]|CORESOURCE [131500]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|CHAMPVA [1240]|CHAMP VA [124000]|165.00||||165.00|123.75|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|165.00||||165.00|12.08|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|165.00||||165.00|13.13|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|||165.00||||165.00|49.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|165.00||||165.00|107.25|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|165.00||||165.00|79.12|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|165.00||||165.00|165|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|165.00||||165.00|34.65|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|UMR [2035]|UMR OPTIONS [203501]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|165.00||||165.00|14.97|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|165.00||||165.00|15.01|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|FIRST HEALTH [1375]|QUALCHOICE [137513]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|FMH BENEFIT SERVICES [1390]|FMH [139000]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MULTIPLAN [1680]|IHC HS [168011]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|HEALTHNET [1495]|HEALTHNET [149500]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|AETNA [1015]|AETNA ACO WILCO [101532]|165.00||||165.00|19.16|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|TRUSTMARK [2030]|STARMARK [203000]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|165.00||||165.00|8.08|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|165.00||||165.00|12.68|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|165.00||||165.00|13.13|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|165.00||||165.00|99|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|165.00||||165.00|82.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|165.00||||165.00|82.67|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|165.00||||165.00|57.92|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|165.00||||165.00|70.29|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|165.00||||165.00|14.97|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|165.00||||165.00|148.5|165|8.08 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MULTIPLAN [1680]|HMA [168003]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|165.00||||165.00||| 30286638|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB COXIELLA BRUNETII(Q FEVER)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|165.00||||165.00||| 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|270.00||||270.00|15.85|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|270.00||||270.00|94.77|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|270.00||||270.00|135.27|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|270.00||||270.00|17.79|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|270.00||||270.00|115.02|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|270.00||||270.00|135|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|270.00||||270.00|15.13|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|270.00||||270.00|15.62|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|270.00||||270.00|15.85|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|270.00||||270.00|15.08|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|270.00||||270.00|9.61|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|TRUSTMARK [2030]|STARMARK [203000]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|AETNA [1015]|AETNA ACO WILCO [101532]|270.00||||270.00|22.77|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|HEALTHNET [1495]|HEALTHNET [149500]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|270.00||||270.00|20.72|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MULTIPLAN [1680]|HMA [168003]|270.00||||270.00|21.62|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MULTIPLAN [1680]|IHC HS [168011]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|270.00||||270.00|17.86|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|270.00||||270.00|17.79|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|270.00||||270.00|14.7|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|UMR [2035]|UMR OPTIONS [203501]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|270.00||||270.00|21.04|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|270.00||||270.00|56.7|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|270.00||||270.00|162|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|270.00||||270.00|270|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|270.00||||270.00|129.47|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|270.00||||270.00|175.5|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|||270.00||||270.00|81|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|270.00||||270.00|15.62|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|270.00||||270.00|14.41|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|270.00||||270.00|14.36|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|CHAMPVA [1240]|CHAMP VA [124000]|270.00||||270.00|202.5|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|270.00||||270.00|20.72|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|CORESOURCE [1315]|CORESOURCE [131500]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|270.00||||270.00|16.24|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|GEHA [1415]|GEHA [141500]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|270.00||||270.00|243|270|9.61 30286641|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CRYPTOCOCCUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|270.00||||270.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|182.00||||182.00|16.2|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|CORESOURCE [1315]|CORESOURCE [131500]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|182.00||||182.00|112.84|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.00||||182.00|14.34|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.00||||182.00|14.39|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|||182.00||||182.00|54.6|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.00||||182.00|118.3|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.00||||182.00|182|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.00||||182.00|113.02|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|UMR [2035]|UMR OPTIONS [203501]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.00||||182.00|17.77|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|182.00||||182.00|17.83|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.00||||182.00|14.39|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.00||||182.00|14.68|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|182.00||||182.00|20.69|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.00||||182.00|38.22|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MULTIPLAN [1680]|HMA [168003]|182.00||||182.00|21.59|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MULTIPLAN [1680]|IHC HS [168011]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|HEALTHNET [1495]|HEALTHNET [149500]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|AETNA [1015]|AETNA ACO WILCO [101532]|182.00||||182.00|22.75|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.00||||182.00|14.39|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.00||||182.00|87.27|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.00||||182.00|15.59|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|TRUSTMARK [2030]|STARMARK [203000]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|182.00||||182.00|9.59|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.00||||182.00|15.06|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.00||||182.00|14.39|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|CHAMPVA [1240]|CHAMP VA [124000]|182.00||||182.00|136.5|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.00||||182.00|15.59|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|GEHA [1415]|GEHA [141500]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.00||||182.00|109.2|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.00||||182.00|15.11|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.00||||182.00|91|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|182.00||||182.00|77.53|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.00||||182.00|63.88|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|182.00||||182.00|91.18|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.00||||182.00|17.77|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.00||||182.00|14.39|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.00||||182.00|14.39|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.00||||182.00|163.8|182|9.59 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|182.00||||182.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|182.00||||182.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.00||||182.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.00||||182.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.00||||182.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|182.00||||182.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.00||||182.00||| 30286644|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.00||||182.00||| 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|339.00||||339.00|18.54|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|339.00||||339.00|20.8|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|339.00||||339.00|169.84|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|339.00||||339.00|144.41|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|339.00||||339.00|17.69|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|339.00||||339.00|203.4|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|339.00||||339.00|18.26|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|339.00||||339.00|18.54|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|339.00||||339.00|17.64|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|339.00||||339.00|11.23|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|AETNA [1015]|AETNA ACO WILCO [101532]|339.00||||339.00|26.62|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|HEALTHNET [1495]|HEALTHNET [149500]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MULTIPLAN [1680]|IHC HS [168011]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|339.00||||339.00|24.22|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MULTIPLAN [1680]|HMA [168003]|339.00||||339.00|25.28|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|339.00||||339.00|20.88|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|339.00||||339.00|20.8|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|339.00||||339.00|17.19|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|UMR [2035]|UMR OPTIONS [203501]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|339.00||||339.00|24.6|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|339.00||||339.00|71.19|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|339.00||||339.00|339|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|TRUSTMARK [2030]|STARMARK [203000]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|339.00||||339.00|162.55|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|339.00||||339.00|169.5|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|339.00||||339.00|220.35|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|339.00||||339.00|118.99|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|||339.00||||339.00|101.7|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|339.00||||339.00|18.26|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|339.00||||339.00|16.85|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|339.00||||339.00|16.8|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|CHAMPVA [1240]|CHAMP VA [124000]|339.00||||339.00|254.25|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|339.00||||339.00|24.22|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|CORESOURCE [1315]|CORESOURCE [131500]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|339.00||||339.00|18.98|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|GEHA [1415]|GEHA [141500]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|339.00||||339.00|305.1|339|11.23 30286645|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB CYTOMEGALOVIRUS (CMV) IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|339.00||||339.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|GEHA [1415]|GEHA [141500]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|205.00||||205.00|17.13|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00|153.75|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205.00||||205.00|15.16|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205.00||||205.00|16.48|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|||205.00||||205.00|61.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205.00||||205.00|133.25|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|98.3|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205.00||||205.00|205|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205.00||||205.00|43.05|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|UMR [2035]|UMR OPTIONS [203501]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|18.77|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|205.00||||205.00|18.84|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MULTIPLAN [1680]|IHC HS [168011]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|HEALTHNET [1495]|HEALTHNET [149500]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|24.04|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|TRUSTMARK [2030]|STARMARK [203000]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|205.00||||205.00|10.14|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205.00||||205.00|15.92|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|CORESOURCE [1315]|CORESOURCE [131500]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205.00||||205.00|16.48|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205.00||||205.00|123|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205.00||||205.00|102.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205.00||||205.00|71.96|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|205.00||||205.00|102.71|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205.00||||205.00|18.77|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|205.00||||205.00|87.33|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205.00||||205.00|184.5|205|10.14 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MULTIPLAN [1680]|HMA [168003]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00||| 30286648|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB DIPTHERIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205.00||||205.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|16.28|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|14.29|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|13.81|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|8.79|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|20.84|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|16.34|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|16.28|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|||192.00||||192.00|57.6|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|14.29|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|13.15|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|14.85|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|8.79 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00||| 30286651|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS CALIFORNIA LA CROSSE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|14.85|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|13.15|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|||192.00||||192.00|57.6|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|16.28|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|16.34|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|14.29|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|20.84|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|8.79|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|13.81|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|14.29|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|16.28|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|8.79 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00||| 30286652|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS EASTERN EQUINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|16.28|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|13.81|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|8.79|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|20.84|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|16.34|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|16.28|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|14.29|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|||192.00||||192.00|57.6|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|14.29|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|13.15|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|14.85|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|8.79 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00||| 30286653|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS ST. LOUIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|14.85|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|13.15|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|14.29|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|||192.00||||192.00|57.6|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|16.28|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|16.34|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|20.84|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|8.79|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|13.81|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|14.29|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|16.28|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|8.79 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00||| 30286654|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENCEPHALITIS WESTERN EQUINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|164.00||||164.00|82.16|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|164.00||||164.00|69.86|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|164.00||||164.00|57.56|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|164.00||||164.00|82|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|164.00||||164.00|14.12|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|164.00||||164.00|13.64|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|164.00||||164.00|8.68|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|TRUSTMARK [2030]|STARMARK [203000]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|AETNA [1015]|AETNA ACO WILCO [101532]|164.00||||164.00|20.59|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|HEALTHNET [1495]|HEALTHNET [149500]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MULTIPLAN [1680]|IHC HS [168011]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|164.00||||164.00|16.14|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|164.00||||164.00|16.08|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|UMR [2035]|UMR OPTIONS [203501]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|164.00||||164.00|34.44|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|164.00||||164.00|164|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|164.00||||164.00|78.64|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|164.00||||164.00|98.4|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|164.00||||164.00|16.08|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|164.00||||164.00|106.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|||164.00||||164.00|49.2|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|164.00||||164.00|14.12|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|164.00||||164.00|12.99|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|CHAMPVA [1240]|CHAMP VA [124000]|164.00||||164.00|123|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|CORESOURCE [1315]|CORESOURCE [131500]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|164.00||||164.00|14.68|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|GEHA [1415]|GEHA [141500]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|164.00||||164.00|147.6|164|8.68 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MULTIPLAN [1680]|HMA [168003]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|164.00||||164.00||| 30286658|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB ENTEROVIRUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|164.00||||164.00||| 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|GEHA [1415]|GEHA [141500]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|273.00||||273.00|14.77|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|CORESOURCE [1315]|CORESOURCE [131500]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|273.00||||273.00|18.86|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|273.00||||273.00|13.08|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|||273.00||||273.00|81.9|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|273.00||||273.00|177.45|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273.00||||273.00|130.9|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|273.00||||273.00|273|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|273.00||||273.00|19.16|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|UMR [2035]|UMR OPTIONS [203501]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273.00||||273.00|16.2|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|273.00||||273.00|16.25|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273.00||||273.00|13.38|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|273.00||||273.00|57.33|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MULTIPLAN [1680]|IHC HS [168011]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MULTIPLAN [1680]|HMA [168003]|273.00||||273.00|19.68|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|273.00||||273.00|18.86|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|HEALTHNET [1495]|HEALTHNET [149500]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|273.00||||273.00|14.21|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|AETNA [1015]|AETNA ACO WILCO [101532]|273.00||||273.00|20.74|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|TRUSTMARK [2030]|STARMARK [203000]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|273.00||||273.00|8.75|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|273.00||||273.00|13.73|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|CHAMPVA [1240]|CHAMP VA [124000]|273.00||||273.00|204.75|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|273.00||||273.00|14.43|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|273.00||||273.00|14.21|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273.00||||273.00|163.8|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|273.00||||273.00|13.78|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273.00||||273.00|136.5|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|273.00||||273.00|16.2|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|273.00||||273.00|95.82|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|273.00||||273.00|116.3|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|273.00||||273.00|136.77|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273.00||||273.00|13.12|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|273.00||||273.00|14.43|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|273.00||||273.00|245.7|273|8.75 30286663|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBEA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|273.00||||273.00||| 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247.00||||247.00|16.82|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247.00||||247.00|86.7|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247.00||||247.00|18.88|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|247.00||||247.00|105.22|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|247.00||||247.00|123.75|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247.00||||247.00|16.05|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247.00||||247.00|148.2|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247.00||||247.00|16.82|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247.00||||247.00|16|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|247.00||||247.00|10.19|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|TRUSTMARK [2030]|STARMARK [203000]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|AETNA [1015]|AETNA ACO WILCO [101532]|247.00||||247.00|24.17|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|HEALTHNET [1495]|HEALTHNET [149500]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MULTIPLAN [1680]|IHC HS [168011]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|247.00||||247.00|21.98|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MULTIPLAN [1680]|HMA [168003]|247.00||||247.00|22.94|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|FMH BENEFIT SERVICES [1390]|FMH [139000]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|FIRST HEALTH [1375]|QUALCHOICE [137513]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|247.00||||247.00|18.94|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247.00||||247.00|18.88|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247.00||||247.00|15.6|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|UMR [2035]|UMR OPTIONS [203501]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247.00||||247.00|22.32|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247.00||||247.00|51.87|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247.00||||247.00|247|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247.00||||247.00|16.56|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247.00||||247.00|123.5|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247.00||||247.00|118.44|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247.00||||247.00|160.55|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|||247.00||||247.00|74.1|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247.00||||247.00|16.56|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247.00||||247.00|15.29|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247.00||||247.00|15.24|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|CHAMPVA [1240]|CHAMP VA [124000]|247.00||||247.00|185.25|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|247.00||||247.00|21.98|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|CORESOURCE [1315]|CORESOURCE [131500]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|247.00||||247.00|17.21|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|GEHA [1415]|GEHA [141500]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247.00||||247.00|222.3|247|10.19 30286664|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR (EBNA)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|247.00||||247.00||| 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|GEHA [1415]|GEHA [141500]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|275.00||||275.00|20.42|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|275.00||||275.00|26.08|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|CHAMPVA [1240]|CHAMP VA [124000]|275.00||||275.00|206.25|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|275.00||||275.00|18.08|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|275.00||||275.00|19.65|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|||275.00||||275.00|82.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|275.00||||275.00|178.75|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|275.00||||275.00|131.86|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|275.00||||275.00|275|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|275.00||||275.00|57.75|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|275.00||||275.00|26.48|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|UMR [2035]|UMR OPTIONS [203501]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|275.00||||275.00|18.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|275.00||||275.00|22.4|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|275.00||||275.00|22.47|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|FIRST HEALTH [1375]|QUALCHOICE [137513]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|FMH BENEFIT SERVICES [1390]|FMH [139000]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MULTIPLAN [1680]|IHC HS [168011]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|275.00||||275.00|26.08|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MULTIPLAN [1680]|HMA [168003]|275.00||||275.00|27.21|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|HEALTHNET [1495]|HEALTHNET [149500]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|AETNA [1015]|AETNA ACO WILCO [101532]|275.00||||275.00|28.67|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|TRUSTMARK [2030]|STARMARK [203000]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|275.00||||275.00|12.1|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|275.00||||275.00|18.98|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|CORESOURCE [1315]|CORESOURCE [131500]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|275.00||||275.00|19.95|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|275.00||||275.00|19.65|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|275.00||||275.00|165|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|275.00||||275.00|19.05|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|275.00||||275.00|137.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|275.00||||275.00|117.15|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|275.00||||275.00|137.78|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|275.00||||275.00|22.4|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|275.00||||275.00|96.53|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|275.00||||275.00|18.14|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|275.00||||275.00|19.95|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|275.00||||275.00|247.5|275|12.1 30286665|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EPSTEIN-BARR VCA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|275.00||||275.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|140.00||||140.00|70.14|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|140.00||||140.00|59.64|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|140.00||||140.00|49.14|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|140.00||||140.00|70|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|140.00||||140.00|84|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|140.00||||140.00|11.03|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|140.00||||140.00|10.65|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|140.00||||140.00|6.79|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|TRUSTMARK [2030]|STARMARK [203000]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|AETNA [1015]|AETNA ACO WILCO [101532]|140.00||||140.00|16.08|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|HEALTHNET [1495]|HEALTHNET [149500]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MULTIPLAN [1680]|IHC HS [168011]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|140.00||||140.00|12.61|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|140.00||||140.00|12.56|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|UMR [2035]|UMR OPTIONS [203501]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|140.00||||140.00|29.4|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|140.00||||140.00|140|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|140.00||||140.00|67.13|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|140.00||||140.00|12.56|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|140.00||||140.00|91|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|||140.00||||140.00|42|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|140.00||||140.00|11.03|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|140.00||||140.00|10.14|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|CHAMPVA [1240]|CHAMP VA [124000]|140.00||||140.00|105|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|CORESOURCE [1315]|CORESOURCE [131500]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|140.00||||140.00|11.46|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|GEHA [1415]|GEHA [141500]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|140.00||||140.00|126|140|6.79 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|MULTIPLAN [1680]|HMA [168003]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|140.00||||140.00||| 30286666|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB EHRLICHIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|140.00||||140.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|15.94|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|14.12|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|15.34|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|||150.00||||150.00|45|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|14.16|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|17.53|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00|20.14|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|8.5|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|14.82|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|15.34|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|14.16|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|8.5 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 30286668|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FRANCISELLA TULARENSIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154.00||||154.00|13.48|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|154.00||||154.00|77.15|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154.00||||154.00|54.05|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|154.00||||154.00|65.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154.00||||154.00|12.86|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154.00||||154.00|92.4|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154.00||||154.00|13.48|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154.00||||154.00|12.82|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|154.00||||154.00|8.17|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|AETNA [1015]|AETNA ACO WILCO [101532]|154.00||||154.00|19.38|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|HEALTHNET [1495]|HEALTHNET [149500]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MULTIPLAN [1680]|IHC HS [168011]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|154.00||||154.00|17.61|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|FMH BENEFIT SERVICES [1390]|FMH [139000]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|FIRST HEALTH [1375]|QUALCHOICE [137513]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|154.00||||154.00|15.19|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MULTIPLAN [1680]|HMA [168003]|154.00||||154.00|18.38|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154.00||||154.00|15.13|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154.00||||154.00|12.5|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|TRUSTMARK [2030]|STARMARK [203000]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|UMR [2035]|UMR OPTIONS [203501]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154.00||||154.00|17.89|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154.00||||154.00|32.34|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154.00||||154.00|13.28|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154.00||||154.00|154|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154.00||||154.00|73.84|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154.00||||154.00|100.1|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154.00||||154.00|77|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154.00||||154.00|15.13|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|||154.00||||154.00|46.2|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154.00||||154.00|13.28|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154.00||||154.00|12.25|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154.00||||154.00|12.21|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|CHAMPVA [1240]|CHAMP VA [124000]|154.00||||154.00|115.5|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|154.00||||154.00|17.61|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|CORESOURCE [1315]|CORESOURCE [131500]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|154.00||||154.00|13.8|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|GEHA [1415]|GEHA [141500]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154.00||||154.00|138.6|154|8.17 30286671|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB FUNGUS NOT ELSEWHERE SPECIFIED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|154.00||||154.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|GEHA [1415]|GEHA [141500]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|209.00||||209.00|16.58|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|CORESOURCE [1315]|CORESOURCE [131500]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|CHAMPVA [1240]|CHAMP VA [124000]|209.00||||209.00|156.75|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209.00||||209.00|14.68|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209.00||||209.00|15.95|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|||209.00||||209.00|62.7|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209.00||||209.00|135.85|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209.00||||209.00|100.22|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209.00||||209.00|209|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209.00||||209.00|43.89|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|UMR [2035]|UMR OPTIONS [203501]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209.00||||209.00|18.17|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|209.00||||209.00|18.24|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MULTIPLAN [1680]|IHC HS [168011]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|HEALTHNET [1495]|HEALTHNET [149500]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|AETNA [1015]|AETNA ACO WILCO [101532]|209.00||||209.00|23.25|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|TRUSTMARK [2030]|STARMARK [203000]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|209.00||||209.00|9.81|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209.00||||209.00|15.41|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209.00||||209.00|15.95|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209.00||||209.00|125.4|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209.00||||209.00|104.5|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209.00||||209.00|18.17|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|209.00||||209.00|89.03|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|209.00||||209.00|104.71|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209.00||||209.00|73.36|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209.00||||209.00|188.1|209|9.81 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MULTIPLAN [1680]|HMA [168003]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209.00||||209.00||| 30286674|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB GIARDIA LAMBLIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209.00||||209.00||| 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|387.00||||387.00|18.54|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|387.00||||387.00|164.86|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|387.00||||387.00|17.91|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|387.00||||387.00|135.84|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|387.00||||387.00|193.89|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|387.00||||387.00|193.5|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|387.00||||387.00|17.69|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|387.00||||387.00|18.26|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|387.00||||387.00|18.54|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|387.00||||387.00|17.64|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|387.00||||387.00|10.11|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|TRUSTMARK [2030]|STARMARK [203000]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|AETNA [1015]|AETNA ACO WILCO [101532]|387.00||||387.00|23.97|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|HEALTHNET [1495]|HEALTHNET [149500]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|387.00||||387.00|24.22|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MULTIPLAN [1680]|HMA [168003]|387.00||||387.00|25.28|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|FMH BENEFIT SERVICES [1390]|FMH [139000]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|FIRST HEALTH [1375]|QUALCHOICE [137513]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MULTIPLAN [1680]|IHC HS [168011]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|387.00||||387.00|20.88|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|387.00||||387.00|17.91|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|387.00||||387.00|17.19|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|UMR [2035]|UMR OPTIONS [203501]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|387.00||||387.00|24.6|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|387.00||||387.00|81.27|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|387.00||||387.00|232.2|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|387.00||||387.00|387|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|387.00||||387.00|185.57|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|387.00||||387.00|251.55|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|||387.00||||387.00|116.1|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|387.00||||387.00|18.26|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|387.00||||387.00|16.85|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|387.00||||387.00|16.8|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|CHAMPVA [1240]|CHAMP VA [124000]|387.00||||387.00|290.25|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|387.00||||387.00|24.22|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|CORESOURCE [1315]|CORESOURCE [131500]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|387.00||||387.00|18.98|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|GEHA [1415]|GEHA [141500]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|387.00||||387.00|348.3|387|10.11 30286677|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELICOBACTER PYLORI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|387.00||||387.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|220.00||||220.00|14.66|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|CORESOURCE [1315]|CORESOURCE [131500]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|220.00||||220.00|12.96|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|||220.00||||220.00|66|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|220.00||||220.00|143|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|220.00||||220.00|220|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|220.00||||220.00|46.2|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|UMR [2035]|UMR OPTIONS [203501]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|220.00||||220.00|16.06|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|220.00||||220.00|16.12|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|FIRST HEALTH [1375]|QUALCHOICE [137513]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|FMH BENEFIT SERVICES [1390]|FMH [139000]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MULTIPLAN [1680]|IHC HS [168011]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|HEALTHNET [1495]|HEALTHNET [149500]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|AETNA [1015]|AETNA ACO WILCO [101532]|220.00||||220.00|20.55|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|220.00||||220.00|105.49|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|220.00||||220.00|14.1|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|TRUSTMARK [2030]|STARMARK [203000]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|220.00||||220.00|8.67|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|220.00||||220.00|13.61|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|CHAMPVA [1240]|CHAMP VA [124000]|220.00||||220.00|165|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|220.00||||220.00|14.1|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|GEHA [1415]|GEHA [141500]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|220.00||||220.00|132|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|220.00||||220.00|110|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|220.00||||220.00|16.06|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|220.00||||220.00|77.22|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|220.00||||220.00|93.72|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|220.00||||220.00|110.22|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|220.00||||220.00|198|220|8.67 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MULTIPLAN [1680]|HMA [168003]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|220.00||||220.00||| 30286682|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HELMINTH NOT ELSEWHERE SPECIFIED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|220.00||||220.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|214.00||||214.00|19.56|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|214.00||||214.00|75.11|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|214.00||||214.00|107.21|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|214.00||||214.00|128.4|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|214.00||||214.00|17.16|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|214.00||||214.00|16.58|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|AETNA [1015]|AETNA ACO WILCO [101532]|214.00||||214.00|25.03|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|HEALTHNET [1495]|HEALTHNET [149500]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MULTIPLAN [1680]|IHC HS [168011]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|FMH BENEFIT SERVICES [1390]|FMH [139000]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|FIRST HEALTH [1375]|QUALCHOICE [137513]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|214.00||||214.00|19.62|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|214.00||||214.00|19.56|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|TRUSTMARK [2030]|STARMARK [203000]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|UMR [2035]|UMR OPTIONS [203501]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|214.00||||214.00|10.56|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|214.00||||214.00|44.94|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|214.00||||214.00|214|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|214.00||||214.00|102.61|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|214.00||||214.00|107|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|214.00||||214.00|139.1|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|214.00||||214.00|91.16|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|||214.00||||214.00|64.2|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|214.00||||214.00|17.16|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|214.00||||214.00|15.79|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|CHAMPVA [1240]|CHAMP VA [124000]|214.00||||214.00|160.5|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|CORESOURCE [1315]|CORESOURCE [131500]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|214.00||||214.00|17.84|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|GEHA [1415]|GEHA [141500]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|214.00||||214.00|192.6|214|10.56 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|MULTIPLAN [1680]|HMA [168003]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|214.00||||214.00||| 30286684|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEMOPHILUS INFLUENZA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|214.00||||214.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|GEHA [1415]|GEHA [141500]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|134.00||||134.00|10.23|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|CHAMPVA [1240]|CHAMP VA [124000]|134.00||||134.00|100.5|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134.00||||134.00|9.05|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134.00||||134.00|9.84|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|||134.00||||134.00|40.2|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134.00||||134.00|87.1|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134.00||||134.00|64.25|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134.00||||134.00|134|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134.00||||134.00|28.14|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|UMR [2035]|UMR OPTIONS [203501]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134.00||||134.00|10.36|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|134.00||||134.00|11.25|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|FIRST HEALTH [1375]|QUALCHOICE [137513]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|FMH BENEFIT SERVICES [1390]|FMH [139000]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MULTIPLAN [1680]|IHC HS [168011]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|HEALTHNET [1495]|HEALTHNET [149500]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|AETNA [1015]|AETNA ACO WILCO [101532]|134.00||||134.00|13.26|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|TRUSTMARK [2030]|STARMARK [203000]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|134.00||||134.00|5.59|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134.00||||134.00|9.51|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|CORESOURCE [1315]|CORESOURCE [131500]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134.00||||134.00|9.84|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134.00||||134.00|80.4|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134.00||||134.00|67|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134.00||||134.00|10.36|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|134.00||||134.00|57.08|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|134.00||||134.00|67.13|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134.00||||134.00|47.03|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134.00||||134.00|120.6|134|5.59 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MULTIPLAN [1680]|HMA [168003]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134.00||||134.00||| 30286687|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV-I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134.00||||134.00||| 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|243.00||||243.00|21.29|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|243.00||||243.00|121.74|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|243.00||||243.00|85.29|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|243.00||||243.00|23.9|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|243.00||||243.00|121.5|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|243.00||||243.00|20.32|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|243.00||||243.00|20.97|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|243.00||||243.00|21.29|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|243.00||||243.00|20.25|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|243.00||||243.00|12.91|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|TRUSTMARK [2030]|STARMARK [203000]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|AETNA [1015]|AETNA ACO WILCO [101532]|243.00||||243.00|30.6|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|HEALTHNET [1495]|HEALTHNET [149500]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|243.00||||243.00|27.82|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MULTIPLAN [1680]|HMA [168003]|243.00||||243.00|29.03|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|FMH BENEFIT SERVICES [1390]|FMH [139000]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|FIRST HEALTH [1375]|QUALCHOICE [137513]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|243.00||||243.00|23.98|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|243.00||||243.00|23.9|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|243.00||||243.00|19.74|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MULTIPLAN [1680]|IHC HS [168011]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|UMR [2035]|UMR OPTIONS [203501]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|243.00||||243.00|28.25|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|243.00||||243.00|51.03|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|243.00||||243.00|145.8|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|243.00||||243.00|243|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|243.00||||243.00|116.52|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|243.00||||243.00|103.52|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|243.00||||243.00|157.95|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|||243.00||||243.00|72.9|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|243.00||||243.00|20.97|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|243.00||||243.00|19.35|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|243.00||||243.00|19.28|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|CHAMPVA [1240]|CHAMP VA [124000]|243.00||||243.00|182.25|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|243.00||||243.00|27.82|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|CORESOURCE [1315]|CORESOURCE [131500]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|243.00||||243.00|21.8|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|GEHA [1415]|GEHA [141500]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|243.00||||243.00|218.7|243|12.91 30286689|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HTLV/HIV CONFIRM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|243.00||||243.00||| 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|260.00||||260.00|19.32|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|CORESOURCE [1315]|CORESOURCE [131500]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|260.00||||260.00|24.67|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|CHAMPVA [1240]|CHAMP VA [124000]|260.00||||260.00|195|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260.00||||260.00|17.1|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|||260.00||||260.00|78|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260.00||||260.00|169|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260.00||||260.00|260|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260.00||||260.00|54.6|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260.00||||260.00|25.05|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|UMR [2035]|UMR OPTIONS [203501]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260.00||||260.00|21.19|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|260.00||||260.00|21.26|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260.00||||260.00|17.5|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MULTIPLAN [1680]|HMA [168003]|260.00||||260.00|25.74|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MULTIPLAN [1680]|IHC HS [168011]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|260.00||||260.00|24.67|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260.00||||260.00|124.67|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|HEALTHNET [1495]|HEALTHNET [149500]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260.00||||260.00|18.59|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|AETNA [1015]|AETNA ACO WILCO [101532]|260.00||||260.00|27.13|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|TRUSTMARK [2030]|STARMARK [203000]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|260.00||||260.00|11.44|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260.00||||260.00|17.95|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260.00||||260.00|18.88|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260.00||||260.00|18.59|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260.00||||260.00|156|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|GEHA [1415]|GEHA [141500]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260.00||||260.00|18.02|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260.00||||260.00|130|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|260.00||||260.00|110.76|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260.00||||260.00|91.26|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260.00||||260.00|21.19|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|260.00||||260.00|130.26|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260.00||||260.00|17.16|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260.00||||260.00|18.88|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260.00||||260.00|234|260|11.44 30286692|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP DELTA AGENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|260.00||||260.00||| 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|509.00||||509.00|15.83|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|509.00||||509.00|255.01|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|509.00||||509.00|178.66|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|509.00||||509.00|17.77|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|509.00||||509.00|254.5|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|509.00||||509.00|15.11|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|509.00||||509.00|305.4|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|509.00||||509.00|15.83|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|509.00||||509.00|15.06|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|AETNA [1015]|AETNA ACO WILCO [101532]|509.00||||509.00|22.75|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|HEALTHNET [1495]|HEALTHNET [149500]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MULTIPLAN [1680]|IHC HS [168011]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|509.00||||509.00|20.69|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MULTIPLAN [1680]|HMA [168003]|509.00||||509.00|21.59|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|FMH BENEFIT SERVICES [1390]|FMH [139000]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|FIRST HEALTH [1375]|QUALCHOICE [137513]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|509.00||||509.00|17.83|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|509.00||||509.00|17.77|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|509.00||||509.00|14.68|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|UMR [2035]|UMR OPTIONS [203501]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|509.00||||509.00|21.01|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|TRUSTMARK [2030]|STARMARK [203000]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|509.00||||509.00|9.59|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|509.00||||509.00|106.89|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|509.00||||509.00|15.59|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|509.00||||509.00|509|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|509.00||||509.00|244.07|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|509.00||||509.00|330.85|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|509.00||||509.00|216.83|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|||509.00||||509.00|152.7|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|509.00||||509.00|15.59|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|509.00||||509.00|14.39|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|509.00||||509.00|14.34|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|CHAMPVA [1240]|CHAMP VA [124000]|509.00||||509.00|381.75|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|509.00||||509.00|20.69|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|CORESOURCE [1315]|CORESOURCE [131500]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|509.00||||509.00|16.2|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|GEHA [1415]|GEHA [141500]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|509.00||||509.00|458.1|509|9.59 30286694|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|509.00||||509.00||| 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|GEHA [1415]|GEHA [141500]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|166.00||||166.00|14.85|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|166.00||||166.00|18.96|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|CHAMPVA [1240]|CHAMP VA [124000]|166.00||||166.00|124.5|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166.00||||166.00|13.15|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166.00||||166.00|14.29|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|||166.00||||166.00|49.8|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166.00||||166.00|107.9|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166.00||||166.00|79.6|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166.00||||166.00|166|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166.00||||166.00|34.86|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|UMR [2035]|UMR OPTIONS [203501]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166.00||||166.00|13.45|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166.00||||166.00|16.28|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|166.00||||166.00|16.34|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|FIRST HEALTH [1375]|QUALCHOICE [137513]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|FMH BENEFIT SERVICES [1390]|FMH [139000]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|166.00||||166.00|18.96|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166.00||||166.00|19.26|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MULTIPLAN [1680]|HMA [168003]|166.00||||166.00|19.79|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MULTIPLAN [1680]|IHC HS [168011]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|HEALTHNET [1495]|HEALTHNET [149500]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|AETNA [1015]|AETNA ACO WILCO [101532]|166.00||||166.00|20.84|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|TRUSTMARK [2030]|STARMARK [203000]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|166.00||||166.00|8.79|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166.00||||166.00|13.81|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166.00||||166.00|14.51|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166.00||||166.00|14.29|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|CORESOURCE [1315]|CORESOURCE [131500]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166.00||||166.00|99.6|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166.00||||166.00|13.85|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166.00||||166.00|83|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166.00||||166.00|58.27|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166.00||||166.00|16.28|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|166.00||||166.00|70.72|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|166.00||||166.00|83.17|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166.00||||166.00|13.19|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166.00||||166.00|14.51|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166.00||||166.00|149.4|166|8.79 30286695|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|166.00||||166.00||| 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|243.00||||243.00|28.25|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|243.00||||243.00|51.03|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|243.00||||243.00|243|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|243.00||||243.00|116.52|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|243.00||||243.00|157.95|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|||243.00||||243.00|72.9|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|243.00||||243.00|20.97|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|243.00||||243.00|19.28|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|CHAMPVA [1240]|CHAMP VA [124000]|243.00||||243.00|182.25|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|243.00||||243.00|27.82|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|CORESOURCE [1315]|CORESOURCE [131500]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|243.00||||243.00|21.8|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|GEHA [1415]|GEHA [141500]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|TRUSTMARK [2030]|STARMARK [203000]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|FIRST HEALTH [1375]|QUALCHOICE [137513]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|243.00||||243.00|20.32|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|FMH BENEFIT SERVICES [1390]|FMH [139000]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|243.00||||243.00|23.9|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|243.00||||243.00|145.8|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|UMR [2035]|UMR OPTIONS [203501]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MULTIPLAN [1680]|HMA [168003]|243.00||||243.00|29.03|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|243.00||||243.00|103.52|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|243.00||||243.00|23.98|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|243.00||||243.00|20.97|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|243.00||||243.00|121.74|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|243.00||||243.00|27.82|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|243.00||||243.00|19.74|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|243.00||||243.00|21.29|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MULTIPLAN [1680]|IHC HS [168011]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|243.00||||243.00|21.29|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|HEALTHNET [1495]|HEALTHNET [149500]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|243.00||||243.00|121.5|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|243.00||||243.00|85.29|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|AETNA [1015]|AETNA ACO WILCO [101532]|243.00||||243.00|30.6|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|243.00||||243.00|19.35|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|243.00||||243.00|23.9|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|243.00||||243.00|20.25|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|243.00||||243.00|12.91|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|AETNA [1015]|COVENTRY HEALTHCARE [101502]|243.00||||243.00|218.7|243|12.91 30286696|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HERPES SIMPLEX TYPE II|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|243.00||||243.00||| 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198.00||||198.00|99|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MULTIPLAN [1680]|IHC HS [168011]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198.00||||198.00|15.43|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198.00||||198.00|15.43|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|TRUSTMARK [2030]|STARMARK [203000]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198.00||||198.00|69.5|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|UMR [2035]|UMR OPTIONS [203501]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|198.00||||198.00|17.08|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|GEHA [1415]|GEHA [141500]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198.00||||198.00|14.48|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|CHAMPVA [1240]|CHAMP VA [124000]|198.00||||198.00|148.5|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|198.00||||198.00|84.35|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|198.00||||198.00|19.82|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198.00||||198.00|14.94|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|198.00||||198.00|8.33|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198.00||||198.00|41.58|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198.00||||198.00|14.94|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|||198.00||||198.00|59.4|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198.00||||198.00|198|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|FIRST HEALTH [1375]|QUALCHOICE [137513]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198.00||||198.00|15.17|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|CORESOURCE [1315]|CORESOURCE [131500]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198.00||||198.00|118.8|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198.00||||198.00|13.74|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198.00||||198.00|14.43|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MULTIPLAN [1680]|HMA [168003]|198.00||||198.00|20.69|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|AETNA [1015]|AETNA ACO WILCO [101532]|198.00||||198.00|19.75|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198.00||||198.00|94.94|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198.00||||198.00|128.7|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|HEALTHNET [1495]|HEALTHNET [149500]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|198.00||||198.00|15.53|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198.00||||198.00|20.13|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198.00||||198.00|15.17|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|FMH BENEFIT SERVICES [1390]|FMH [139000]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|198.00||||198.00|99.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198.00||||198.00|14.07|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|198.00||||198.00|19.82|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198.00||||198.00|178.2|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198.00||||198.00|13.79|198|8.33 30286698|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HISTOPLASMA AB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|198.00||||198.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|9.64|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|10.02|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|||150.00||||150.00|45|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|9.31|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|10.97|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|9.64|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|10.97|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|5.92|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|8.87|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00|14.03|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|11.02|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|5.92 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 30286701|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|GEHA [1415]|GEHA [141500]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|||182.00||||182.00|54.6|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|CHAMPVA [1240]|CHAMP VA [124000]|182.00||||182.00|136.5|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.00||||182.00|182|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|182.00||||182.00|19.44|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.00||||182.00|38.22|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|182.00||||182.00|77.53|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.00||||182.00|14.65|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.00||||182.00|87.27|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|182.00||||182.00|15.23|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|182.00||||182.00|19.44|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|HEALTHNET [1495]|HEALTHNET [149500]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|AETNA [1015]|AETNA ACO WILCO [101532]|182.00||||182.00|21.37|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MULTIPLAN [1680]|HMA [168003]|182.00||||182.00|20.28|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.00||||182.00|118.3|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.00||||182.00|14.65|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|182.00||||182.00|9.01|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.00||||182.00|16.69|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MULTIPLAN [1680]|IHC HS [168011]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.00||||182.00|16.69|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.00||||182.00|63.88|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.00||||182.00|14.2|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|TRUSTMARK [2030]|STARMARK [203000]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.00||||182.00|19.74|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.00||||182.00|13.79|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|182.00||||182.00|91.18|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.00||||182.00|14.14|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|182.00||||182.00|16.75|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|CORESOURCE [1315]|CORESOURCE [131500]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|UMR [2035]|UMR OPTIONS [203501]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.00||||182.00|14.87|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.00||||182.00|13.47|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.00||||182.00|91|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.00||||182.00|14.87|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.00||||182.00|163.8|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.00||||182.00|13.52|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.00||||182.00|109.2|182|9.01 30286702|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-2|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|182.00||||182.00||| 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232.00||||232.00|13.67|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|232.00||||232.00|15.45|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|CHAMPVA [1240]|CHAMP VA [124000]|232.00||||232.00|174|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|232.00||||232.00|19.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|CORESOURCE [1315]|CORESOURCE [131500]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|GEHA [1415]|GEHA [141500]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232.00||||232.00|15.08|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232.00||||232.00|16.92|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|232.00||||232.00|98.83|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232.00||||232.00|116|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|232.00||||232.00|116.23|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232.00||||232.00|14.86|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232.00||||232.00|139.2|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232.00||||232.00|81.43|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232.00||||232.00|15.08|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232.00||||232.00|16.92|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|232.00||||232.00|9.14|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|232.00||||232.00|19.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|232.00||||232.00|16.99|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232.00||||232.00|14.35|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232.00||||232.00|232|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MULTIPLAN [1680]|IHC HS [168011]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MULTIPLAN [1680]|HMA [168003]|232.00||||232.00|20.57|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|UMR [2035]|UMR OPTIONS [203501]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232.00||||232.00|20.02|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232.00||||232.00|14.4|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232.00||||232.00|13.98|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232.00||||232.00|48.72|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|||232.00||||232.00|69.6|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|TRUSTMARK [2030]|STARMARK [203000]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|HEALTHNET [1495]|HEALTHNET [149500]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232.00||||232.00|14.86|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232.00||||232.00|111.24|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232.00||||232.00|150.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|AETNA [1015]|AETNA ACO WILCO [101532]|232.00||||232.00|21.66|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|232.00||||232.00|13.71|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|232.00||||232.00|208.8|232|9.14 30286703|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HIV-1/HIV-2 SGL ASSAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|232.00||||232.00||| 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|GEHA [1415]|GEHA [141500]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158.00||||158.00|13.06|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|158.00||||158.00|13.57|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158.00||||158.00|12.02|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|158.00||||158.00|17.32|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158.00||||158.00|33.18|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158.00||||158.00|12.29|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|UMR [2035]|UMR OPTIONS [203501]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158.00||||158.00|158|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|158.00||||158.00|118.5|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158.00||||158.00|17.59|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158.00||||158.00|12.62|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MULTIPLAN [1680]|IHC HS [168011]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|158.00||||158.00|17.32|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MULTIPLAN [1680]|HMA [168003]|158.00||||158.00|18.08|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|TRUSTMARK [2030]|STARMARK [203000]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|158.00||||158.00|14.94|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|158.00||||158.00|19.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158.00||||158.00|8.03|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|158.00||||158.00|79.16|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158.00||||158.00|14.88|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.00||||158.00|75.76|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158.00||||158.00|14.88|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158.00||||158.00|94.8|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158.00||||158.00|13.26|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158.00||||158.00|13.06|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158.00||||158.00|12.05|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158.00||||158.00|79|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|158.00||||158.00|67.31|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158.00||||158.00|12.65|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158.00||||158.00|55.46|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158.00||||158.00|142.2|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|||158.00||||158.00|47.4|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158.00||||158.00|102.7|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158.00||||158.00|13.26|158|8.03 30286704|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|158.00||||158.00||| 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254.00||||254.00|12.95|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|254.00||||254.00|108.2|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254.00||||254.00|152.4|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|254.00||||254.00|127.25|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254.00||||254.00|127|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254.00||||254.00|12.36|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254.00||||254.00|89.15|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254.00||||254.00|12.75|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|HEALTHNET [1495]|HEALTHNET [149500]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|254.00||||254.00|16.92|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MULTIPLAN [1680]|IHC HS [168011]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|AETNA [1015]|AETNA ACO WILCO [101532]|254.00||||254.00|18.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MULTIPLAN [1680]|HMA [168003]|254.00||||254.00|17.66|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|254.00||||254.00|14.58|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254.00||||254.00|53.34|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254.00||||254.00|254|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254.00||||254.00|14.54|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254.00||||254.00|17.18|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|TRUSTMARK [2030]|STARMARK [203000]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|UMR [2035]|UMR OPTIONS [203501]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|254.00||||254.00|7.85|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254.00||||254.00|12.31|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|||254.00||||254.00|76.2|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254.00||||254.00|12.01|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|CORESOURCE [1315]|CORESOURCE [131500]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|254.00||||254.00|16.92|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|CHAMPVA [1240]|CHAMP VA [124000]|254.00||||254.00|190.5|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254.00||||254.00|12.75|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254.00||||254.00|14.54|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|254.00||||254.00|11.77|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254.00||||254.00|121.79|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254.00||||254.00|165.1|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254.00||||254.00|11.72|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|GEHA [1415]|GEHA [141500]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254.00||||254.00|12.95|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254.00||||254.00|228.6|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|254.00||||254.00|13.25|254|7.85 30286705|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B CORE (HBCAB) IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|254.00||||254.00||| 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|GEHA [1415]|GEHA [141500]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|CORESOURCE [1315]|CORESOURCE [131500]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|CHAMPVA [1240]|CHAMP VA [124000]|408.00||||408.00|306|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|408.00||||408.00|195.64|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|408.00||||408.00|11.64|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|408.00||||408.00|15.68|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|408.00||||408.00|85.68|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|UMR [2035]|UMR OPTIONS [203501]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|408.00||||408.00|15.44|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MULTIPLAN [1680]|IHC HS [168011]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|408.00||||408.00|12.1|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|408.00||||408.00|15.44|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MULTIPLAN [1680]|HMA [168003]|408.00||||408.00|16.11|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|TRUSTMARK [2030]|STARMARK [203000]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|AETNA [1015]|AETNA ACO WILCO [101532]|408.00||||408.00|16.97|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|FMH BENEFIT SERVICES [1390]|FMH [139000]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|408.00||||408.00|13.26|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|HEALTHNET [1495]|HEALTHNET [149500]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|408.00||||408.00|408|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|408.00||||408.00|13.26|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|408.00||||408.00|7.16|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|408.00||||408.00|204.41|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|408.00||||408.00|143.21|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|FIRST HEALTH [1375]|QUALCHOICE [137513]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|408.00||||408.00|10.71|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|408.00||||408.00|11.28|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|408.00||||408.00|265.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|408.00||||408.00|11.24|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|408.00||||408.00|173.81|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|408.00||||408.00|13.3|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|408.00||||408.00|10.95|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|408.00||||408.00|11.81|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|408.00||||408.00|11.64|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|||408.00||||408.00|122.4|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|408.00||||408.00|11.81|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|408.00||||408.00|367.2|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|408.00||||408.00|244.8|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|408.00||||408.00|204|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|408.00||||408.00|10.74|408|7.16 30286706|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP B SURFACE (HBSAB)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|408.00||||408.00||| 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|FIRST HEALTH [1375]|QUALCHOICE [137513]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MULTIPLAN [1680]|HMA [168003]|165.00||||165.00|17.36|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|165.00||||165.00|12.73|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|165.00||||165.00|82.67|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|165.00||||165.00|57.92|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|165.00||||165.00|82.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|165.00||||165.00|14.28|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|165.00||||165.00|99|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|165.00||||165.00|12.54|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|165.00||||165.00|12.73|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|165.00||||165.00|7.71|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|165.00||||165.00|12.11|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MULTIPLAN [1680]|IHC HS [168011]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|AETNA [1015]|AETNA ACO WILCO [101532]|165.00||||165.00|18.28|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|165.00||||165.00|16.63|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|CHAMPVA [1240]|CHAMP VA [124000]|165.00||||165.00|123.75|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|165.00||||165.00|34.65|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|165.00||||165.00|16.89|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|UMR [2035]|UMR OPTIONS [203501]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|165.00||||165.00|14.28|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|165.00||||165.00|14.33|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|165.00||||165.00|165|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|TRUSTMARK [2030]|STARMARK [203000]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|165.00||||165.00|79.12|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|CORESOURCE [1315]|CORESOURCE [131500]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|165.00||||165.00|107.25|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|165.00||||165.00|11.8|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|||165.00||||165.00|49.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|165.00||||165.00|70.29|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|165.00||||165.00|12.15|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|165.00||||165.00|11.54|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|165.00||||165.00|16.63|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|HEALTHNET [1495]|HEALTHNET [149500]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|165.00||||165.00|13.03|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|165.00||||165.00|11.57|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|GEHA [1415]|GEHA [141500]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|165.00||||165.00|12.54|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|FMH BENEFIT SERVICES [1390]|FMH [139000]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|165.00||||165.00|148.5|165|7.71 30286707|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP BE (HBEAB)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|165.00||||165.00||| 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|173.00||||173.00|173|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|CHAMPVA [1240]|CHAMP VA [124000]|173.00||||173.00|129.75|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|CORESOURCE [1315]|CORESOURCE [131500]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|173.00||||173.00|13.43|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|||173.00||||173.00|51.9|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|173.00||||173.00|112.45|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|173.00||||173.00|15.29|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|UMR [2035]|UMR OPTIONS [203501]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|173.00||||173.00|36.33|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|173.00||||173.00|12.64|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|TRUSTMARK [2030]|STARMARK [203000]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|FMH BENEFIT SERVICES [1390]|FMH [139000]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MULTIPLAN [1680]|IHC HS [168011]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MULTIPLAN [1680]|HMA [168003]|173.00||||173.00|18.59|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|173.00||||173.00|17.81|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|HEALTHNET [1495]|HEALTHNET [149500]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|173.00||||173.00|15.35|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|173.00||||173.00|17.81|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|AETNA [1015]|AETNA ACO WILCO [101532]|173.00||||173.00|19.58|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|173.00||||173.00|15.29|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|173.00||||173.00|82.95|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|173.00||||173.00|60.72|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|FIRST HEALTH [1375]|QUALCHOICE [137513]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|173.00||||173.00|18.09|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|173.00||||173.00|8.26|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|173.00||||173.00|13.63|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|GEHA [1415]|GEHA [141500]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|173.00||||173.00|12.35|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|173.00||||173.00|86.5|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|173.00||||173.00|103.8|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|173.00||||173.00|73.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|173.00||||173.00|13.96|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|173.00||||173.00|13.63|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|173.00||||173.00|12.97|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|173.00||||173.00|86.67|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|173.00||||173.00|155.7|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|173.00||||173.00|13.01|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|173.00||||173.00|13.43|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|173.00||||173.00|12.39|173|8.26 30286708|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|173.00||||173.00||| 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MULTIPLAN [1680]|HMA [168003]|250.00||||250.00|16.89|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|250.00||||250.00|16.19|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|250.00||||250.00|12.39|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|250.00||||250.00|11.82|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|250.00||||250.00|87.75|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|250.00||||250.00|13.9|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|250.00||||250.00|125|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|250.00||||250.00|150|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|250.00||||250.00|12.19|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|250.00||||250.00|11.78|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|250.00||||250.00|125.25|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|250.00||||250.00|7.51|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|TRUSTMARK [2030]|STARMARK [203000]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|250.00||||250.00|13.94|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|250.00||||250.00|106.5|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|250.00||||250.00|13.9|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|250.00||||250.00|16.44|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|UMR [2035]|UMR OPTIONS [203501]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|250.00||||250.00|52.5|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|AETNA [1015]|AETNA ACO WILCO [101532]|250.00||||250.00|17.8|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MULTIPLAN [1680]|IHC HS [168011]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|250.00||||250.00|250|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|HEALTHNET [1495]|HEALTHNET [149500]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|250.00||||250.00|12.39|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|250.00||||250.00|119.88|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|||250.00||||250.00|75|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|250.00||||250.00|16.19|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|CHAMPVA [1240]|CHAMP VA [124000]|250.00||||250.00|187.5|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|250.00||||250.00|162.5|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|250.00||||250.00|11.22|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|250.00||||250.00|12.67|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|250.00||||250.00|12.19|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|250.00||||250.00|11.49|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|CORESOURCE [1315]|CORESOURCE [131500]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|GEHA [1415]|GEHA [141500]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|250.00||||250.00|225|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|250.00||||250.00|11.26|250|7.51 30286709|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP A (HAAB) IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|250.00||||250.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230.00||||230.00|14.68|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230.00||||230.00|13.5|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230.00||||230.00|142.6|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|CORESOURCE [1315]|CORESOURCE [131500]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230.00||||230.00|13.55|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|CHAMPVA [1240]|CHAMP VA [124000]|230.00||||230.00|172.5|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230.00||||230.00|15.26|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230.00||||230.00|230|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230.00||||230.00|110.29|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230.00||||230.00|48.3|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230.00||||230.00|97.98|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230.00||||230.00|142.83|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230.00||||230.00|16.79|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|TRUSTMARK [2030]|STARMARK [203000]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|FIRST HEALTH [1375]|QUALCHOICE [137513]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230.00||||230.00|13.55|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230.00||||230.00|13.55|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MULTIPLAN [1680]|IHC HS [168011]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|HEALTHNET [1495]|HEALTHNET [149500]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230.00||||230.00|19.48|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MULTIPLAN [1680]|HMA [168003]|230.00||||230.00|20.33|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230.00||||230.00|16.73|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|AETNA [1015]|AETNA ACO WILCO [101532]|230.00||||230.00|21.43|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230.00||||230.00|13.82|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230.00||||230.00|149.5|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|GEHA [1415]|GEHA [141500]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|||230.00||||230.00|69|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230.00||||230.00|16.73|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230.00||||230.00|9.04|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230.00||||230.00|13.55|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230.00||||230.00|115|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230.00||||230.00|115.23|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230.00||||230.00|13.55|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230.00||||230.00|13.55|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230.00||||230.00|14.68|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|UMR [2035]|UMR OPTIONS [203501]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230.00||||230.00|80.73|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|FMH BENEFIT SERVICES [1390]|FMH [139000]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230.00||||230.00|138|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230.00||||230.00|14.23|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230.00||||230.00|14.18|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230.00||||230.00|207|230|9.04 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230.00||||230.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230.00||||230.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230.00||||230.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230.00||||230.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230.00||||230.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230.00||||230.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230.00||||230.00||| 30286710|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB INFLUENZA TYPE A OR B|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230.00||||230.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3876.00||||3876.00|1651.18|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3876.00||||3876.00|1941.88|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3876.00||||3876.00|1360.48|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3876.00||||3876.00|1938|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3876.00||||3876.00|18.3|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3876.00||||3876.00|2325.6|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3876.00||||3876.00|10.13|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|TRUSTMARK [2030]|STARMARK [203000]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|AETNA [1015]|AETNA ACO WILCO [101532]|3876.00||||3876.00|24.02|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|HEALTHNET [1495]|HEALTHNET [149500]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MULTIPLAN [1680]|IHC HS [168011]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|FIRST HEALTH [1375]|QUALCHOICE [137513]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3876.00||||3876.00|17.68|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|UMR [2035]|UMR OPTIONS [203501]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3876.00||||3876.00|17.77|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3876.00||||3876.00|20.92|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3876.00||||3876.00|813.96|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3876.00||||3876.00|3876|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3876.00||||3876.00|1858.54|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|CORESOURCE [1315]|CORESOURCE [131500]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3876.00||||3876.00|18.3|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|||3876.00||||3876.00|1162.8|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3876.00||||3876.00|17.77|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|CHAMPVA [1240]|CHAMP VA [124000]|3876.00||||3876.00|2907|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3876.00||||3876.00|19.02|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3876.00||||3876.00|2519.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|FMH BENEFIT SERVICES [1390]|FMH [139000]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|GEHA [1415]|GEHA [141500]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3876.00||||3876.00|16.84|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3876.00||||3876.00|3488.4|3876|10.13 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MULTIPLAN [1680]|HMA [168003]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3876.00||||3876.00||| 30286711|EAP|0302 - LABORATORY-IMMUNOLOGY|HC STRATFY JCV AB W/RFX INHB ASY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3876.00||||3876.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|16.57|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|15.25|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|17.22|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|||192.00||||192.00|57.6|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|10.2|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|24.18|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|18.89|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|18.95|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|16.01|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|18.89|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|16.57|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|10.2 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00||| 30286713|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEGIONELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|172.00||||172.00|12.82|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|172.00||||172.00|15.12|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|172.00||||172.00|86.17|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|172.00||||172.00|73.27|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|172.00||||172.00|86|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|172.00||||172.00|103.2|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|172.00||||172.00|13.28|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|172.00||||172.00|8.17|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MULTIPLAN [1680]|IHC HS [168011]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|TRUSTMARK [2030]|STARMARK [203000]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|HEALTHNET [1495]|HEALTHNET [149500]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|172.00||||172.00|15.12|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|UMR [2035]|UMR OPTIONS [203501]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|172.00||||172.00|36.12|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|172.00||||172.00|15.19|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|172.00||||172.00|172|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|172.00||||172.00|82.47|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|CHAMPVA [1240]|CHAMP VA [124000]|172.00||||172.00|129|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|172.00||||172.00|111.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|||172.00||||172.00|51.6|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|172.00||||172.00|60.37|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|172.00||||172.00|12.21|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|172.00||||172.00|13.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|CORESOURCE [1315]|CORESOURCE [131500]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|GEHA [1415]|GEHA [141500]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|AETNA [1015]|AETNA ACO WILCO [101532]|172.00||||172.00|19.35|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|172.00||||172.00|13.28|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|172.00||||172.00|154.8|172|8.17 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MULTIPLAN [1680]|HMA [168003]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|172.00||||172.00||| 30286717|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEISHMANIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|172.00||||172.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|178.00||||178.00|20.07|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|FIRST HEALTH [1375]|QUALCHOICE [137513]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MULTIPLAN [1680]|IHC HS [168011]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|AETNA [1015]|AETNA ACO WILCO [101532]|178.00||||178.00|23.04|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|HEALTHNET [1495]|HEALTHNET [149500]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|TRUSTMARK [2030]|STARMARK [203000]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|FMH BENEFIT SERVICES [1390]|FMH [139000]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|178.00||||178.00|16.28|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|178.00||||178.00|9.72|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|178.00||||178.00|89.18|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|178.00||||178.00|16.95|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|178.00||||178.00|16.28|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|178.00||||178.00|75.83|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|178.00||||178.00|17.55|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|178.00||||178.00|62.48|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|178.00||||178.00|89|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|UMR [2035]|UMR OPTIONS [203501]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|178.00||||178.00|106.8|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|CORESOURCE [1315]|CORESOURCE [131500]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|CHAMPVA [1240]|CHAMP VA [124000]|178.00||||178.00|133.5|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|178.00||||178.00|18.24|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|178.00||||178.00|16.14|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|GEHA [1415]|GEHA [141500]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|178.00||||178.00|17.55|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|||178.00||||178.00|53.4|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|178.00||||178.00|115.7|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|178.00||||178.00|85.35|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|178.00||||178.00|178|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|178.00||||178.00|37.38|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|178.00||||178.00|160.2|178|9.72 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MULTIPLAN [1680]|HMA [168003]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|178.00||||178.00||| 30286720|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LEPTOSPIRA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|178.00||||178.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162.00||||162.00|15.89|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162.00||||162.00|56.86|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|162.00||||162.00|81.16|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162.00||||162.00|81|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162.00||||162.00|97.2|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162.00||||162.00|13.95|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|162.00||||162.00|8.58|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|TRUSTMARK [2030]|STARMARK [203000]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|HEALTHNET [1495]|HEALTHNET [149500]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MULTIPLAN [1680]|IHC HS [168011]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162.00||||162.00|15.89|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|UMR [2035]|UMR OPTIONS [203501]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|162.00||||162.00|15.95|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162.00||||162.00|34.02|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162.00||||162.00|162|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162.00||||162.00|13.47|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162.00||||162.00|77.68|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162.00||||162.00|105.3|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|||162.00||||162.00|48.6|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|162.00||||162.00|69.01|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|AETNA [1015]|AETNA ACO WILCO [101532]|162.00||||162.00|20.34|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162.00||||162.00|13.95|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|GEHA [1415]|GEHA [141500]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|162.00||||162.00|14.5|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|CORESOURCE [1315]|CORESOURCE [131500]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|CHAMPVA [1240]|CHAMP VA [124000]|162.00||||162.00|121.5|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162.00||||162.00|12.83|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162.00||||162.00|145.8|162|8.58 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MULTIPLAN [1680]|HMA [168003]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162.00||||162.00||| 30286727|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB LYMPHOCYTIC CHORIOMENINGITIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|162.00||||162.00||| 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|172.00||||172.00|111.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|GEHA [1415]|GEHA [141500]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|172.00||||172.00|18.76|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|CORESOURCE [1315]|CORESOURCE [131500]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|CHAMPVA [1240]|CHAMP VA [124000]|172.00||||172.00|129|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|172.00||||172.00|14.7|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|172.00||||172.00|14.14|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|172.00||||172.00|82.47|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|172.00||||172.00|172|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|172.00||||172.00|36.12|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|172.00||||172.00|19.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|172.00||||172.00|13.31|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|172.00||||172.00|16.11|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MULTIPLAN [1680]|IHC HS [168011]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|172.00||||172.00|18.76|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MULTIPLAN [1680]|HMA [168003]|172.00||||172.00|19.58|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|HEALTHNET [1495]|HEALTHNET [149500]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|AETNA [1015]|AETNA ACO WILCO [101532]|172.00||||172.00|20.63|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|172.00||||172.00|16.16|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|TRUSTMARK [2030]|STARMARK [203000]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|||172.00||||172.00|51.6|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|UMR [2035]|UMR OPTIONS [203501]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|172.00||||172.00|8.7|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|172.00||||172.00|13.66|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|172.00||||172.00|13.01|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|172.00||||172.00|14.36|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|172.00||||172.00|14.14|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|172.00||||172.00|13.7|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|172.00||||172.00|73.27|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|172.00||||172.00|60.37|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|172.00||||172.00|14.36|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|172.00||||172.00|86.17|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|172.00||||172.00|16.11|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|172.00||||172.00|86|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|172.00||||172.00|103.2|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|172.00||||172.00|154.8|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|172.00||||172.00|13.05|172|8.7 30286735|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MUMPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|172.00||||172.00||| 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00|14.56|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00|13.9|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|14.35|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00|14.56|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|13.86|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|8.83|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|20.92|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00|19.03|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00|19.86|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|16.34|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00|13.5|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|16.41|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00|19.33|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|||192.00||||192.00|57.6|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|16.34|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|14.35|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|13.2|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|14.92|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00|19.03|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00|13.24|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|8.83 30286738|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MYCOPLASMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|178.00||||178.00|18|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|CORESOURCE [1315]|CORESOURCE [131500]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|CHAMPVA [1240]|CHAMP VA [124000]|178.00||||178.00|133.5|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|GEHA [1415]|GEHA [141500]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|178.00||||178.00|17.32|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|||178.00||||178.00|53.4|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|178.00||||178.00|115.7|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|178.00||||178.00|85.35|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|178.00||||178.00|37.38|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|178.00||||178.00|19.8|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MULTIPLAN [1680]|IHC HS [168011]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|HEALTHNET [1495]|HEALTHNET [149500]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|178.00||||178.00|178|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|AETNA [1015]|AETNA ACO WILCO [101532]|178.00||||178.00|22.75|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|TRUSTMARK [2030]|STARMARK [203000]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|UMR [2035]|UMR OPTIONS [203501]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|178.00||||178.00|16.28|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|178.00||||178.00|9.59|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|178.00||||178.00|16.73|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|178.00||||178.00|15.93|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|178.00||||178.00|17.32|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|178.00||||178.00|62.48|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|178.00||||178.00|160.2|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|178.00||||178.00|75.83|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|178.00||||178.00|89.18|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|178.00||||178.00|16.28|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|178.00||||178.00|89|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|178.00||||178.00|106.8|178|9.59 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MULTIPLAN [1680]|HMA [168003]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|178.00||||178.00||| 30286744|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB NOCARDIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|178.00||||178.00||| 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|443.00||||443.00|221.5|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|443.00||||443.00|155.49|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|443.00||||443.00|221.94|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|443.00||||443.00|18.56|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|443.00||||443.00|188.72|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|443.00||||443.00|15.78|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|443.00||||443.00|265.8|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|443.00||||443.00|16.29|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|443.00||||443.00|16.53|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|443.00||||443.00|10.02|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|TRUSTMARK [2030]|STARMARK [203000]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|443.00||||443.00|16.53|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MULTIPLAN [1680]|IHC HS [168011]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|443.00||||443.00|18.63|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|443.00||||443.00|18.56|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|443.00||||443.00|15.33|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|HEALTHNET [1495]|HEALTHNET [149500]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|UMR [2035]|UMR OPTIONS [203501]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|443.00||||443.00|21.94|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|443.00||||443.00|15.73|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MULTIPLAN [1680]|HMA [168003]|443.00||||443.00|22.55|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|443.00||||443.00|21.61|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|443.00||||443.00|93.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|443.00||||443.00|443|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|AETNA [1015]|AETNA ACO WILCO [101532]|443.00||||443.00|23.76|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|443.00||||443.00|212.42|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|443.00||||443.00|287.95|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|||443.00||||443.00|132.9|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|443.00||||443.00|16.29|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|443.00||||443.00|21.61|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|GEHA [1415]|GEHA [141500]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|443.00||||443.00|16.93|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|CORESOURCE [1315]|CORESOURCE [131500]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|443.00||||443.00|14.98|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|CHAMPVA [1240]|CHAMP VA [124000]|443.00||||443.00|332.25|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|443.00||||443.00|15.03|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|443.00||||443.00|398.7|443|10.02 30286747|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PARVOVIRUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|443.00||||443.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|GEHA [1415]|GEHA [141500]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.00||||50.00|14.85|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|CORESOURCE [1315]|CORESOURCE [131500]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|CHAMPVA [1240]|CHAMP VA [124000]|50.00||||50.00|37.5|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.00||||50.00|13.15|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.00||||50.00|14.29|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.00||||50.00|32.5|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.00||||50.00|23.98|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.00||||50.00|50|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.00||||50.00|10.5|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.00||||50.00|16.28|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MULTIPLAN [1680]|IHC HS [168011]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|UMR [2035]|UMR OPTIONS [203501]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|HEALTHNET [1495]|HEALTHNET [149500]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.00||||50.00|16.34|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|AETNA [1015]|AETNA ACO WILCO [101532]|50.00||||50.00|20.84|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|TRUSTMARK [2030]|STARMARK [203000]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|||50.00||||50.00|15|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.00||||50.00|8.79|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.00||||50.00|13.81|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.00||||50.00|14.29|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.00||||50.00|30|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.00||||50.00|16.28|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.00||||50.00|21.3|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.00||||50.00|25.05|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.00||||50.00|17.55|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.00||||50.00|25|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.00||||50.00|45|50|8.79 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MULTIPLAN [1680]|HMA [168003]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.00||||50.00||| 30286750|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB MALARIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.00||||50.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|168.00||||168.00|58.97|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|168.00||||168.00|71.57|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|168.00||||168.00|15.29|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|168.00||||168.00|84|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|168.00||||168.00|100.8|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|168.00||||168.00|13.43|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|168.00||||168.00|12.97|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|168.00||||168.00|8.26|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|TRUSTMARK [2030]|STARMARK [203000]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|168.00||||168.00|15.29|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|168.00||||168.00|15.35|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|UMR [2035]|UMR OPTIONS [203501]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MULTIPLAN [1680]|IHC HS [168011]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|168.00||||168.00|35.28|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|168.00||||168.00|168|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|HEALTHNET [1495]|HEALTHNET [149500]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|168.00||||168.00|80.56|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|168.00||||168.00|109.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|AETNA [1015]|AETNA ACO WILCO [101532]|168.00||||168.00|19.58|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|||168.00||||168.00|50.4|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|168.00||||168.00|84.17|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|168.00||||168.00|13.43|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|168.00||||168.00|12.35|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|168.00||||168.00|13.96|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|CORESOURCE [1315]|CORESOURCE [131500]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|CHAMPVA [1240]|CHAMP VA [124000]|168.00||||168.00|126|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|GEHA [1415]|GEHA [141500]|168.00||||168.00|151.2|168|8.26 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MULTIPLAN [1680]|HMA [168003]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|168.00||||168.00||| 30286753|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB PROTOZOA AMOEBIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|168.00||||168.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|659.00||||659.00|17.9|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|CORESOURCE [1315]|CORESOURCE [131500]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|CHAMPVA [1240]|CHAMP VA [124000]|659.00||||659.00|494.25|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|659.00||||659.00|15.84|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|659.00||||659.00|17.22|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|||659.00||||659.00|197.7|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|659.00||||659.00|315.99|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|659.00||||659.00|659|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|659.00||||659.00|138.39|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|659.00||||659.00|19.69|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MULTIPLAN [1680]|IHC HS [168011]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|FIRST HEALTH [1375]|QUALCHOICE [137513]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|HEALTHNET [1495]|HEALTHNET [149500]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|659.00||||659.00|15.91|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|AETNA [1015]|AETNA ACO WILCO [101532]|659.00||||659.00|22.6|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|FMH BENEFIT SERVICES [1390]|FMH [139000]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|TRUSTMARK [2030]|STARMARK [203000]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|659.00||||659.00|428.35|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|659.00||||659.00|9.53|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|659.00||||659.00|16.63|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|659.00||||659.00|17.22|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|659.00||||659.00|15.91|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|659.00||||659.00|280.73|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|GEHA [1415]|GEHA [141500]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|UMR [2035]|UMR OPTIONS [203501]|659.00||||659.00|593.1|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|659.00||||659.00|329.5|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|659.00||||659.00|231.31|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|659.00||||659.00|395.4|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|659.00||||659.00|330.16|659|9.53 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MULTIPLAN [1680]|HMA [168003]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|659.00||||659.00||| 30286756|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RSV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|659.00||||659.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|260.00||||260.00|91.26|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|260.00||||260.00|23.9|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|260.00||||260.00|110.76|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|260.00||||260.00|130|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|260.00||||260.00|156|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|260.00||||260.00|20.97|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|260.00||||260.00|20.25|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|260.00||||260.00|12.91|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|TRUSTMARK [2030]|STARMARK [203000]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|AETNA [1015]|AETNA ACO WILCO [101532]|260.00||||260.00|30.6|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MULTIPLAN [1680]|IHC HS [168011]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|FIRST HEALTH [1375]|QUALCHOICE [137513]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|260.00||||260.00|23.9|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|UMR [2035]|UMR OPTIONS [203501]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|260.00||||260.00|23.98|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|FMH BENEFIT SERVICES [1390]|FMH [139000]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|260.00||||260.00|54.6|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|260.00||||260.00|260|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|HEALTHNET [1495]|HEALTHNET [149500]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|260.00||||260.00|124.67|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|260.00||||260.00|169|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|||260.00||||260.00|78|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|260.00||||260.00|130.26|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|260.00||||260.00|20.97|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|GEHA [1415]|GEHA [141500]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|260.00||||260.00|21.8|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|CORESOURCE [1315]|CORESOURCE [131500]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|CHAMPVA [1240]|CHAMP VA [124000]|260.00||||260.00|195|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|260.00||||260.00|19.28|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|260.00||||260.00|234|260|12.91 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MULTIPLAN [1680]|HMA [168003]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|260.00||||260.00||| 30286757|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RICKETTSIA AB QL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|260.00||||260.00||| 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|289.00||||289.00|16.2|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|GEHA [1415]|GEHA [141500]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|289.00||||289.00|20.69|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|CORESOURCE [1315]|CORESOURCE [131500]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|CHAMPVA [1240]|CHAMP VA [124000]|289.00||||289.00|216.75|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|289.00||||289.00|15.59|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|289.00||||289.00|187.85|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|289.00||||289.00|138.58|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|289.00||||289.00|289|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|289.00||||289.00|60.69|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|289.00||||289.00|21.01|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|UMR [2035]|UMR OPTIONS [203501]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|289.00||||289.00|14.68|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|289.00||||289.00|17.77|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MULTIPLAN [1680]|IHC HS [168011]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|289.00||||289.00|20.69|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MULTIPLAN [1680]|HMA [168003]|289.00||||289.00|21.59|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|HEALTHNET [1495]|HEALTHNET [149500]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|289.00||||289.00|17.83|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|AETNA [1015]|AETNA ACO WILCO [101532]|289.00||||289.00|22.75|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|TRUSTMARK [2030]|STARMARK [203000]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|||289.00||||289.00|86.7|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|289.00||||289.00|9.59|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|289.00||||289.00|15.06|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|289.00||||289.00|15.83|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|289.00||||289.00|14.34|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|289.00||||289.00|15.59|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|289.00||||289.00|15.11|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|289.00||||289.00|123.11|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|289.00||||289.00|15.83|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|289.00||||289.00|14.39|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|289.00||||289.00|101.44|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|289.00||||289.00|17.77|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|289.00||||289.00|144.79|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|289.00||||289.00|144.5|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|289.00||||289.00|173.4|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|289.00||||289.00|260.1|289|9.59 30286762|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|289.00||||289.00||| 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|219.00||||219.00|13.52|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|219.00||||219.00|76.87|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|219.00||||219.00|14.17|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|219.00||||219.00|93.29|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|219.00||||219.00|109.72|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|219.00||||219.00|109.5|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|219.00||||219.00|131.4|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|219.00||||219.00|13.96|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|219.00||||219.00|13.48|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|219.00||||219.00|8.59|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|TRUSTMARK [2030]|STARMARK [203000]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|AETNA [1015]|AETNA ACO WILCO [101532]|219.00||||219.00|20.35|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MULTIPLAN [1680]|IHC HS [168011]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|219.00||||219.00|18.52|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|219.00||||219.00|15.9|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|219.00||||219.00|13.14|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|219.00||||219.00|15.96|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|UMR [2035]|UMR OPTIONS [203501]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MULTIPLAN [1680]|HMA [168003]|219.00||||219.00|19.32|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|219.00||||219.00|18.8|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|219.00||||219.00|45.99|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|HEALTHNET [1495]|HEALTHNET [149500]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|219.00||||219.00|219|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|219.00||||219.00|14.17|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|219.00||||219.00|105.01|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|219.00||||219.00|142.35|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|||219.00||||219.00|65.7|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|219.00||||219.00|13.96|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|219.00||||219.00|15.9|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|219.00||||219.00|12.84|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|219.00||||219.00|14.51|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|GEHA [1415]|GEHA [141500]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|CORESOURCE [1315]|CORESOURCE [131500]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|219.00||||219.00|18.52|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|CHAMPVA [1240]|CHAMP VA [124000]|219.00||||219.00|164.25|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|219.00||||219.00|12.88|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|219.00||||219.00|197.1|219|8.59 30286765|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB RUBEOLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|219.00||||219.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|CORESOURCE [1315]|CORESOURCE [131500]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|CHAMPVA [1240]|CHAMP VA [124000]|125.00||||125.00|93.75|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|GEHA [1415]|GEHA [141500]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|125.00||||125.00|14.29|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|||125.00||||125.00|37.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.00||||125.00|59.94|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|125.00||||125.00|26.25|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|UMR [2035]|UMR OPTIONS [203501]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|125.00||||125.00|16.34|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MULTIPLAN [1680]|IHC HS [168011]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|HEALTHNET [1495]|HEALTHNET [149500]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|125.00||||125.00|125|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|AETNA [1015]|AETNA ACO WILCO [101532]|125.00||||125.00|20.84|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|TRUSTMARK [2030]|STARMARK [203000]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|125.00||||125.00|81.25|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|125.00||||125.00|8.79|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|125.00||||125.00|16.28|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|125.00||||125.00|13.81|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|125.00||||125.00|14.85|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|125.00||||125.00|13.15|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|125.00||||125.00|14.29|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.00||||125.00|75|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|125.00||||125.00|62.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|125.00||||125.00|43.88|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|125.00||||125.00|112.5|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|125.00||||125.00|53.25|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|125.00||||125.00|62.63|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|125.00||||125.00|16.28|125|8.79 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MULTIPLAN [1680]|HMA [168003]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.00||||125.00||| 30286768|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB SALMONELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|125.00||||125.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205.00||||205.00|71.96|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|205.00||||205.00|87.33|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|205.00||||205.00|102.71|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205.00||||205.00|102.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205.00||||205.00|123|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205.00||||205.00|16.03|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|205.00||||205.00|9.86|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|TRUSTMARK [2030]|STARMARK [203000]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|AETNA [1015]|AETNA ACO WILCO [101532]|205.00||||205.00|23.39|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|HEALTHNET [1495]|HEALTHNET [149500]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MULTIPLAN [1680]|IHC HS [168011]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|205.00||||205.00|18.32|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|UMR [2035]|UMR OPTIONS [203501]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205.00||||205.00|18.27|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205.00||||205.00|43.05|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205.00||||205.00|205|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205.00||||205.00|15.49|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205.00||||205.00|98.3|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205.00||||205.00|133.25|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205.00||||205.00|18.27|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|||205.00||||205.00|61.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205.00||||205.00|16.03|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205.00||||205.00|14.75|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|CHAMPVA [1240]|CHAMP VA [124000]|205.00||||205.00|153.75|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|GEHA [1415]|GEHA [141500]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|205.00||||205.00|16.66|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|CORESOURCE [1315]|CORESOURCE [131500]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205.00||||205.00|184.5|205|9.86 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MULTIPLAN [1680]|HMA [168003]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|205.00||||205.00||| 30286774|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TETANUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205.00||||205.00||| 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|GEHA [1415]|GEHA [141500]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|182.00||||182.00|16.2|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|CORESOURCE [1315]|CORESOURCE [131500]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|CHAMPVA [1240]|CHAMP VA [124000]|182.00||||182.00|136.5|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.00||||182.00|15.59|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|||182.00||||182.00|54.6|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.00||||182.00|118.3|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.00||||182.00|87.27|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.00||||182.00|182|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.00||||182.00|38.22|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.00||||182.00|14.68|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.00||||182.00|17.77|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MULTIPLAN [1680]|IHC HS [168011]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|182.00||||182.00|20.69|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MULTIPLAN [1680]|HMA [168003]|182.00||||182.00|21.59|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|HEALTHNET [1495]|HEALTHNET [149500]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|182.00||||182.00|17.83|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|AETNA [1015]|AETNA ACO WILCO [101532]|182.00||||182.00|22.75|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|TRUSTMARK [2030]|STARMARK [203000]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|UMR [2035]|UMR OPTIONS [203501]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|182.00||||182.00|9.59|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.00||||182.00|15.06|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.00||||182.00|15.83|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.00||||182.00|14.34|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.00||||182.00|15.59|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.00||||182.00|15.11|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|182.00||||182.00|91.18|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.00||||182.00|14.39|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.00||||182.00|15.83|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|182.00||||182.00|20.69|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.00||||182.00|21.01|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|182.00||||182.00|77.53|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.00||||182.00|17.77|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.00||||182.00|63.88|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.00||||182.00|109.2|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.00||||182.00|163.8|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.00||||182.00|91|182|9.59 30286777|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|182.00||||182.00||| 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|182.00||||182.00|91.18|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|182.00||||182.00|77.53|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.00||||182.00|91|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.00||||182.00|109.2|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.00||||182.00|15.62|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.00||||182.00|15.08|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|182.00||||182.00|9.61|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|TRUSTMARK [2030]|STARMARK [203000]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MULTIPLAN [1680]|IHC HS [168011]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|182.00||||182.00|20.72|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MULTIPLAN [1680]|HMA [168003]|182.00||||182.00|21.62|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|182.00||||182.00|17.86|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.00||||182.00|17.78|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|UMR [2035]|UMR OPTIONS [203501]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.00||||182.00|21.04|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|HEALTHNET [1495]|HEALTHNET [149500]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|AETNA [1015]|AETNA ACO WILCO [101532]|182.00||||182.00|22.77|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.00||||182.00|38.22|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.00||||182.00|14.7|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.00||||182.00|182|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.00||||182.00|87.27|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.00||||182.00|118.3|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|||182.00||||182.00|54.6|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.00||||182.00|15.85|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.00||||182.00|15.62|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.00||||182.00|14.36|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|182.00||||182.00|16.24|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.00||||182.00|15.13|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.00||||182.00|63.88|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|GEHA [1415]|GEHA [141500]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|182.00||||182.00|20.72|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|CORESOURCE [1315]|CORESOURCE [131500]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|CHAMPVA [1240]|CHAMP VA [124000]|182.00||||182.00|136.5|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.00||||182.00|163.8|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.00||||182.00|15.85|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.00||||182.00|14.41|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.00||||182.00|17.78|182|9.61 30286778|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TOXOPLASMA IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|182.00||||182.00||| 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|GEHA [1415]|GEHA [141500]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|287.00||||287.00|14.92|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|CORESOURCE [1315]|CORESOURCE [131500]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|287.00||||287.00|19.03|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|CHAMPVA [1240]|CHAMP VA [124000]|287.00||||287.00|215.25|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|287.00||||287.00|13.2|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|287.00||||287.00|14.35|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|||287.00||||287.00|86.1|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|287.00||||287.00|137.62|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|287.00||||287.00|287|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|287.00||||287.00|60.27|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|287.00||||287.00|19.33|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|UMR [2035]|UMR OPTIONS [203501]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|287.00||||287.00|13.5|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|287.00||||287.00|16.34|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|287.00||||287.00|16.41|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MULTIPLAN [1680]|IHC HS [168011]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|287.00||||287.00|19.03|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MULTIPLAN [1680]|HMA [168003]|287.00||||287.00|19.86|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|HEALTHNET [1495]|HEALTHNET [149500]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|AETNA [1015]|AETNA ACO WILCO [101532]|287.00||||287.00|20.92|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|287.00||||287.00|186.55|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|TRUSTMARK [2030]|STARMARK [203000]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|287.00||||287.00|8.83|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|287.00||||287.00|13.86|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|287.00||||287.00|14.56|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|287.00||||287.00|14.35|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|287.00||||287.00|172.2|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|287.00||||287.00|13.9|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|287.00||||287.00|143.5|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|287.00||||287.00|143.79|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|287.00||||287.00|16.34|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|287.00||||287.00|122.26|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|287.00||||287.00|100.74|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|287.00||||287.00|13.24|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|287.00||||287.00|14.56|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|287.00||||287.00|258.3|287|8.83 30286780|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ANTIBODY TREPONEMA PALLIDUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|287.00||||287.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|234.00||||234.00|82.13|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|234.00||||234.00|15.51|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|234.00||||234.00|99.68|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|234.00||||234.00|117.23|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|234.00||||234.00|117|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|234.00||||234.00|140.4|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|234.00||||234.00|13.61|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|234.00||||234.00|8.38|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|TRUSTMARK [2030]|STARMARK [203000]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|AETNA [1015]|AETNA ACO WILCO [101532]|234.00||||234.00|19.86|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|HEALTHNET [1495]|HEALTHNET [149500]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MULTIPLAN [1680]|IHC HS [168011]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|234.00||||234.00|15.56|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|234.00||||234.00|15.51|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|UMR [2035]|UMR OPTIONS [203501]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|234.00||||234.00|13.15|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|234.00||||234.00|49.14|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|234.00||||234.00|234|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|234.00||||234.00|112.2|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|234.00||||234.00|152.1|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|||234.00||||234.00|70.2|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|234.00||||234.00|13.61|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|234.00||||234.00|12.52|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|CHAMPVA [1240]|CHAMP VA [124000]|234.00||||234.00|175.5|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|CORESOURCE [1315]|CORESOURCE [131500]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|234.00||||234.00|14.15|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|GEHA [1415]|GEHA [141500]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|234.00||||234.00|210.6|234|8.38 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MULTIPLAN [1680]|HMA [168003]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|234.00||||234.00||| 30286784|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB TRICHINELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|234.00||||234.00||| 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|GEHA [1415]|GEHA [141500]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|CORESOURCE [1315]|CORESOURCE [131500]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|162.00||||162.00|18.52|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|CHAMPVA [1240]|CHAMP VA [124000]|162.00||||162.00|121.5|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|162.00||||162.00|13.96|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|162.00||||162.00|105.3|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|162.00||||162.00|77.68|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|162.00||||162.00|162|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|162.00||||162.00|34.02|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|162.00||||162.00|18.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|UMR [2035]|UMR OPTIONS [203501]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|162.00||||162.00|13.14|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|162.00||||162.00|15.9|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|162.00||||162.00|15.96|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|FIRST HEALTH [1375]|QUALCHOICE [137513]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|FMH BENEFIT SERVICES [1390]|FMH [139000]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MULTIPLAN [1680]|IHC HS [168011]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|162.00||||162.00|18.52|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MULTIPLAN [1680]|HMA [168003]|162.00||||162.00|19.32|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|HEALTHNET [1495]|HEALTHNET [149500]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|AETNA [1015]|AETNA ACO WILCO [101532]|162.00||||162.00|20.35|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|||162.00||||162.00|48.6|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|TRUSTMARK [2030]|STARMARK [203000]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|162.00||||162.00|12.84|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|162.00||||162.00|8.59|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|162.00||||162.00|13.48|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|162.00||||162.00|14.17|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|162.00||||162.00|14.51|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|162.00||||162.00|13.96|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|162.00||||162.00|97.2|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|162.00||||162.00|13.52|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|162.00||||162.00|81|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|162.00||||162.00|81.16|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|162.00||||162.00|15.9|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|162.00||||162.00|56.86|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|162.00||||162.00|69.01|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|162.00||||162.00|12.88|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|162.00||||162.00|14.17|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|162.00||||162.00|145.8|162|8.59 30286787|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VARICELLA ZOSTER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|162.00||||162.00||| 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|220.00||||220.00|20.8|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|220.00||||220.00|110.22|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|220.00||||220.00|93.72|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|220.00||||220.00|110|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|220.00||||220.00|17.69|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|220.00||||220.00|132|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|220.00||||220.00|18.26|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|220.00||||220.00|18.54|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|220.00||||220.00|17.64|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|220.00||||220.00|11.23|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|TRUSTMARK [2030]|STARMARK [203000]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|AETNA [1015]|AETNA ACO WILCO [101532]|220.00||||220.00|26.62|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MULTIPLAN [1680]|IHC HS [168011]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MULTIPLAN [1680]|HMA [168003]|220.00||||220.00|25.28|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|220.00||||220.00|24.22|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|FMH BENEFIT SERVICES [1390]|FMH [139000]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|FIRST HEALTH [1375]|QUALCHOICE [137513]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|HEALTHNET [1495]|HEALTHNET [149500]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|220.00||||220.00|20.88|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|220.00||||220.00|20.8|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|220.00||||220.00|17.19|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|UMR [2035]|UMR OPTIONS [203501]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|220.00||||220.00|24.6|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|220.00||||220.00|46.2|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|220.00||||220.00|220|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|220.00||||220.00|105.49|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|220.00||||220.00|143|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|||220.00||||220.00|66|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|220.00||||220.00|77.22|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|220.00||||220.00|18.26|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|220.00||||220.00|18.54|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|220.00||||220.00|16.85|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|220.00||||220.00|16.8|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|CHAMPVA [1240]|CHAMP VA [124000]|220.00||||220.00|165|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|220.00||||220.00|24.22|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|CORESOURCE [1315]|CORESOURCE [131500]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|220.00||||220.00|18.98|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|GEHA [1415]|GEHA [141500]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|220.00||||220.00|198|220|11.23 30286788|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB IGM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|220.00||||220.00||| 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|GEHA [1415]|GEHA [141500]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|217.00||||217.00|16.2|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|CORESOURCE [1315]|CORESOURCE [131500]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|CHAMPVA [1240]|CHAMP VA [124000]|217.00||||217.00|162.75|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|217.00||||217.00|14.34|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|217.00||||217.00|15.59|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|||217.00||||217.00|65.1|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|217.00||||217.00|141.05|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|217.00||||217.00|104.05|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|217.00||||217.00|45.57|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|217.00||||217.00|21.01|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|UMR [2035]|UMR OPTIONS [203501]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|217.00||||217.00|14.68|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|217.00||||217.00|17.77|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|217.00||||217.00|17.83|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|FIRST HEALTH [1375]|QUALCHOICE [137513]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|FMH BENEFIT SERVICES [1390]|FMH [139000]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MULTIPLAN [1680]|IHC HS [168011]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|217.00||||217.00|20.69|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|217.00||||217.00|217|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MULTIPLAN [1680]|HMA [168003]|217.00||||217.00|21.59|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|HEALTHNET [1495]|HEALTHNET [149500]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|AETNA [1015]|AETNA ACO WILCO [101532]|217.00||||217.00|22.75|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|TRUSTMARK [2030]|STARMARK [203000]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|217.00||||217.00|9.59|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|217.00||||217.00|15.06|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|217.00||||217.00|20.69|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|217.00||||217.00|15.83|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|217.00||||217.00|15.59|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|217.00||||217.00|130.2|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|217.00||||217.00|15.11|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|217.00||||217.00|108.5|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|217.00||||217.00|17.77|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|217.00||||217.00|76.17|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|217.00||||217.00|108.72|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|217.00||||217.00|92.44|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|217.00||||217.00|14.39|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|217.00||||217.00|15.83|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|217.00||||217.00|195.3|217|9.59 30286789|EAP|0302 - LABORATORY-IMMUNOLOGY|HC WEST NILE VIRUS AB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|217.00||||217.00||| 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|345.00||||345.00|14.17|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|345.00||||345.00|121.1|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|345.00||||345.00|172.85|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|345.00||||345.00|15.9|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|345.00||||345.00|172.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|345.00||||345.00|13.52|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|345.00||||345.00|207|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|345.00||||345.00|13.96|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|345.00||||345.00|14.17|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|345.00||||345.00|8.59|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|TRUSTMARK [2030]|STARMARK [203000]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|HEALTHNET [1495]|HEALTHNET [149500]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MULTIPLAN [1680]|IHC HS [168011]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MULTIPLAN [1680]|HMA [168003]|345.00||||345.00|19.32|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|FMH BENEFIT SERVICES [1390]|FMH [139000]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|345.00||||345.00|18.52|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|FIRST HEALTH [1375]|QUALCHOICE [137513]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|345.00||||345.00|15.96|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|345.00||||345.00|15.9|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|345.00||||345.00|13.14|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|AETNA [1015]|AETNA ACO WILCO [101532]|345.00||||345.00|20.35|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|UMR [2035]|UMR OPTIONS [203501]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|345.00||||345.00|13.48|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|345.00||||345.00|18.8|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|345.00||||345.00|72.45|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|345.00||||345.00|345|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|345.00||||345.00|146.97|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|345.00||||345.00|165.43|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|345.00||||345.00|224.25|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|||345.00||||345.00|103.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|345.00||||345.00|13.96|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|345.00||||345.00|12.88|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|345.00||||345.00|12.84|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|CHAMPVA [1240]|CHAMP VA [124000]|345.00||||345.00|258.75|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|345.00||||345.00|18.52|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|CORESOURCE [1315]|CORESOURCE [131500]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|345.00||||345.00|14.51|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|GEHA [1415]|GEHA [141500]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|345.00||||345.00|310.5|345|8.59 30286790|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB VIRUS NOT SPECIFIED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|345.00||||345.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|GEHA [1415]|GEHA [141500]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|CORESOURCE [1315]|CORESOURCE [131500]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|CHAMPVA [1240]|CHAMP VA [124000]|178.00||||178.00|133.5|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|178.00||||178.00|13.15|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|178.00||||178.00|14.29|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|178.00||||178.00|115.7|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|178.00||||178.00|85.35|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|178.00||||178.00|178|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|178.00||||178.00|37.38|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|178.00||||178.00|16.28|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|178.00||||178.00|16.34|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|UMR [2035]|UMR OPTIONS [203501]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MULTIPLAN [1680]|IHC HS [168011]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|HEALTHNET [1495]|HEALTHNET [149500]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|||178.00||||178.00|53.4|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|AETNA [1015]|AETNA ACO WILCO [101532]|178.00||||178.00|20.84|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|TRUSTMARK [2030]|STARMARK [203000]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|178.00||||178.00|8.79|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|178.00||||178.00|13.81|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|178.00||||178.00|14.29|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|178.00||||178.00|106.8|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|178.00||||178.00|14.85|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|178.00||||178.00|89|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|178.00||||178.00|75.83|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|178.00||||178.00|89.18|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|178.00||||178.00|16.28|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|178.00||||178.00|62.48|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|178.00||||178.00|160.2|178|8.79 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MULTIPLAN [1680]|HMA [168003]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|178.00||||178.00||| 30286793|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB YERSINIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|178.00||||178.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158.00||||158.00|79|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|158.00||||158.00|79.16|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158.00||||158.00|55.46|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|158.00||||158.00|67.31|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158.00||||158.00|94.8|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158.00||||158.00|11.23|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|TRUSTMARK [2030]|STARMARK [203000]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|AETNA [1015]|AETNA ACO WILCO [101532]|158.00||||158.00|26.62|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MULTIPLAN [1680]|IHC HS [168011]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|HEALTHNET [1495]|HEALTHNET [149500]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|FMH BENEFIT SERVICES [1390]|FMH [139000]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|FIRST HEALTH [1375]|QUALCHOICE [137513]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158.00||||158.00|20.8|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|158.00||||158.00|39.5|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|UMR [2035]|UMR OPTIONS [203501]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158.00||||158.00|33.18|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158.00||||158.00|158|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158.00||||158.00|102.7|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.00||||158.00|75.76|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|||158.00||||158.00|47.4|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158.00||||158.00|20.8|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|CHAMPVA [1240]|CHAMP VA [124000]|158.00||||158.00|118.5|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|CORESOURCE [1315]|CORESOURCE [131500]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|GEHA [1415]|GEHA [141500]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158.00||||158.00|142.2|158|11.23 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MULTIPLAN [1680]|HMA [168003]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|158.00||||158.00||| 30286794|EAP|0302 - LABORATORY-IMMUNOLOGY|HC ZIKA VIRUS IGM ANTIBODY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|158.00||||158.00||| 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|GEHA [1415]|GEHA [141500]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|CORESOURCE [1315]|CORESOURCE [131500]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|199.00||||199.00|17.92|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|CHAMPVA [1240]|CHAMP VA [124000]|199.00||||199.00|149.25|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|199.00||||199.00|15.86|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|199.00||||199.00|17.24|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|||199.00||||199.00|59.7|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|199.00||||199.00|95.42|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|199.00||||199.00|199|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|199.00||||199.00|41.79|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|199.00||||199.00|23.23|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|UMR [2035]|UMR OPTIONS [203501]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|199.00||||199.00|16.23|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|199.00||||199.00|19.71|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|199.00||||199.00|19.64|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MULTIPLAN [1680]|IHC HS [168011]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|199.00||||199.00|22.87|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MULTIPLAN [1680]|HMA [168003]|199.00||||199.00|23.87|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|HEALTHNET [1495]|HEALTHNET [149500]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|199.00||||199.00|129.35|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|AETNA [1015]|AETNA ACO WILCO [101532]|199.00||||199.00|25.13|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|TRUSTMARK [2030]|STARMARK [203000]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|199.00||||199.00|10.6|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|199.00||||199.00|16.65|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|199.00||||199.00|22.87|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|199.00||||199.00|17.5|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|199.00||||199.00|17.24|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|199.00||||199.00|119.4|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|199.00||||199.00|16.71|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|199.00||||199.00|99.7|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|199.00||||199.00|19.64|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|199.00||||199.00|84.77|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|199.00||||199.00|69.85|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|199.00||||199.00|99.5|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|199.00||||199.00|15.91|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|199.00||||199.00|179.1|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|199.00||||199.00|17.5|199|10.6 30286800|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB THYROGLOBULIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|199.00||||199.00||| 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|240.00||||240.00|15.7|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|240.00||||240.00|120|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|240.00||||240.00|17.61|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|240.00||||240.00|120.24|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|240.00||||240.00|84.24|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|240.00||||240.00|14.98|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|240.00||||240.00|144|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|240.00||||240.00|15.7|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|240.00||||240.00|14.93|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|240.00||||240.00|9.51|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|TRUSTMARK [2030]|STARMARK [203000]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|AETNA [1015]|AETNA ACO WILCO [101532]|240.00||||240.00|22.55|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|HEALTHNET [1495]|HEALTHNET [149500]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MULTIPLAN [1680]|IHC HS [168011]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MULTIPLAN [1680]|HMA [168003]|240.00||||240.00|21.41|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|FMH BENEFIT SERVICES [1390]|FMH [139000]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|FIRST HEALTH [1375]|QUALCHOICE [137513]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|240.00||||240.00|20.51|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|240.00||||240.00|17.61|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|240.00||||240.00|17.68|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|240.00||||240.00|14.56|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|UMR [2035]|UMR OPTIONS [203501]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|240.00||||240.00|20.83|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|240.00||||240.00|50.4|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|240.00||||240.00|15.46|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|240.00||||240.00|240|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|240.00||||240.00|115.08|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|240.00||||240.00|156|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|240.00||||240.00|102.24|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|||240.00||||240.00|72|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|240.00||||240.00|15.46|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|240.00||||240.00|14.27|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|240.00||||240.00|14.22|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|CHAMPVA [1240]|CHAMP VA [124000]|240.00||||240.00|180|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|240.00||||240.00|20.51|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|240.00||||240.00|16.07|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|CORESOURCE [1315]|CORESOURCE [131500]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|GEHA [1415]|GEHA [141500]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|240.00||||240.00|216|240|9.51 30286803|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|240.00||||240.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|GEHA [1415]|GEHA [141500]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|CORESOURCE [1315]|CORESOURCE [131500]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|411.00||||411.00|17.44|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|CHAMPVA [1240]|CHAMP VA [124000]|411.00||||411.00|308.25|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|411.00||||411.00|16.78|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|411.00||||411.00|267.15|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|411.00||||411.00|197.07|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|411.00||||411.00|411|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|411.00||||411.00|86.31|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|411.00||||411.00|19.19|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|411.00||||411.00|19.13|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|FIRST HEALTH [1375]|QUALCHOICE [137513]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|FMH BENEFIT SERVICES [1390]|FMH [139000]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|UMR [2035]|UMR OPTIONS [203501]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MULTIPLAN [1680]|IHC HS [168011]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|HEALTHNET [1495]|HEALTHNET [149500]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|AETNA [1015]|AETNA ACO WILCO [101532]|411.00||||411.00|24.48|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|||411.00||||411.00|123.3|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|TRUSTMARK [2030]|STARMARK [203000]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|411.00||||411.00|10.33|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|411.00||||411.00|15.44|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|411.00||||411.00|16.21|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|411.00||||411.00|16.78|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|411.00||||411.00|246.6|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|411.00||||411.00|205.91|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|411.00||||411.00|19.13|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|411.00||||411.00|175.09|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|411.00||||411.00|144.26|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|411.00||||411.00|205.5|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|411.00||||411.00|369.9|411|10.33 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MULTIPLAN [1680]|HMA [168003]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|411.00||||411.00||| 30286804|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AB HEP C CONFIRM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|411.00||||411.00||| 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|406.00||||406.00|28.39|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.00||||406.00|203|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|406.00||||406.00|31.86|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|406.00||||406.00|172.96|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|406.00||||406.00|142.51|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|406.00||||406.00|203.41|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|406.00||||406.00|243.6|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|406.00||||406.00|27.96|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|406.00||||406.00|27.01|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|406.00||||406.00|17.2|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|TRUSTMARK [2030]|STARMARK [203000]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|AETNA [1015]|AETNA ACO WILCO [101532]|406.00||||406.00|40.78|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|HEALTHNET [1495]|HEALTHNET [149500]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MULTIPLAN [1680]|IHC HS [168011]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|406.00||||406.00|37.1|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MULTIPLAN [1680]|HMA [168003]|406.00||||406.00|38.72|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|FMH BENEFIT SERVICES [1390]|FMH [139000]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|FIRST HEALTH [1375]|QUALCHOICE [137513]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.00||||406.00|31.86|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|406.00||||406.00|31.97|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|406.00||||406.00|26.33|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|UMR [2035]|UMR OPTIONS [203501]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|406.00||||406.00|37.68|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|406.00||||406.00|28.39|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|406.00||||406.00|85.26|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|406.00||||406.00|406|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|406.00||||406.00|27.1|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.00||||406.00|194.68|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|406.00||||406.00|263.9|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|||406.00||||406.00|121.8|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|406.00||||406.00|27.96|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|406.00||||406.00|25.81|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|406.00||||406.00|25.73|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|CHAMPVA [1240]|CHAMP VA [124000]|406.00||||406.00|304.5|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|406.00||||406.00|37.1|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|406.00||||406.00|29.06|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|CORESOURCE [1315]|CORESOURCE [131500]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|GEHA [1415]|GEHA [141500]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|406.00||||406.00|365.4|406|17.2 30286812|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING SINGLE AG A/B/C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|406.00||||406.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|GEHA [1415]|GEHA [141500]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|CORESOURCE [1315]|CORESOURCE [131500]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|496.00||||496.00|65.31|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|CHAMPVA [1240]|CHAMP VA [124000]|496.00||||496.00|372|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|496.00||||496.00|57.8|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|496.00||||496.00|62.84|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|||496.00||||496.00|148.8|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|496.00||||496.00|237.83|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|496.00||||496.00|496|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|496.00||||496.00|104.16|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|UMR [2035]|UMR OPTIONS [203501]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|496.00||||496.00|71.84|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|496.00||||496.00|71.6|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|FIRST HEALTH [1375]|QUALCHOICE [137513]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|FMH BENEFIT SERVICES [1390]|FMH [139000]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MULTIPLAN [1680]|IHC HS [168011]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|HEALTHNET [1495]|HEALTHNET [149500]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|496.00||||496.00|322.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|AETNA [1015]|AETNA ACO WILCO [101532]|496.00||||496.00|91.66|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|TRUSTMARK [2030]|STARMARK [203000]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|496.00||||496.00|38.66|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|496.00||||496.00|60.69|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|496.00||||496.00|62.84|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|496.00||||496.00|297.6|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|496.00||||496.00|71.6|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|496.00||||496.00|174.1|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|496.00||||496.00|211.3|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|496.00||||496.00|248.5|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|496.00||||496.00|248|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|496.00||||496.00|446.4|496|38.66 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MULTIPLAN [1680]|HMA [168003]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|496.00||||496.00||| 30286813|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG A/B/C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|496.00||||496.00||| 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|862.00||||862.00|116.75|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|862.00||||862.00|431|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|862.00||||862.00|367.21|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|862.00||||862.00|431.86|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|862.00||||862.00|111.45|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|862.00||||862.00|517.2|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|862.00||||862.00|114.99|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|862.00||||862.00|116.75|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|862.00||||862.00|63.68|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|TRUSTMARK [2030]|STARMARK [203000]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|AETNA [1015]|AETNA ACO WILCO [101532]|862.00||||862.00|150.98|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|HEALTHNET [1495]|HEALTHNET [149500]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MULTIPLAN [1680]|IHC HS [168011]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|862.00||||862.00|152.59|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MULTIPLAN [1680]|HMA [168003]|862.00||||862.00|159.21|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|862.00||||862.00|131.47|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|862.00||||862.00|108.26|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|UMR [2035]|UMR OPTIONS [203501]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|862.00||||862.00|154.96|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|862.00||||862.00|181.02|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|862.00||||862.00|111.07|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|862.00||||862.00|862|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|862.00||||862.00|413.33|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|862.00||||862.00|560.3|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|862.00||||862.00|302.56|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|||862.00||||862.00|258.6|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|862.00||||862.00|114.99|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|862.00||||862.00|106.14|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|862.00||||862.00|105.78|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|CHAMPVA [1240]|CHAMP VA [124000]|862.00||||862.00|646.5|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|862.00||||862.00|152.59|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|862.00||||862.00|119.52|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|CORESOURCE [1315]|CORESOURCE [131500]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|GEHA [1415]|GEHA [141500]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|862.00||||862.00|775.8|862|63.68 30286817|EAP|0302 - LABORATORY-IMMUNOLOGY|HC HLA TYPING MULTI AG DR/DQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|862.00||||862.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|GEHA [1415]|GEHA [141500]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|CHAMPVA [1240]|CHAMP VA [124000]|281.00||||281.00|210.75|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|||281.00||||281.00|84.3|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281.00||||281.00|182.65|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281.00||||281.00|134.74|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281.00||||281.00|281|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281.00||||281.00|59.01|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281.00||||281.00|120.83|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|FIRST HEALTH [1375]|QUALCHOICE [137513]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|UMR [2035]|UMR OPTIONS [203501]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|FMH BENEFIT SERVICES [1390]|FMH [139000]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MULTIPLAN [1680]|IHC HS [168011]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|HEALTHNET [1495]|HEALTHNET [149500]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|TRUSTMARK [2030]|STARMARK [203000]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281.00||||281.00|70.25|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|CORESOURCE [1315]|CORESOURCE [131500]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281.00||||281.00|168.6|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281.00||||281.00|120.83|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|281.00||||281.00|140.78|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281.00||||281.00|98.63|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|281.00||||281.00|119.71|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281.00||||281.00|140.5|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281.00||||281.00|252.9|281|59.01 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MULTIPLAN [1680]|HMA [168003]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|AETNA [1015]|AETNA ACO WILCO [101532]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281.00||||281.00||| 30286849|EAP|0302 - LABORATORY-IMMUNOLOGY|HC IMMUNOLOGY PROC UNLISTED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281.00||||281.00||| 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254.00||||254.00|50.4|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254.00||||254.00|45.82|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254.00||||254.00|121.87|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254.00||||254.00|9.77|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|254.00||||254.00|127.25|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254.00||||254.00|89.15|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254.00||||254.00|152.4|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254.00||||254.00|10.58|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254.00||||254.00|10.22|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|254.00||||254.00|5.86|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|TRUSTMARK [2030]|STARMARK [203000]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|254.00||||254.00|13.9|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MULTIPLAN [1680]|IHC HS [168011]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|254.00||||254.00|65.87|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MULTIPLAN [1680]|HMA [168003]|254.00||||254.00|70.63|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254.00||||254.00|45.82|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254.00||||254.00|9.77|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|254.00||||254.00|12.1|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254.00||||254.00|48.03|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|UMR [2035]|UMR OPTIONS [203501]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254.00||||254.00|68.75|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254.00||||254.00|53.34|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254.00||||254.00|45.82|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254.00||||254.00|254|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254.00||||254.00|121.79|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254.00||||254.00|165.1|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|||254.00||||254.00|76.2|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254.00||||254.00|50.4|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254.00||||254.00|49.44|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|254.00||||254.00|108.2|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254.00||||254.00|10.58|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254.00||||254.00|47.09|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254.00||||254.00|9.73|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|254.00||||254.00|190.5|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|254.00||||254.00|65.87|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|254.00||||254.00|11|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|GEHA [1415]|GEHA [141500]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254.00||||254.00|228.6|254|5.86 30286850|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|254.00||||254.00||| 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|GEHA [1415]|GEHA [141500]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|CORESOURCE [1315]|CORESOURCE [131500]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|298.00||||298.00|171.51|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|298.00||||298.00|196.36|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|CHAMPVA [1240]|CHAMP VA [124000]|298.00||||298.00|223.5|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|298.00||||298.00|151.77|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|298.00||||298.00|165.01|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|||298.00||||298.00|89.4|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|298.00||||298.00|142.89|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|298.00||||298.00|298|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|298.00||||298.00|62.58|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|298.00||||298.00|199.42|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|UMR [2035]|UMR OPTIONS [203501]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|298.00||||298.00|139.32|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|298.00||||298.00|188.66|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|298.00||||298.00|128.14|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MULTIPLAN [1680]|IHC HS [168011]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|298.00||||298.00|196.36|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MULTIPLAN [1680]|HMA [168003]|298.00||||298.00|204.89|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|HEALTHNET [1495]|HEALTHNET [149500]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|298.00||||298.00|193.7|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|AETNA [1015]|AETNA ACO WILCO [101532]|298.00||||298.00|42.96|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|TRUSTMARK [2030]|STARMARK [203000]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|298.00||||298.00|86.84|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|298.00||||298.00|159.37|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|298.00||||298.00|150.25|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|298.00||||298.00|165.01|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|298.00||||298.00|178.8|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|298.00||||298.00|143.42|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|298.00||||298.00|128.14|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|298.00||||298.00|126.95|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|298.00||||298.00|149.3|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|298.00||||298.00|104.6|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|298.00||||298.00|298|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|298.00||||298.00|136.59|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|298.00||||298.00|268.2|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|298.00||||298.00|150.25|298|42.96 30286860|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB ELUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|298.00||||298.00||| 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1135.00||||1135.00|296.75|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1135.00||||1135.00|655.46|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1135.00||||1135.00|483.51|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1135.00||||1135.00|488.05|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1135.00||||1135.00|568.64|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1135.00||||1135.00|398.39|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1135.00||||1135.00|283.26|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1135.00||||1135.00|681|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1135.00||||1135.00|296.75|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1135.00||||1135.00|164.53|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|TRUSTMARK [2030]|STARMARK [203000]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|AETNA [1015]|AETNA ACO WILCO [101532]|1135.00||||1135.00|59.01|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|HEALTHNET [1495]|HEALTHNET [149500]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MULTIPLAN [1680]|IHC HS [168011]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MULTIPLAN [1680]|HMA [168003]|1135.00||||1135.00|404.65|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1135.00||||1135.00|387.82|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1135.00||||1135.00|488.05|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1135.00||||1135.00|315.88|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1135.00||||1135.00|275.16|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|UMR [2035]|UMR OPTIONS [203501]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1135.00||||1135.00|266.84|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1135.00||||1135.00|393.86|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1135.00||||1135.00|238.35|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1135.00||||1135.00|276.28|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1135.00||||1135.00|1135|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1135.00||||1135.00|544.23|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1135.00||||1135.00|737.75|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|||1135.00||||1135.00|340.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1135.00||||1135.00|276.28|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1135.00||||1135.00|269.77|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1135.00||||1135.00|254.12|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|CHAMPVA [1240]|CHAMP VA [124000]|1135.00||||1135.00|851.25|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1135.00||||1135.00|387.82|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1135.00||||1135.00|287.16|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|CORESOURCE [1315]|CORESOURCE [131500]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|GEHA [1415]|GEHA [141500]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1135.00||||1135.00|1021.5|1135|59.01 30286870|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC AB IDENTIFICATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1135.00||||1135.00||| 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|GEHA [1415]|GEHA [141500]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|278.00||||278.00|6.07|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|278.00||||278.00|44.52|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|CHAMPVA [1240]|CHAMP VA [124000]|278.00||||278.00|208.5|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|278.00||||278.00|5.84|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|278.00||||278.00|180.7|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|278.00||||278.00|133.3|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|278.00||||278.00|278|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|278.00||||278.00|58.38|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|278.00||||278.00|45.21|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|UMR [2035]|UMR OPTIONS [203501]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|278.00||||278.00|31.59|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|278.00||||278.00|6.67|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|278.00||||278.00|6.65|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|FIRST HEALTH [1375]|QUALCHOICE [137513]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|FMH BENEFIT SERVICES [1390]|FMH [139000]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MULTIPLAN [1680]|IHC HS [168011]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|278.00||||278.00|44.52|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MULTIPLAN [1680]|HMA [168003]|278.00||||278.00|46.45|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|HEALTHNET [1495]|HEALTHNET [149500]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|AETNA [1015]|AETNA ACO WILCO [101532]|278.00||||278.00|8.52|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|||278.00||||278.00|83.4|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|TRUSTMARK [2030]|STARMARK [203000]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|278.00||||278.00|3.59|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|278.00||||278.00|5.37|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|278.00||||278.00|5.64|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|278.00||||278.00|31.82|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|278.00||||278.00|34.06|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|CORESOURCE [1315]|CORESOURCE [131500]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|278.00||||278.00|5.84|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|278.00||||278.00|166.8|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|278.00||||278.00|32.52|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|278.00||||278.00|118.43|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|278.00||||278.00|6.65|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|278.00||||278.00|139.28|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|278.00||||278.00|97.58|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|278.00||||278.00|76.78|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|278.00||||278.00|30.97|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|278.00||||278.00|250.2|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|278.00||||278.00|34.06|278|3.59 30286880|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS DIRECT IGG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|278.00||||278.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|619.00||||619.00|345.93|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|619.00||||619.00|6.39|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|619.00||||619.00|263.69|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|619.00||||619.00|310.12|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|619.00||||619.00|371.4|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|619.00||||619.00|5.61|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|619.00||||619.00|5.42|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|TRUSTMARK [2030]|STARMARK [203000]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|AETNA [1015]|AETNA ACO WILCO [101532]|619.00||||619.00|8.18|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|HEALTHNET [1495]|HEALTHNET [149500]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MULTIPLAN [1680]|IHC HS [168011]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|FMH BENEFIT SERVICES [1390]|FMH [139000]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|FIRST HEALTH [1375]|QUALCHOICE [137513]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|619.00||||619.00|6.39|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|619.00||||619.00|6.41|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|UMR [2035]|UMR OPTIONS [203501]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|619.00||||619.00|3.45|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|619.00||||619.00|129.99|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|619.00||||619.00|619|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|619.00||||619.00|296.81|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|619.00||||619.00|402.35|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|||619.00||||619.00|185.7|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|619.00||||619.00|217.27|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|619.00||||619.00|5.61|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|619.00||||619.00|5.17|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|CHAMPVA [1240]|CHAMP VA [124000]|619.00||||619.00|464.25|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|619.00||||619.00|5.83|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|CORESOURCE [1315]|CORESOURCE [131500]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|GEHA [1415]|GEHA [141500]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|619.00||||619.00|557.1|619|3.45 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MULTIPLAN [1680]|HMA [168003]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|619.00||||619.00||| 30286886|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COOMBS INDIRECT TITER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|619.00||||619.00||| 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|GEHA [1415]|GEHA [141500]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|CORESOURCE [1315]|CORESOURCE [131500]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123.00||||123.00|3.37|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|CHAMPVA [1240]|CHAMP VA [124000]|123.00||||123.00|92.25|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123.00||||123.00|2.98|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123.00||||123.00|3.24|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|||123.00||||123.00|36.9|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123.00||||123.00|79.95|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123.00||||123.00|58.98|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123.00||||123.00|123|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123.00||||123.00|25.83|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123.00||||123.00|123|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|UMR [2035]|UMR OPTIONS [203501]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123.00||||123.00|105.86|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123.00||||123.00|3.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123.00||||123.00|3.69|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|FIRST HEALTH [1375]|QUALCHOICE [137513]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|FMH BENEFIT SERVICES [1390]|FMH [139000]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MULTIPLAN [1680]|IHC HS [168011]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123.00||||123.00|123|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MULTIPLAN [1680]|HMA [168003]|123.00||||123.00|155.68|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|HEALTHNET [1495]|HEALTHNET [149500]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|AETNA [1015]|AETNA ACO WILCO [101532]|123.00||||123.00|4.73|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|TRUSTMARK [2030]|STARMARK [203000]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123.00||||123.00|1.99|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123.00||||123.00|3.13|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123.00||||123.00|123|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123.00||||123.00|114.16|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123.00||||123.00|3.24|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123.00||||123.00|73.8|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123.00||||123.00|108.97|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123.00||||123.00|61.62|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123.00||||123.00|52.4|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123.00||||123.00|3.69|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123.00||||123.00|43.17|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123.00||||123.00|123|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123.00||||123.00|103.78|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123.00||||123.00|110.7|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123.00||||123.00|111.09|155.68|1.99 30286900|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING ABO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123.00||||123.00||| 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.00||||96.00|34.06|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.00||||96.00|76.78|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.00||||96.00|3.69|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.00||||96.00|48.1|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.00||||96.00|40.9|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.00||||96.00|33.41|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.00||||96.00|57.6|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.00||||96.00|35.01|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.00||||96.00|1.99|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|TRUSTMARK [2030]|STARMARK [203000]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|AETNA [1015]|AETNA ACO WILCO [101532]|96.00||||96.00|4.73|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|HEALTHNET [1495]|HEALTHNET [149500]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MULTIPLAN [1680]|IHC HS [168011]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MULTIPLAN [1680]|HMA [168003]|96.00||||96.00|47.74|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.00||||96.00|45.75|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.00||||96.00|3.69|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.00||||96.00|3.7|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.00||||96.00|32.46|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|UMR [2035]|UMR OPTIONS [203501]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.00||||96.00|3.13|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.00||||96.00|46.46|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.00||||96.00|20.16|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.00||||96.00|3.24|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.00||||96.00|96|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.00||||96.00|33.7|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.00||||96.00|46.03|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.00||||96.00|62.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|||96.00||||96.00|28.8|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.00||||96.00|3.24|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.00||||96.00|31.82|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.00||||96.00|2.98|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|CHAMPVA [1240]|CHAMP VA [124000]|96.00||||96.00|72|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.00||||96.00|45.75|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.00||||96.00|3.37|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|CORESOURCE [1315]|CORESOURCE [131500]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|GEHA [1415]|GEHA [141500]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.00||||96.00|86.4|96|1.99 30286901|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH (D)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.00||||96.00||| 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|GEHA [1415]|GEHA [141500]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|CORESOURCE [1315]|CORESOURCE [131500]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|169.00||||169.00|7.15|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|CHAMPVA [1240]|CHAMP VA [124000]|169.00||||169.00|126.75|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169.00||||169.00|6.33|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169.00||||169.00|269.77|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|169.00||||169.00|269.77|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169.00||||169.00|6.88|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169.00||||169.00|109.85|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169.00||||169.00|81.04|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169.00||||169.00|35.49|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169.00||||169.00|269.77|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169.00||||169.00|275.16|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|169.00||||169.00|7.87|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169.00||||169.00|6.35|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169.00||||169.00|269.77|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|FIRST HEALTH [1375]|QUALCHOICE [137513]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|UMR [2035]|UMR OPTIONS [203501]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|FMH BENEFIT SERVICES [1390]|FMH [139000]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169.00||||169.00|269.77|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MULTIPLAN [1680]|IHC HS [168011]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MULTIPLAN [1680]|HMA [168003]|169.00||||169.00|404.65|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|||169.00||||169.00|50.7|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|HEALTHNET [1495]|HEALTHNET [149500]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169.00||||169.00|269.77|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|AETNA [1015]|AETNA ACO WILCO [101532]|169.00||||169.00|9.03|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|TRUSTMARK [2030]|STARMARK [203000]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|169.00||||169.00|3.81|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169.00||||169.00|6.65|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169.00||||169.00|296.75|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169.00||||169.00|6.88|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169.00||||169.00|101.4|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|169.00||||169.00|84.67|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|169.00||||169.00|71.99|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169.00||||169.00|6.35|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169.00||||169.00|59.32|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169.00||||169.00|269.77|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169.00||||169.00|169|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169.00||||169.00|152.1|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169.00||||169.00|296.75|404.65|3.81 30286902|EAP|0302 - LABORATORY-IMMUNOLOGY|HC AG DONOR TYPING DIRECT TEST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|169.00||||169.00||| 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166.00||||166.00|296.75|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166.00||||166.00|269.77|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|166.00||||166.00|83.17|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166.00||||166.00|4.73|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|166.00||||166.00|70.72|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166.00||||166.00|99.6|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166.00||||166.00|4.15|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166.00||||166.00|4.01|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|TRUSTMARK [2030]|STARMARK [203000]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|AETNA [1015]|AETNA ACO WILCO [101532]|166.00||||166.00|6.05|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166.00||||166.00|269.77|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|HEALTHNET [1495]|HEALTHNET [149500]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MULTIPLAN [1680]|IHC HS [168011]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MULTIPLAN [1680]|HMA [168003]|166.00||||166.00|404.65|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166.00||||166.00|269.77|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166.00||||166.00|269.77|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166.00||||166.00|4.73|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|166.00||||166.00|4.75|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166.00||||166.00|275.16|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166.00||||166.00|269.77|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|UMR [2035]|UMR OPTIONS [203501]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|166.00||||166.00|2.55|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166.00||||166.00|296.75|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166.00||||166.00|34.86|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166.00||||166.00|79.6|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166.00||||166.00|107.9|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|||166.00||||166.00|49.8|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166.00||||166.00|58.27|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166.00||||166.00|4.15|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|166.00||||166.00|269.77|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166.00||||166.00|269.77|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166.00||||166.00|3.81|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|CHAMPVA [1240]|CHAMP VA [124000]|166.00||||166.00|124.5|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|166.00||||166.00|166|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|166.00||||166.00|4.31|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|CORESOURCE [1315]|CORESOURCE [131500]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|GEHA [1415]|GEHA [141500]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166.00||||166.00|149.4|404.65|2.55 30286905|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLOOD TYPING RBC ANTIGEN OTH/THAN ABO/RH D EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|166.00||||166.00||| 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|GEHA [1415]|GEHA [141500]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|CORESOURCE [1315]|CORESOURCE [131500]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|195.00||||195.00|8.73|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|CHAMPVA [1240]|CHAMP VA [124000]|195.00||||195.00|146.25|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195.00||||195.00|7.73|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195.00||||195.00|8.4|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|||195.00||||195.00|58.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195.00||||195.00|93.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195.00||||195.00|195|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195.00||||195.00|40.95|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195.00||||195.00|46.46|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|UMR [2035]|UMR OPTIONS [203501]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195.00||||195.00|32.46|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|195.00||||195.00|9.6|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195.00||||195.00|9.57|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MULTIPLAN [1680]|IHC HS [168011]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|195.00||||195.00|45.75|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MULTIPLAN [1680]|HMA [168003]|195.00||||195.00|47.74|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|HEALTHNET [1495]|HEALTHNET [149500]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195.00||||195.00|126.75|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|AETNA [1015]|AETNA ACO WILCO [101532]|195.00||||195.00|12.24|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|TRUSTMARK [2030]|STARMARK [203000]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|195.00||||195.00|5.17|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195.00||||195.00|8.12|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|195.00||||195.00|45.75|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195.00||||195.00|35.01|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195.00||||195.00|8.4|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195.00||||195.00|117|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195.00||||195.00|33.41|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|195.00||||195.00|83.07|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195.00||||195.00|9.57|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195.00||||195.00|68.45|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|195.00||||195.00|97.7|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195.00||||195.00|76.78|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195.00||||195.00|31.82|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195.00||||195.00|175.5|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195.00||||195.00|35.01|195|5.17 30286906|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD TYPING RH PHENOTYPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|195.00||||195.00||| 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|512.00||||512.00|146.21|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|512.00||||512.00|345.93|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|512.00||||512.00|218.11|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|512.00||||512.00|179.71|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|512.00||||512.00|220.16|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|512.00||||512.00|139.56|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|512.00||||512.00|307.2|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|512.00||||512.00|146.21|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|512.00||||512.00|136.59|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|512.00||||512.00|159.37|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|512.00||||512.00|86.84|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|TRUSTMARK [2030]|STARMARK [203000]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|AETNA [1015]|AETNA ACO WILCO [101532]|512.00||||512.00|47.69|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|HEALTHNET [1495]|HEALTHNET [149500]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MULTIPLAN [1680]|IHC HS [168011]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MULTIPLAN [1680]|HMA [168003]|512.00||||512.00|199.37|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|FMH BENEFIT SERVICES [1390]|FMH [139000]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|FIRST HEALTH [1375]|QUALCHOICE [137513]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|512.00||||512.00|191.08|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|512.00||||512.00|220.16|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|512.00||||512.00|188.66|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|512.00||||512.00|135.57|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|UMR [2035]|UMR OPTIONS [203501]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|512.00||||512.00|194.06|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|512.00||||512.00|107.52|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|512.00||||512.00|512|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|512.00||||512.00|245.5|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|512.00||||512.00|332.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|512.00||||512.00|165.01|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|512.00||||512.00|256.51|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|||512.00||||512.00|153.6|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|512.00||||512.00|165.01|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|512.00||||512.00|132.92|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|512.00||||512.00|151.77|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|CHAMPVA [1240]|CHAMP VA [124000]|512.00||||512.00|384|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|512.00||||512.00|191.08|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|512.00||||512.00|171.51|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|CORESOURCE [1315]|CORESOURCE [131500]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|GEHA [1415]|GEHA [141500]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|512.00||||512.00|460.8|512|47.69 30286920|EAP|0302 - LABORATORY-IMMUNOLOGY|HC CROSSMATCH IMMEDIAT SPIN AUTO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|512.00||||512.00||| 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|GEHA [1415]|GEHA [141500]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|CORESOURCE [1315]|CORESOURCE [131500]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|410.00||||410.00|171.51|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|410.00||||410.00|196.36|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|CHAMPVA [1240]|CHAMP VA [124000]|410.00||||410.00|307.5|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|410.00||||410.00|165.01|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|||410.00||||410.00|123|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|410.00||||410.00|266.5|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|410.00||||410.00|196.6|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|410.00||||410.00|410|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|410.00||||410.00|86.1|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|410.00||||410.00|199.42|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|410.00||||410.00|139.32|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|410.00||||410.00|188.66|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|410.00||||410.00|176.3|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|FIRST HEALTH [1375]|QUALCHOICE [137513]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|UMR [2035]|UMR OPTIONS [203501]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|FMH BENEFIT SERVICES [1390]|FMH [139000]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MULTIPLAN [1680]|IHC HS [168011]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|410.00||||410.00|196.36|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MULTIPLAN [1680]|HMA [168003]|410.00||||410.00|204.89|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|HEALTHNET [1495]|HEALTHNET [149500]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|AETNA [1015]|AETNA ACO WILCO [101532]|410.00||||410.00|38.24|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|TRUSTMARK [2030]|STARMARK [203000]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|410.00||||410.00|86.84|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|410.00||||410.00|159.37|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|410.00||||410.00|150.25|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|410.00||||410.00|151.77|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|410.00||||410.00|165.01|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|410.00||||410.00|246|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|410.00||||410.00|143.42|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|410.00||||410.00|176.3|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|410.00||||410.00|174.66|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|410.00||||410.00|205.41|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|410.00||||410.00|143.91|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|410.00||||410.00|345.93|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|410.00||||410.00|136.59|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|410.00||||410.00|369|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|410.00||||410.00|150.25|410|38.24 30286923|EAP|0302 - LABORATORY-IMMUNOLOGY|HC COMPAT TEST EACH UNIT ELECT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|410.00||||410.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124.00||||124.00|124|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124.00||||124.00|53.32|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|124.00||||124.00|52.82|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|124.00||||124.00|62.12|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124.00||||124.00|43.52|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124.00||||124.00|74.4|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124.00||||124.00|19.53|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124.00||||124.00|18.86|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|124.00||||124.00|86.84|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|TRUSTMARK [2030]|STARMARK [203000]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|124.00||||124.00|26.91|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|HEALTHNET [1495]|HEALTHNET [149500]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MULTIPLAN [1680]|IHC HS [168011]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124.00||||124.00|53.32|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|124.00||||124.00|22.33|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|UMR [2035]|UMR OPTIONS [203501]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124.00||||124.00|26.04|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124.00||||124.00|124|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124.00||||124.00|59.46|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124.00||||124.00|80.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|||124.00||||124.00|37.2|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124.00||||124.00|19.53|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124.00||||124.00|17.96|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|CHAMPVA [1240]|CHAMP VA [124000]|124.00||||124.00|93|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|124.00||||124.00|20.3|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|CORESOURCE [1315]|CORESOURCE [131500]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|GEHA [1415]|GEHA [141500]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124.00||||124.00|111.6|124|17.96 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MULTIPLAN [1680]|HMA [168003]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124.00||||124.00||| 30286927|EAP|0302 - LABORATORY-IMMUNOLOGY|HC FRESH FROZEN PLASMA THAWING EACH UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|124.00||||124.00||| 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|GEHA [1415]|GEHA [141500]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|CORESOURCE [1315]|CORESOURCE [131500]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|235.00||||235.00|104.27|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|CHAMPVA [1240]|CHAMP VA [124000]|235.00||||235.00|176.25|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235.00||||235.00|92.28|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235.00||||235.00|100.32|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|||235.00||||235.00|70.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235.00||||235.00|112.68|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235.00||||235.00|235|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235.00||||235.00|49.35|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235.00||||235.00|46.46|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|UMR [2035]|UMR OPTIONS [203501]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235.00||||235.00|32.46|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|235.00||||235.00|114.7|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235.00||||235.00|101.05|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MULTIPLAN [1680]|IHC HS [168011]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|235.00||||235.00|45.75|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MULTIPLAN [1680]|HMA [168003]|235.00||||235.00|47.74|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|HEALTHNET [1495]|HEALTHNET [149500]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235.00||||235.00|152.75|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|AETNA [1015]|AETNA ACO WILCO [101532]|235.00||||235.00|40.13|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|TRUSTMARK [2030]|STARMARK [203000]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|235.00||||235.00|19.27|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235.00||||235.00|96.89|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|235.00||||235.00|45.75|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235.00||||235.00|35.01|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235.00||||235.00|100.32|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235.00||||235.00|141|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235.00||||235.00|33.41|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235.00||||235.00|82.49|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|235.00||||235.00|100.11|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|235.00||||235.00|117.74|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235.00||||235.00|101.05|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235.00||||235.00|76.78|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235.00||||235.00|31.82|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235.00||||235.00|211.5|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235.00||||235.00|35.01|235|19.27 30286945|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT IRRADIATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|235.00||||235.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|HEALTHNET [1495]|HEALTHNET [149500]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MULTIPLAN [1680]|IHC HS [168011]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|FMH BENEFIT SERVICES [1390]|FMH [139000]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|FIRST HEALTH [1375]|QUALCHOICE [137513]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|236.00||||236.00|188.66|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|UMR [2035]|UMR OPTIONS [203501]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236.00||||236.00|49.56|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236.00||||236.00|101.48|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236.00||||236.00|236|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236.00||||236.00|113.16|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236.00||||236.00|153.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|||236.00||||236.00|70.8|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236.00||||236.00|165.01|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|AETNA [1015]|AETNA ACO WILCO [101532]|236.00||||236.00|44.86|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236.00||||236.00|151.77|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|CHAMPVA [1240]|CHAMP VA [124000]|236.00||||236.00|177|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|236.00||||236.00|171.51|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|CORESOURCE [1315]|CORESOURCE [131500]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|GEHA [1415]|GEHA [141500]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236.00||||236.00|236|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|236.00||||236.00|86.84|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236.00||||236.00|101.48|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236.00||||236.00|165.01|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|236.00||||236.00|100.54|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236.00||||236.00|141.6|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|236.00||||236.00|118.24|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236.00||||236.00|159.37|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236.00||||236.00|82.84|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|TRUSTMARK [2030]|STARMARK [203000]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236.00||||236.00|212.4|236|44.86 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MULTIPLAN [1680]|HMA [168003]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236.00||||236.00||| 30286965|EAP|0302 - LABORATORY-IMMUNOLOGY|HC BLD PRODUCT POOLING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236.00||||236.00||| 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.00||||139.00|76.78|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|HEALTHNET [1495]|HEALTHNET [149500]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|UMR [2035]|UMR OPTIONS [203501]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139.00||||139.00|44.24|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139.00||||139.00|45.75|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.00||||139.00|35.59|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.00||||139.00|83.4|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.00||||139.00|35.01|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.00||||139.00|32.46|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139.00||||139.00|69.64|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|AETNA [1015]|AETNA ACO WILCO [101532]|139.00||||139.00|40.13|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|||139.00||||139.00|41.7|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139.00||||139.00|40.21|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139.00||||139.00|45.75|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.00||||139.00|38.69|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139.00||||139.00|19.27|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MULTIPLAN [1680]|HMA [168003]|139.00||||139.00|47.74|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MULTIPLAN [1680]|IHC HS [168011]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.00||||139.00|48.79|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.00||||139.00|59.77|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.00||||139.00|37.37|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.00||||139.00|35.01|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.00||||139.00|38.69|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.00||||139.00|139|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.00||||139.00|46.46|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.00||||139.00|33.41|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.00||||139.00|29.19|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.00||||139.00|66.65|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|CORESOURCE [1315]|CORESOURCE [131500]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|GEHA [1415]|GEHA [141500]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|TRUSTMARK [2030]|STARMARK [203000]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.00||||139.00|59.77|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.00||||139.00|125.1|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139.00||||139.00|31.82|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.00||||139.00|90.35|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|CHAMPVA [1240]|CHAMP VA [124000]|139.00||||139.00|104.25|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139.00||||139.00|59.21|139|19.27 30286970|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRETREATMENT CHEMICAL/DRUG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139.00||||139.00||| 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|823.00||||823.00|188.66|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|823.00||||823.00|394.63|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|823.00||||823.00|823|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|823.00||||823.00|393.86|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|823.00||||823.00|172.83|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|823.00||||823.00|165.01|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|823.00||||823.00|151.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|823.00||||823.00|171.51|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|UMR [2035]|UMR OPTIONS [203501]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|823.00||||823.00|275.16|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|FIRST HEALTH [1375]|QUALCHOICE [137513]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|823.00||||823.00|412.32|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|CORESOURCE [1315]|CORESOURCE [131500]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|GEHA [1415]|GEHA [141500]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|823.00||||823.00|350.6|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|823.00||||823.00|493.8|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|823.00||||823.00|655.46|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|823.00||||823.00|296.75|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|823.00||||823.00|296.75|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|823.00||||823.00|159.37|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|CHAMPVA [1240]|CHAMP VA [124000]|823.00||||823.00|617.25|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|HEALTHNET [1495]|HEALTHNET [149500]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|823.00||||823.00|288.87|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|823.00||||823.00|353.89|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|FMH BENEFIT SERVICES [1390]|FMH [139000]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|823.00||||823.00|534.95|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|823.00||||823.00|387.82|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|823.00||||823.00|164.53|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|823.00||||823.00|283.26|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|823.00||||823.00|165.01|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|TRUSTMARK [2030]|STARMARK [203000]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|||823.00||||823.00|246.9|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|823.00||||823.00|387.82|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|823.00||||823.00|269.77|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MULTIPLAN [1680]|HMA [168003]|823.00||||823.00|404.65|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|AETNA [1015]|AETNA ACO WILCO [101532]|823.00||||823.00|32.1|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|MULTIPLAN [1680]|IHC HS [168011]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|823.00||||823.00|740.7|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|823.00||||823.00|353.89|823|32.1 30286971|EAP|0302 - LABORATORY-IMMUNOLOGY|HC RBC PRTRMNT INCUB W/ ENZYMES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|823.00||||823.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226.00||||226.00|151.77|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|226.00||||226.00|171.51|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226.00||||226.00|47.46|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|||226.00||||226.00|67.8|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|GEHA [1415]|GEHA [141500]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226.00||||226.00|226|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226.00||||226.00|146.9|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|UMR [2035]|UMR OPTIONS [203501]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|CORESOURCE [1315]|CORESOURCE [131500]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226.00||||226.00|97.18|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|226.00||||226.00|188.66|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MULTIPLAN [1680]|IHC HS [168011]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|TRUSTMARK [2030]|STARMARK [203000]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|CHAMPVA [1240]|CHAMP VA [124000]|226.00||||226.00|169.5|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|226.00||||226.00|86.84|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226.00||||226.00|159.37|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|HEALTHNET [1495]|HEALTHNET [149500]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226.00||||226.00|226|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|226.00||||226.00|113.23|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226.00||||226.00|79.33|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226.00||||226.00|108.37|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226.00||||226.00|97.18|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|AETNA [1015]|AETNA ACO WILCO [101532]|226.00||||226.00|34.93|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226.00||||226.00|165.01|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226.00||||226.00|165.01|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|226.00||||226.00|96.28|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226.00||||226.00|203.4|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226.00||||226.00|135.6|226|34.93 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|MULTIPLAN [1680]|HMA [168003]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226.00||||226.00||| 30286985|EAP|0302 - LABORATORY-IMMUNOLOGY|HC SPLIT BLD PRODUCT EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226.00||||226.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208.00||||208.00|5.22|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208.00||||208.00|135.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|208.00||||208.00|5.97|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|UMR [2035]|UMR OPTIONS [203501]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|208.00||||208.00|5.43|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208.00||||208.00|5.57|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208.00||||208.00|4.8|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|CHAMPVA [1240]|CHAMP VA [124000]|208.00||||208.00|156|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|CORESOURCE [1315]|CORESOURCE [131500]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|||208.00||||208.00|62.4|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|GEHA [1415]|GEHA [141500]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208.00||||208.00|99.74|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208.00||||208.00|43.68|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208.00||||208.00|208|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208.00||||208.00|5.04|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208.00||||208.00|124.8|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|208.00||||208.00|104.21|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|208.00||||208.00|88.61|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208.00||||208.00|5.22|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208.00||||208.00|5.57|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|208.00||||208.00|3.01|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|TRUSTMARK [2030]|STARMARK [203000]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MULTIPLAN [1680]|IHC HS [168011]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|AETNA [1015]|AETNA ACO WILCO [101532]|208.00||||208.00|7.12|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208.00||||208.00|73.01|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|HEALTHNET [1495]|HEALTHNET [149500]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|FMH BENEFIT SERVICES [1390]|FMH [139000]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|FIRST HEALTH [1375]|QUALCHOICE [137513]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208.00||||208.00|187.2|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208.00||||208.00|104|208|3.01 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MULTIPLAN [1680]|HMA [168003]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208.00||||208.00||| 30585002|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLEED TIME|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208.00||||208.00||| 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|GEHA [1415]|GEHA [141500]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|CORESOURCE [1315]|CORESOURCE [131500]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87.00||||87.00|41.72|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87.00||||87.00|56.55|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|CHAMPVA [1240]|CHAMP VA [124000]|87.00||||87.00|65.25|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|87.00||||87.00|5.46|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87.00||||87.00|87|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|||87.00||||87.00|26.1|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87.00||||87.00|5.55|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|UMR [2035]|UMR OPTIONS [203501]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87.00||||87.00|4.11|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87.00||||87.00|4.24|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87.00||||87.00|18.27|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|AETNA [1015]|AETNA ACO WILCO [101532]|87.00||||87.00|5.43|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MULTIPLAN [1680]|HMA [168003]|87.00||||87.00|5.7|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|87.00||||87.00|5.46|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|HEALTHNET [1495]|HEALTHNET [149500]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|87.00||||87.00|4.27|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MULTIPLAN [1680]|IHC HS [168011]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87.00||||87.00|30.54|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|87.00||||87.00|37.06|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87.00||||87.00|4.24|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87.00||||87.00|4.11|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|TRUSTMARK [2030]|STARMARK [203000]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87.00||||87.00|3.99|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87.00||||87.00|4.18|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87.00||||87.00|4.18|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|87.00||||87.00|43.59|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87.00||||87.00|52.2|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87.00||||87.00|43.5|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87.00||||87.00|3.97|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87.00||||87.00|78.3|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|87.00||||87.00|2.29|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87.00||||87.00|3.88|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|87.00||||87.00|4.7|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87.00||||87.00|3.8|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87.00||||87.00|3.78|87|2.29 30585007|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD DIFFERENTIAL WBC MANUAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|87.00||||87.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00|12.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|||25.00||||25.00|7.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|7|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00|9.96|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00|8.67|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00|25|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|7|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00|4.2|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00|6.97|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00|7.58|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00|7.88|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00|7.58|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00|7.32|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|25|4.2 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 30585013|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT SPUN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.00||||96.00|2.57|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.00||||96.00|62.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|CORESOURCE [1315]|CORESOURCE [131500]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.00||||96.00|3.41|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.00||||96.00|2.67|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.00||||96.00|2.94|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.00||||96.00|3.46|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.00||||96.00|20.16|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.00||||96.00|2.93|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.00||||96.00|2.48|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|TRUSTMARK [2030]|STARMARK [203000]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|HEALTHNET [1495]|HEALTHNET [149500]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.00||||96.00|3.41|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MULTIPLAN [1680]|IHC HS [168011]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.00||||96.00|96|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.00||||96.00|1.58|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|AETNA [1015]|AETNA ACO WILCO [101532]|96.00||||96.00|3.74|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.00||||96.00|2.61|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.00||||96.00|2.42|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.00||||96.00|40.9|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.00||||96.00|2.61|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.00||||96.00|2.93|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.00||||96.00|57.6|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.00||||96.00|48|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.00||||96.00|48.1|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.00||||96.00|46.03|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.00||||96.00|2.57|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.00||||96.00|2.36|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|GEHA [1415]|GEHA [141500]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MULTIPLAN [1680]|HMA [168003]|96.00||||96.00|3.56|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|CHAMPVA [1240]|CHAMP VA [124000]|96.00||||96.00|72|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.00||||96.00|2.37|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|||96.00||||96.00|28.8|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|UMR [2035]|UMR OPTIONS [203501]|96.00||||96.00|86.4|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.00||||96.00|2.49|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.00||||96.00|33.7|96|1.58 30585014|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMATOCRIT NON SPUN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.00||||96.00||| 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|97.00||||97.00|2.36|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|CHAMPVA [1240]|CHAMP VA [124000]|97.00||||97.00|72.75|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|97.00||||97.00|3.41|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|97.00||||97.00|2.67|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|CORESOURCE [1315]|CORESOURCE [131500]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|GEHA [1415]|GEHA [141500]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|97.00||||97.00|2.57|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|97.00||||97.00|63.05|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97.00||||97.00|46.51|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|||97.00||||97.00|29.1|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97.00||||97.00|2.49|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|97.00||||97.00|41.32|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|97.00||||97.00|2.61|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|97.00||||97.00|2.93|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|97.00||||97.00|34.05|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|97.00||||97.00|48.6|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|97.00||||97.00|58.2|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|97.00||||97.00|2.57|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|UMR [2035]|UMR OPTIONS [203501]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|97.00||||97.00|48.5|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|97.00||||97.00|2.48|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|97.00||||97.00|1.58|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MULTIPLAN [1680]|HMA [168003]|97.00||||97.00|3.56|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MULTIPLAN [1680]|IHC HS [168011]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|97.00||||97.00|3.41|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|AETNA [1015]|AETNA ACO WILCO [101532]|97.00||||97.00|3.74|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|HEALTHNET [1495]|HEALTHNET [149500]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|97.00||||97.00|20.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|TRUSTMARK [2030]|STARMARK [203000]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|97.00||||97.00|2.94|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|97.00||||97.00|2.61|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97.00||||97.00|2.42|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|97.00||||97.00|3.46|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97.00||||97.00|2.93|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97.00||||97.00|2.37|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|97.00||||97.00|87.3|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|97.00||||97.00|97|97|1.58 30585018|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|97.00||||97.00||| 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|GEHA [1415]|GEHA [141500]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|CORESOURCE [1315]|CORESOURCE [131500]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|226.00||||226.00|8.74|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226.00||||226.00|7.74|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|226.00||||226.00|11.17|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|||226.00||||226.00|67.8|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226.00||||226.00|108.37|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226.00||||226.00|7.93|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226.00||||226.00|47.46|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|UMR [2035]|UMR OPTIONS [203501]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|226.00||||226.00|9.61|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226.00||||226.00|226|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|FMH BENEFIT SERVICES [1390]|FMH [139000]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|FIRST HEALTH [1375]|QUALCHOICE [137513]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226.00||||226.00|11.34|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|226.00||||226.00|5.18|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MULTIPLAN [1680]|IHC HS [168011]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|HEALTHNET [1495]|HEALTHNET [149500]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MULTIPLAN [1680]|HMA [168003]|226.00||||226.00|11.66|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|AETNA [1015]|AETNA ACO WILCO [101532]|226.00||||226.00|12.28|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|TRUSTMARK [2030]|STARMARK [203000]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226.00||||226.00|8.41|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|226.00||||226.00|113.23|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|226.00||||226.00|96.28|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226.00||||226.00|135.6|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226.00||||226.00|79.33|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226.00||||226.00|113|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|CHAMPVA [1240]|CHAMP VA [124000]|226.00||||226.00|169.5|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|226.00||||226.00|11.17|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226.00||||226.00|8.16|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226.00||||226.00|203.4|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226.00||||226.00|9.59|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226.00||||226.00|8.41|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226.00||||226.00|8.55|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226.00||||226.00|8.55|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226.00||||226.00|146.9|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226.00||||226.00|9.59|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226.00||||226.00|8.13|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|226.00||||226.00|7.77|226|5.18 30585025|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/AUTO DIFF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|226.00||||226.00||| 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|114.00||||114.00|48.56|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|114.00||||114.00|57.11|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114.00||||114.00|7.12|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114.00||||114.00|57|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114.00||||114.00|7.98|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114.00||||114.00|68.4|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114.00||||114.00|40.01|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114.00||||114.00|6.79|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114.00||||114.00|7.01|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|TRUSTMARK [2030]|STARMARK [203000]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MULTIPLAN [1680]|HMA [168003]|114.00||||114.00|9.71|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|114.00||||114.00|9.3|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|FIRST HEALTH [1375]|QUALCHOICE [137513]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|FMH BENEFIT SERVICES [1390]|FMH [139000]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|114.00||||114.00|4.31|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|HEALTHNET [1495]|HEALTHNET [149500]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|114.00||||114.00|8.01|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|AETNA [1015]|AETNA ACO WILCO [101532]|114.00||||114.00|10.21|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114.00||||114.00|7.98|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114.00||||114.00|114|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114.00||||114.00|6.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MULTIPLAN [1680]|IHC HS [168011]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|UMR [2035]|UMR OPTIONS [203501]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114.00||||114.00|7.12|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114.00||||114.00|9.45|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114.00||||114.00|6.77|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114.00||||114.00|23.94|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114.00||||114.00|54.66|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|114.00||||114.00|7.98|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114.00||||114.00|7.01|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|114.00||||114.00|9.3|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114.00||||114.00|6.44|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|CHAMPVA [1240]|CHAMP VA [124000]|114.00||||114.00|85.5|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|114.00||||114.00|7.29|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|||114.00||||114.00|34.2|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|GEHA [1415]|GEHA [141500]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|114.00||||114.00|6.47|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114.00||||114.00|102.6|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114.00||||114.00|74.1|114|4.31 30585027|EAP|0305 - LABORATORY-HEMATOLOGY|HC CBC AUTO W/O DIFF|CORESOURCE [1315]|CORESOURCE [131500]|114.00||||114.00|102.6|114|4.31 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.00||||61.00|4.29|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.00||||61.00|4.85|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|CORESOURCE [1315]|CORESOURCE [131500]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.00||||61.00|4.67|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|CHAMPVA [1240]|CHAMP VA [124000]|61.00||||61.00|45.75|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.00||||61.00|39.65|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.00||||61.00|61|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.00||||61.00|12.81|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|UMR [2035]|UMR OPTIONS [203501]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.00||||61.00|5.34|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.00||||61.00|5.32|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|TRUSTMARK [2030]|STARMARK [203000]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MULTIPLAN [1680]|IHC HS [168011]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|AETNA [1015]|AETNA ACO WILCO [101532]|61.00||||61.00|6.81|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|||61.00||||61.00|18.3|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|HEALTHNET [1495]|HEALTHNET [149500]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.00||||61.00|5.32|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.00||||61.00|30.56|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.00||||61.00|21.41|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.00||||61.00|25.99|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.00||||61.00|30.5|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.00||||61.00|36.6|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.00||||61.00|4.51|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.00||||61.00|4.67|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|GEHA [1415]|GEHA [141500]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.00||||61.00|2.87|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.00||||61.00|29.25|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.00||||61.00|54.9|61|2.87 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MULTIPLAN [1680]|HMA [168003]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.00||||61.00||| 30585032|EAP|0305 - LABORATORY-HEMATOLOGY|HC MANUAL CELL COUNT EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.00||||61.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.00||||63.00|31.5|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.00||||63.00|31.56|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.00||||63.00|22.11|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.00||||63.00|37.8|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.00||||63.00|3.27|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.00||||63.00|2.01|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.00||||63.00|3.17|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.00||||63.00|63|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|AETNA [1015]|AETNA ACO WILCO [101532]|63.00||||63.00|4.76|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.00||||63.00|3.73|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|TRUSTMARK [2030]|STARMARK [203000]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MULTIPLAN [1680]|IHC HS [168011]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.00||||63.00|3.73|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.00||||63.00|13.23|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|HEALTHNET [1495]|HEALTHNET [149500]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.00||||63.00|3.74|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|CORESOURCE [1315]|CORESOURCE [131500]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|UMR [2035]|UMR OPTIONS [203501]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.00||||63.00|26.84|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|CHAMPVA [1240]|CHAMP VA [124000]|63.00||||63.00|47.25|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.00||||63.00|3.01|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.00||||63.00|3.4|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|GEHA [1415]|GEHA [141500]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.00||||63.00|3.27|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|||63.00||||63.00|18.9|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.00||||63.00|56.7|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.00||||63.00|30.21|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.00||||63.00|40.95|63|2.01 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MULTIPLAN [1680]|HMA [168003]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.00||||63.00||| 30585041|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RBC AUTOMATED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.00||||63.00||| 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|CHAMPVA [1240]|CHAMP VA [124000]|112.00||||112.00|84|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112.00||||112.00|4.32|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|GEHA [1415]|GEHA [141500]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|||112.00||||112.00|33.6|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|112.00||||112.00|4.49|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112.00||||112.00|3.98|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112.00||||112.00|4.93|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112.00||||112.00|23.52|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|AETNA [1015]|AETNA ACO WILCO [101532]|112.00||||112.00|6.32|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112.00||||112.00|4.07|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112.00||||112.00|5.83|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|CORESOURCE [1315]|CORESOURCE [131500]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|112.00||||112.00|4.94|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112.00||||112.00|112|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|UMR [2035]|UMR OPTIONS [203501]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|FIRST HEALTH [1375]|QUALCHOICE [137513]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|FMH BENEFIT SERVICES [1390]|FMH [139000]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|112.00||||112.00|2.66|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MULTIPLAN [1680]|HMA [168003]|112.00||||112.00|5.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|HEALTHNET [1495]|HEALTHNET [149500]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112.00||||112.00|72.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|112.00||||112.00|5.74|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|TRUSTMARK [2030]|STARMARK [203000]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MULTIPLAN [1680]|IHC HS [168011]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112.00||||112.00|4.93|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|112.00||||112.00|47.71|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112.00||||112.00|56|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|112.00||||112.00|5.74|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|112.00||||112.00|56.11|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112.00||||112.00|4.19|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112.00||||112.00|53.7|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112.00||||112.00|4.18|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112.00||||112.00|4.32|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112.00||||112.00|4.39|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112.00||||112.00|4.39|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112.00||||112.00|39.31|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112.00||||112.00|3.99|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112.00||||112.00|100.8|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112.00||||112.00|67.2|112|2.66 30585045|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT RETICULOCYTE AUTO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|112.00||||112.00||| 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|3.13|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00|2.79|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00|2.67|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00|2.75|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00|2.79|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|3.81|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00|3.65|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00|1.69|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00|4.01|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|3.13|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00|29|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00|2.59|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|3.71|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00|3.15|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00|2.75|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00|2.86|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00|2.66|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00|14.5|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00|3.65|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|||29.00||||29.00|8.7|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00|2.54|29|1.69 30585048|EAP|0305 - LABORATORY-HEMATOLOGY|HC BLD CNT WBC AUTOMATED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.00||||127.00|4.46|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127.00||||127.00|6.44|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.00||||127.00|82.55|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.00||||127.00|5.53|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.00||||127.00|127|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.00||||127.00|26.67|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127.00||||127.00|5.55|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.00||||127.00|6.54|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.00||||127.00|4.57|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|UMR [2035]|UMR OPTIONS [203501]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|TRUSTMARK [2030]|STARMARK [203000]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MULTIPLAN [1680]|IHC HS [168011]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.00||||127.00|60.9|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|AETNA [1015]|AETNA ACO WILCO [101532]|127.00||||127.00|7.07|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|||127.00||||127.00|38.1|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.00||||127.00|4.85|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|HEALTHNET [1495]|HEALTHNET [149500]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MULTIPLAN [1680]|HMA [168003]|127.00||||127.00|6.72|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.00||||127.00|4.7|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.00||||127.00|5.53|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.00||||127.00|44.58|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.00||||127.00|63.5|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127.00||||127.00|63.63|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127.00||||127.00|54.1|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.00||||127.00|76.2|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.00||||127.00|4.48|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.00||||127.00|4.85|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.00||||127.00|4.68|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.00||||127.00|4.93|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|CHAMPVA [1240]|CHAMP VA [124000]|127.00||||127.00|95.25|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127.00||||127.00|2.98|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.00||||127.00|4.93|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|GEHA [1415]|GEHA [141500]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|CORESOURCE [1315]|CORESOURCE [131500]|127.00||||127.00|114.3|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127.00||||127.00|5.04|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127.00||||127.00|6.44|127|2.98 30585049|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET CNT AUTO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127.00||||127.00||| 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|719.00||||719.00|640.06|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|719.00||||719.00|719|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|719.00||||719.00|360.22|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|719.00||||719.00|309.17|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|719.00||||719.00|252.37|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|719.00||||719.00|610.97|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|719.00||||719.00|431.4|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|719.00||||719.00|73.89|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|719.00||||719.00|71.37|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MULTIPLAN [1680]|IHC HS [168011]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|719.00||||719.00|719|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|HEALTHNET [1495]|HEALTHNET [149500]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|TRUSTMARK [2030]|STARMARK [203000]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|719.00||||719.00|309.17|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MULTIPLAN [1680]|HMA [168003]|719.00||||719.00|872.81|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|719.00||||719.00|84.48|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|719.00||||719.00|593.51|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|AETNA [1015]|AETNA ACO WILCO [101532]|719.00||||719.00|71.68|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|719.00||||719.00|334.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|UMR [2035]|UMR OPTIONS [203501]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|719.00||||719.00|640.06|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|719.00||||719.00|719|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|719.00||||719.00|150.99|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|719.00||||719.00|719|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|719.00||||719.00|73.89|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|719.00||||719.00|306.29|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|719.00||||719.00|67.97|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|||719.00||||719.00|215.7|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|CHAMPVA [1240]|CHAMP VA [124000]|719.00||||719.00|539.25|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|719.00||||719.00|719|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|719.00||||719.00|76.8|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|CORESOURCE [1315]|CORESOURCE [131500]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|GEHA [1415]|GEHA [141500]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|719.00||||719.00|467.35|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|719.00||||719.00|344.76|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|719.00||||719.00|581.87|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|719.00||||719.00|647.1|872.81|67.97 30585097|EAP|0305 - LABORATORY-HEMATOLOGY|HC BONE MARROW INTERPRETATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|719.00||||719.00||| 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|CHAMPVA [1240]|CHAMP VA [124000]|873.00||||873.00|654.75|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|GEHA [1415]|GEHA [141500]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|CORESOURCE [1315]|CORESOURCE [131500]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|873.00||||873.00|14.61|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|873.00||||873.00|18.66|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|873.00||||873.00|12.93|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|||873.00||||873.00|261.9|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|873.00||||873.00|418.6|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|873.00||||873.00|18.95|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|UMR [2035]|UMR OPTIONS [203501]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|873.00||||873.00|13.24|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|873.00||||873.00|16.08|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|873.00||||873.00|16.03|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|FIRST HEALTH [1375]|QUALCHOICE [137513]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|873.00||||873.00|183.33|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|FMH BENEFIT SERVICES [1390]|FMH [139000]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|873.00||||873.00|873|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|873.00||||873.00|567.45|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MULTIPLAN [1680]|IHC HS [168011]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|873.00||||873.00|14.06|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|873.00||||873.00|18.66|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MULTIPLAN [1680]|HMA [168003]|873.00||||873.00|19.47|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|HEALTHNET [1495]|HEALTHNET [149500]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|AETNA [1015]|COVENTRY HEALTHCARE [101502]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|AETNA [1015]|AETNA ACO WILCO [101532]|873.00||||873.00|20.53|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|TRUSTMARK [2030]|STARMARK [203000]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|873.00||||873.00|13.63|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|873.00||||873.00|16.03|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|873.00||||873.00|306.42|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|873.00||||873.00|371.9|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|873.00||||873.00|436.5|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|873.00||||873.00|437.37|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|873.00||||873.00|523.8|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|873.00||||873.00|14.28|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|873.00||||873.00|14.28|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|873.00||||873.00|13.58|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|873.00||||873.00|14.06|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|873.00||||873.00|8.66|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|873.00||||873.00|12.98|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|873.00||||873.00|785.7|873|8.66 30585210|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR II|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|873.00||||873.00||| 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211.00||||211.00|19.42|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211.00||||211.00|105.5|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|211.00||||211.00|105.71|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211.00||||211.00|74.06|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|211.00||||211.00|89.89|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211.00||||211.00|18.53|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211.00||||211.00|126.6|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211.00||||211.00|19.12|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211.00||||211.00|19.42|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|211.00||||211.00|11.77|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|HEALTHNET [1495]|HEALTHNET [149500]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MULTIPLAN [1680]|HMA [168003]|211.00||||211.00|26.48|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|211.00||||211.00|25.37|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|AETNA [1015]|AETNA ACO WILCO [101532]|211.00||||211.00|27.89|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.00||||211.00|21.79|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MULTIPLAN [1680]|IHC HS [168011]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|TRUSTMARK [2030]|STARMARK [203000]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|211.00||||211.00|21.86|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.00||||211.00|18|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211.00||||211.00|18.47|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|UMR [2035]|UMR OPTIONS [203501]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211.00||||211.00|25.77|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211.00||||211.00|44.31|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211.00||||211.00|101.17|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211.00||||211.00|19.12|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211.00||||211.00|17.59|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|CHAMPVA [1240]|CHAMP VA [124000]|211.00||||211.00|158.25|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211.00||||211.00|21.79|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|211.00||||211.00|25.37|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|211.00||||211.00|19.87|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|CORESOURCE [1315]|CORESOURCE [131500]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|GEHA [1415]|GEHA [141500]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|||211.00||||211.00|63.3|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211.00||||211.00|137.15|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.00||||211.00|189.9|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211.00||||211.00|211|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211.00||||211.00|17.65|211|11.77 30585220|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR V LABILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|211.00||||211.00||| 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|CORESOURCE [1315]|CORESOURCE [131500]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|649.00||||649.00|20.16|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|649.00||||649.00|25.73|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|649.00||||649.00|17.85|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|649.00||||649.00|19.4|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|||649.00||||649.00|194.7|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|649.00||||649.00|421.85|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|649.00||||649.00|136.29|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|649.00||||649.00|649|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|UMR [2035]|UMR OPTIONS [203501]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|649.00||||649.00|26.13|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|649.00||||649.00|22.18|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|649.00||||649.00|22.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|649.00||||649.00|18.26|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|FIRST HEALTH [1375]|QUALCHOICE [137513]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|FMH BENEFIT SERVICES [1390]|FMH [139000]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|649.00||||649.00|311.2|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MULTIPLAN [1680]|IHC HS [168011]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|649.00||||649.00|25.73|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MULTIPLAN [1680]|HMA [168003]|649.00||||649.00|26.85|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|HEALTHNET [1495]|HEALTHNET [149500]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|AETNA [1015]|AETNA ACO WILCO [101532]|649.00||||649.00|28.29|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|649.00||||649.00|19.4|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|649.00||||649.00|389.4|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|649.00||||649.00|227.8|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|649.00||||649.00|276.47|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|649.00||||649.00|325.15|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|649.00||||649.00|324.5|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|649.00||||649.00|22.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|649.00||||649.00|17.9|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|CHAMPVA [1240]|CHAMP VA [124000]|649.00||||649.00|486.75|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|GEHA [1415]|GEHA [141500]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|649.00||||649.00|19.69|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|649.00||||649.00|19.69|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|649.00||||649.00|18.8|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|649.00||||649.00|18.74|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|649.00||||649.00|11.93|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|TRUSTMARK [2030]|STARMARK [203000]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|AETNA [1015]|COVENTRY HEALTHCARE [101502]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|649.00||||649.00|584.1|649|11.93 30585230|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR VII|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|649.00||||649.00||| 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|502.00||||502.00|251|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|502.00||||502.00|19.69|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|502.00||||502.00|251.5|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|502.00||||502.00|22.1|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|502.00||||502.00|176.2|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|502.00||||502.00|18.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|502.00||||502.00|301.2|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|502.00||||502.00|19.4|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|502.00||||502.00|18.74|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|502.00||||502.00|11.93|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|HEALTHNET [1495]|HEALTHNET [149500]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|502.00||||502.00|25.73|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|FIRST HEALTH [1375]|QUALCHOICE [137513]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|TRUSTMARK [2030]|STARMARK [203000]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|502.00||||502.00|22.1|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|FMH BENEFIT SERVICES [1390]|FMH [139000]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MULTIPLAN [1680]|IHC HS [168011]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MULTIPLAN [1680]|HMA [168003]|502.00||||502.00|26.85|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|502.00||||502.00|22.18|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|502.00||||502.00|18.26|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|AETNA [1015]|AETNA ACO WILCO [101532]|502.00||||502.00|28.29|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|UMR [2035]|UMR OPTIONS [203501]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|502.00||||502.00|19.69|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|502.00||||502.00|26.13|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|502.00||||502.00|105.42|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|502.00||||502.00|502|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|502.00||||502.00|326.3|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|502.00||||502.00|213.85|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|CHAMPVA [1240]|CHAMP VA [124000]|502.00||||502.00|376.5|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|502.00||||502.00|25.73|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|502.00||||502.00|17.85|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|502.00||||502.00|20.16|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|CORESOURCE [1315]|CORESOURCE [131500]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|GEHA [1415]|GEHA [141500]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|||502.00||||502.00|150.6|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|502.00||||502.00|19.4|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|502.00||||502.00|240.71|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|502.00||||502.00|451.8|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|502.00||||502.00|17.9|502|11.93 30585240|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII AHG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|502.00||||502.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|GEHA [1415]|GEHA [141500]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|CORESOURCE [1315]|CORESOURCE [131500]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|88.00||||88.00|22.99|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|CHAMPVA [1240]|CHAMP VA [124000]|88.00||||88.00|66|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88.00||||88.00|20.34|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|||88.00||||88.00|26.4|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88.00||||88.00|18.48|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88.00||||88.00|42.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|UMR [2035]|UMR OPTIONS [203501]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|88.00||||88.00|25.29|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88.00||||88.00|25.21|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88.00||||88.00|88|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|FIRST HEALTH [1375]|QUALCHOICE [137513]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|FMH BENEFIT SERVICES [1390]|FMH [139000]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88.00||||88.00|57.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MULTIPLAN [1680]|IHC HS [168011]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88.00||||88.00|22.12|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|HEALTHNET [1495]|HEALTHNET [149500]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|AETNA [1015]|AETNA ACO WILCO [101532]|88.00||||88.00|32.28|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|TRUSTMARK [2030]|STARMARK [203000]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88.00||||88.00|22.12|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|88.00||||88.00|44.09|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88.00||||88.00|25.21|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|88.00||||88.00|37.49|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88.00||||88.00|44|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88.00||||88.00|52.8|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88.00||||88.00|30.89|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|88.00||||88.00|13.61|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88.00||||88.00|79.2|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88.00||||88.00|21.36|88|13.61 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MULTIPLAN [1680]|HMA [168003]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88.00||||88.00||| 30585244|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII RELATED AG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88.00||||88.00||| 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|481.00||||481.00|25.23|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|481.00||||481.00|240.5|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|481.00||||481.00|240.98|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|481.00||||481.00|28.32|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|481.00||||481.00|168.83|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|481.00||||481.00|204.91|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|481.00||||481.00|24.09|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|481.00||||481.00|24.85|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|481.00||||481.00|25.23|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|481.00||||481.00|15.29|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|TRUSTMARK [2030]|STARMARK [203000]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|AETNA [1015]|AETNA ACO WILCO [101532]|481.00||||481.00|36.25|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|HEALTHNET [1495]|HEALTHNET [149500]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MULTIPLAN [1680]|IHC HS [168011]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|481.00||||481.00|32.98|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MULTIPLAN [1680]|HMA [168003]|481.00||||481.00|34.41|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|481.00||||481.00|28.32|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|481.00||||481.00|28.42|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|481.00||||481.00|23.4|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|481.00||||481.00|24|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|UMR [2035]|UMR OPTIONS [203501]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|481.00||||481.00|33.49|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|481.00||||481.00|101.01|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|481.00||||481.00|230.64|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|481.00||||481.00|24.85|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|481.00||||481.00|288.6|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|481.00||||481.00|22.86|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|CHAMPVA [1240]|CHAMP VA [124000]|481.00||||481.00|360.75|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|481.00||||481.00|32.98|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|481.00||||481.00|25.83|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|CORESOURCE [1315]|CORESOURCE [131500]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|GEHA [1415]|GEHA [141500]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|||481.00||||481.00|144.3|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|481.00||||481.00|312.65|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|481.00||||481.00|432.9|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|481.00||||481.00|22.94|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|481.00||||481.00|481|481|15.29 30585245|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW RISTOCETIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|481.00||||481.00||| 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|CORESOURCE [1315]|CORESOURCE [131500]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|979.00||||979.00|25.83|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|979.00||||979.00|32.98|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|979.00||||979.00|22.86|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|979.00||||979.00|469.43|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|979.00||||979.00|636.35|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|979.00||||979.00|205.59|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|UMR [2035]|UMR OPTIONS [203501]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|979.00||||979.00|28.42|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|979.00||||979.00|28.32|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|979.00||||979.00|33.49|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|979.00||||979.00|23.4|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|FIRST HEALTH [1375]|QUALCHOICE [137513]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|979.00||||979.00|979|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|FMH BENEFIT SERVICES [1390]|FMH [139000]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|||979.00||||979.00|293.7|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MULTIPLAN [1680]|IHC HS [168011]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|979.00||||979.00|24.85|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|979.00||||979.00|32.98|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MULTIPLAN [1680]|HMA [168003]|979.00||||979.00|34.41|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|HEALTHNET [1495]|HEALTHNET [149500]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|979.00||||979.00|587.4|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|979.00||||979.00|24.85|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|979.00||||979.00|28.32|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|979.00||||979.00|490.48|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|979.00||||979.00|343.63|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|979.00||||979.00|489.5|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|CHAMPVA [1240]|CHAMP VA [124000]|979.00||||979.00|734.25|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|979.00||||979.00|417.05|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|979.00||||979.00|22.94|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|GEHA [1415]|GEHA [141500]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|979.00||||979.00|25.23|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|979.00||||979.00|24.09|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|979.00||||979.00|25.23|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|979.00||||979.00|24|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|979.00||||979.00|15.29|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|TRUSTMARK [2030]|STARMARK [203000]|979.00||||979.00|881.1|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|AETNA [1015]|AETNA ACO WILCO [101532]|979.00||||979.00|36.25|979|15.29 30585246|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW AG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|979.00||||979.00||| 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|280.00||||280.00|140|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|280.00||||280.00|25.23|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|280.00||||280.00|28.32|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|280.00||||280.00|140.28|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|280.00||||280.00|98.28|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|280.00||||280.00|24.09|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|280.00||||280.00|168|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|280.00||||280.00|24.85|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|280.00||||280.00|24|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|280.00||||280.00|32.98|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MULTIPLAN [1680]|HMA [168003]|280.00||||280.00|34.41|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MULTIPLAN [1680]|IHC HS [168011]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|AETNA [1015]|AETNA ACO WILCO [101532]|280.00||||280.00|36.25|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|TRUSTMARK [2030]|STARMARK [203000]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|280.00||||280.00|28.32|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|280.00||||280.00|28.42|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|280.00||||280.00|23.4|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|280.00||||280.00|15.29|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|UMR [2035]|UMR OPTIONS [203501]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|280.00||||280.00|25.23|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|280.00||||280.00|33.49|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|280.00||||280.00|58.8|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|280.00||||280.00|280|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|CHAMPVA [1240]|CHAMP VA [124000]|280.00||||280.00|210|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|280.00||||280.00|32.98|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|280.00||||280.00|25.83|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|280.00||||280.00|119.28|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|CORESOURCE [1315]|CORESOURCE [131500]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|GEHA [1415]|GEHA [141500]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|||280.00||||280.00|84|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|280.00||||280.00|24.85|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|280.00||||280.00|182|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|280.00||||280.00|134.26|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|HEALTHNET [1495]|HEALTHNET [149500]|280.00||||280.00|252|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|280.00||||280.00|22.94|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|280.00||||280.00|22.86|280|15.29 30585247|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR VIII VW MULTIMETERIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|280.00||||280.00||| 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|CHAMPVA [1240]|CHAMP VA [124000]|438.00||||438.00|328.5|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|GEHA [1415]|GEHA [141500]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|CORESOURCE [1315]|CORESOURCE [131500]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|438.00||||438.00|27.37|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|438.00||||438.00|18.98|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|438.00||||438.00|20.63|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|||438.00||||438.00|131.4|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|438.00||||438.00|210.02|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|438.00||||438.00|27.8|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|UMR [2035]|UMR OPTIONS [203501]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|438.00||||438.00|19.42|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|438.00||||438.00|23.58|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|438.00||||438.00|23.51|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|FIRST HEALTH [1375]|QUALCHOICE [137513]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|FMH BENEFIT SERVICES [1390]|FMH [139000]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|438.00||||438.00|438|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|438.00||||438.00|284.7|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MULTIPLAN [1680]|IHC HS [168011]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|438.00||||438.00|27.37|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MULTIPLAN [1680]|HMA [168003]|438.00||||438.00|28.56|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|HEALTHNET [1495]|HEALTHNET [149500]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|AETNA [1015]|AETNA ACO WILCO [101532]|438.00||||438.00|30.09|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|TRUSTMARK [2030]|STARMARK [203000]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|438.00||||438.00|12.7|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|438.00||||438.00|153.74|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|438.00||||438.00|219.44|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|438.00||||438.00|19.99|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|438.00||||438.00|186.59|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|438.00||||438.00|219|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|438.00||||438.00|23.51|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|438.00||||438.00|91.98|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|438.00||||438.00|20.94|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|438.00||||438.00|21.44|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|438.00||||438.00|20.94|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|438.00||||438.00|19.93|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|438.00||||438.00|20.63|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|438.00||||438.00|394.2|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|438.00||||438.00|19.04|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|438.00||||438.00|262.8|438|12.7 30585250|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR IX CHRISTMAS/PTC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|438.00||||438.00||| 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|267.00||||267.00|133.77|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267.00||||267.00|19.69|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267.00||||267.00|133.5|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267.00||||267.00|93.72|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267.00||||267.00|22.1|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|267.00||||267.00|113.74|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267.00||||267.00|18.8|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267.00||||267.00|160.2|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267.00||||267.00|19.4|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267.00||||267.00|19.69|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|TRUSTMARK [2030]|STARMARK [203000]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|HEALTHNET [1495]|HEALTHNET [149500]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MULTIPLAN [1680]|HMA [168003]|267.00||||267.00|26.85|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|267.00||||267.00|25.73|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|FMH BENEFIT SERVICES [1390]|FMH [139000]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|FIRST HEALTH [1375]|QUALCHOICE [137513]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267.00||||267.00|22.1|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MULTIPLAN [1680]|IHC HS [168011]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|267.00||||267.00|22.18|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267.00||||267.00|18.26|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|AETNA [1015]|AETNA ACO WILCO [101532]|267.00||||267.00|28.29|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|UMR [2035]|UMR OPTIONS [203501]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267.00||||267.00|18.74|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267.00||||267.00|26.13|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267.00||||267.00|56.07|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267.00||||267.00|128.03|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|||267.00||||267.00|80.1|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267.00||||267.00|19.4|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|CHAMPVA [1240]|CHAMP VA [124000]|267.00||||267.00|200.25|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|267.00||||267.00|25.73|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267.00||||267.00|17.85|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|267.00||||267.00|20.16|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|CORESOURCE [1315]|CORESOURCE [131500]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|GEHA [1415]|GEHA [141500]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267.00||||267.00|173.55|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267.00||||267.00|240.3|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267.00||||267.00|267|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267.00||||267.00|17.9|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|267.00||||267.00|11.93|267|11.93 30585260|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR X STUART-PROWER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|267.00||||267.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|356.00||||356.00|20.16|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|CORESOURCE [1315]|CORESOURCE [131500]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|CHAMPVA [1240]|CHAMP VA [124000]|356.00||||356.00|267|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356.00||||356.00|17.85|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356.00||||356.00|231.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356.00||||356.00|170.7|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356.00||||356.00|74.76|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|356.00||||356.00|22.18|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|UMR [2035]|UMR OPTIONS [203501]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356.00||||356.00|22.1|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|FIRST HEALTH [1375]|QUALCHOICE [137513]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356.00||||356.00|356|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|FMH BENEFIT SERVICES [1390]|FMH [139000]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MULTIPLAN [1680]|IHC HS [168011]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|HEALTHNET [1495]|HEALTHNET [149500]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356.00||||356.00|19.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356.00||||356.00|213.6|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|356.00||||356.00|178.36|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|356.00||||356.00|151.66|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356.00||||356.00|124.96|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356.00||||356.00|178|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356.00||||356.00|22.1|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|GEHA [1415]|GEHA [141500]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356.00||||356.00|19.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356.00||||356.00|18.74|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|356.00||||356.00|11.93|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|TRUSTMARK [2030]|STARMARK [203000]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|AETNA [1015]|AETNA ACO WILCO [101532]|356.00||||356.00|28.29|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|||356.00||||356.00|106.8|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356.00||||356.00|320.4|356|11.93 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MULTIPLAN [1680]|HMA [168003]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356.00||||356.00||| 30585270|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|356.00||||356.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|384.00||||384.00|23.89|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|384.00||||384.00|192.38|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|384.00||||384.00|134.78|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|384.00||||384.00|163.58|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|384.00||||384.00|230.4|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|384.00||||384.00|20.97|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|384.00||||384.00|20.25|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|384.00||||384.00|12.9|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|AETNA [1015]|AETNA ACO WILCO [101532]|384.00||||384.00|30.59|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|HEALTHNET [1495]|HEALTHNET [149500]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MULTIPLAN [1680]|IHC HS [168011]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|FMH BENEFIT SERVICES [1390]|FMH [139000]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|FIRST HEALTH [1375]|QUALCHOICE [137513]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|TRUSTMARK [2030]|STARMARK [203000]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|384.00||||384.00|23.89|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|384.00||||384.00|23.98|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|AETNA [1015]|COVENTRY HEALTHCARE [101502]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|UMR [2035]|UMR OPTIONS [203501]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|384.00||||384.00|80.64|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|384.00||||384.00|384|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|CHAMPVA [1240]|CHAMP VA [124000]|384.00||||384.00|288|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|384.00||||384.00|192|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|384.00||||384.00|19.28|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|384.00||||384.00|21.8|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|CORESOURCE [1315]|CORESOURCE [131500]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|GEHA [1415]|GEHA [141500]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|||384.00||||384.00|115.2|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|384.00||||384.00|20.97|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|384.00||||384.00|249.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|384.00||||384.00|184.13|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|384.00||||384.00|345.6|384|12.9 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MULTIPLAN [1680]|HMA [168003]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|384.00||||384.00||| 30585280|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR XII|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|384.00||||384.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|GEHA [1415]|GEHA [141500]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|CORESOURCE [1315]|CORESOURCE [131500]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|CHAMPVA [1240]|CHAMP VA [124000]|231.00||||231.00|173.25|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231.00||||231.00|16.29|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231.00||||231.00|17.7|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|||231.00||||231.00|69.3|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231.00||||231.00|110.76|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|UMR [2035]|UMR OPTIONS [203501]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|231.00||||231.00|20.24|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231.00||||231.00|48.51|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231.00||||231.00|20.17|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|FIRST HEALTH [1375]|QUALCHOICE [137513]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|FMH BENEFIT SERVICES [1390]|FMH [139000]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231.00||||231.00|150.15|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231.00||||231.00|231|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MULTIPLAN [1680]|IHC HS [168011]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|HEALTHNET [1495]|HEALTHNET [149500]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|AETNA [1015]|AETNA ACO WILCO [101532]|231.00||||231.00|25.82|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|TRUSTMARK [2030]|STARMARK [203000]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231.00||||231.00|17.7|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231.00||||231.00|20.17|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|231.00||||231.00|115.73|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|231.00||||231.00|98.41|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231.00||||231.00|115.5|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|231.00||||231.00|18.4|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231.00||||231.00|138.6|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231.00||||231.00|81.08|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231.00||||231.00|17.1|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|231.00||||231.00|10.89|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231.00||||231.00|207.9|231|10.89 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MULTIPLAN [1680]|HMA [168003]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231.00||||231.00||| 30585290|EAP|0305 - LABORATORY-HEMATOLOGY|HC CLOTTING FACTOR XIII|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231.00||||231.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267.00||||267.00|133.5|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267.00||||267.00|93.72|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|267.00||||267.00|113.74|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|267.00||||267.00|133.77|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267.00||||267.00|20.5|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|267.00||||267.00|12.62|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|AETNA [1015]|AETNA ACO WILCO [101532]|267.00||||267.00|29.93|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MULTIPLAN [1680]|IHC HS [168011]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|HEALTHNET [1495]|HEALTHNET [149500]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|TRUSTMARK [2030]|STARMARK [203000]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267.00||||267.00|23.37|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|267.00||||267.00|23.44|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267.00||||267.00|19.81|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|UMR [2035]|UMR OPTIONS [203501]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267.00||||267.00|56.07|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267.00||||267.00|267|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267.00||||267.00|128.03|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267.00||||267.00|20.5|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267.00||||267.00|160.2|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267.00||||267.00|23.37|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267.00||||267.00|18.87|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|CHAMPVA [1240]|CHAMP VA [124000]|267.00||||267.00|200.25|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|267.00||||267.00|21.31|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|CORESOURCE [1315]|CORESOURCE [131500]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|GEHA [1415]|GEHA [141500]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|||267.00||||267.00|80.1|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267.00||||267.00|240.3|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267.00||||267.00|173.55|267|12.62 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MULTIPLAN [1680]|HMA [168003]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|267.00||||267.00||| 30585292|EAP|0305 - LABORATORY-HEMATOLOGY|HC FLETCHER FACTOR ASSAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267.00||||267.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|286.00||||286.00|20.5|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|286.00||||286.00|171.6|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|286.00||||286.00|143.29|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|286.00||||286.00|121.84|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|286.00||||286.00|23.37|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|286.00||||286.00|100.39|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|286.00||||286.00|143|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|GEHA [1415]|GEHA [141500]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|CORESOURCE [1315]|CORESOURCE [131500]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|286.00||||286.00|21.31|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|286.00||||286.00|18.87|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|||286.00||||286.00|85.8|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|286.00||||286.00|185.9|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|286.00||||286.00|137.14|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|286.00||||286.00|286|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|286.00||||286.00|60.06|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|UMR [2035]|UMR OPTIONS [203501]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|286.00||||286.00|23.44|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|286.00||||286.00|20.5|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|286.00||||286.00|23.37|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|CHAMPVA [1240]|CHAMP VA [124000]|286.00||||286.00|214.5|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MULTIPLAN [1680]|IHC HS [168011]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|HEALTHNET [1495]|HEALTHNET [149500]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|AETNA [1015]|AETNA ACO WILCO [101532]|286.00||||286.00|29.93|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|TRUSTMARK [2030]|STARMARK [203000]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|286.00||||286.00|12.62|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|286.00||||286.00|257.4|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|286.00||||286.00|19.81|286|12.62 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|MULTIPLAN [1680]|HMA [168003]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|286.00||||286.00||| 30585293|EAP|0305 - LABORATORY-HEMATOLOGY|HC FITZGERALD FACTOR ASSAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|286.00||||286.00||| 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|513.00||||513.00|256.5|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|513.00||||513.00|14.63|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|513.00||||513.00|257.01|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|513.00||||513.00|218.54|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|513.00||||513.00|12.44|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|513.00||||513.00|307.8|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|513.00||||513.00|12.84|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|513.00||||513.00|13.04|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|513.00||||513.00|12.4|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|513.00||||513.00|7.9|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|TRUSTMARK [2030]|STARMARK [203000]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|AETNA [1015]|AETNA ACO WILCO [101532]|513.00||||513.00|18.74|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MULTIPLAN [1680]|IHC HS [168011]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|513.00||||513.00|17.04|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MULTIPLAN [1680]|HMA [168003]|513.00||||513.00|17.78|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|513.00||||513.00|14.63|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|HEALTHNET [1495]|HEALTHNET [149500]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|513.00||||513.00|14.68|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|513.00||||513.00|12.09|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|UMR [2035]|UMR OPTIONS [203501]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|513.00||||513.00|17.3|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|513.00||||513.00|107.73|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|513.00||||513.00|513|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|513.00||||513.00|180.06|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|513.00||||513.00|245.98|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|513.00||||513.00|333.45|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|||513.00||||513.00|153.9|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|513.00||||513.00|12.84|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|513.00||||513.00|13.04|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|513.00||||513.00|11.85|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|513.00||||513.00|11.81|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|CHAMPVA [1240]|CHAMP VA [124000]|513.00||||513.00|384.75|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|513.00||||513.00|17.04|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|513.00||||513.00|13.35|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|CORESOURCE [1315]|CORESOURCE [131500]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|GEHA [1415]|GEHA [141500]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|513.00||||513.00|461.7|513|7.9 30585300|EAP|0305 - LABORATORY-HEMATOLOGY|HC ANTITHROMBIN III ACTIVITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|513.00||||513.00||| 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|GEHA [1415]|GEHA [141500]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|CORESOURCE [1315]|CORESOURCE [131500]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|408.00||||408.00|17.27|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|CHAMPVA [1240]|CHAMP VA [124000]|408.00||||408.00|306|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|408.00||||408.00|11.97|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|408.00||||408.00|13.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|||408.00||||408.00|122.4|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|408.00||||408.00|265.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|408.00||||408.00|195.64|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|408.00||||408.00|85.68|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|408.00||||408.00|17.53|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|UMR [2035]|UMR OPTIONS [203501]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|408.00||||408.00|12.25|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|408.00||||408.00|14.87|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|408.00||||408.00|14.83|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MULTIPLAN [1680]|IHC HS [168011]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|408.00||||408.00|17.27|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MULTIPLAN [1680]|HMA [168003]|408.00||||408.00|18.02|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|HEALTHNET [1495]|HEALTHNET [149500]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|408.00||||408.00|408|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|AETNA [1015]|AETNA ACO WILCO [101532]|408.00||||408.00|18.98|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|TRUSTMARK [2030]|STARMARK [203000]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|408.00||||408.00|8.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|408.00||||408.00|12.57|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|408.00||||408.00|13.21|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|408.00||||408.00|13.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|408.00||||408.00|244.8|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|408.00||||408.00|12.61|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|408.00||||408.00|204.41|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|408.00||||408.00|13.52|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|408.00||||408.00|14.83|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|408.00||||408.00|173.81|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|408.00||||408.00|143.21|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|408.00||||408.00|204|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|408.00||||408.00|12.01|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|408.00||||408.00|367.2|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|408.00||||408.00|13.21|408|8.01 30585302|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ANTIGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|408.00||||408.00||| 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|617.00||||617.00|15.22|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|617.00||||617.00|308.5|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|617.00||||617.00|309.12|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|617.00||||617.00|216.57|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|617.00||||617.00|17.08|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|617.00||||617.00|14.53|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|617.00||||617.00|370.2|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|617.00||||617.00|15|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|617.00||||617.00|15.22|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|617.00||||617.00|14.48|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|617.00||||617.00|9.22|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|TRUSTMARK [2030]|STARMARK [203000]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|HEALTHNET [1495]|HEALTHNET [149500]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MULTIPLAN [1680]|IHC HS [168011]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|617.00||||617.00|19.9|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MULTIPLAN [1680]|HMA [168003]|617.00||||617.00|20.76|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|617.00||||617.00|17.08|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|617.00||||617.00|17.15|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|617.00||||617.00|14.12|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|AETNA [1015]|AETNA ACO WILCO [101532]|617.00||||617.00|21.86|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|UMR [2035]|UMR OPTIONS [203501]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|617.00||||617.00|20.21|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|617.00||||617.00|129.57|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|617.00||||617.00|617|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|617.00||||617.00|295.85|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|617.00||||617.00|262.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|617.00||||617.00|401.05|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|||617.00||||617.00|185.1|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|617.00||||617.00|15|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|617.00||||617.00|13.84|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|617.00||||617.00|13.79|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|CHAMPVA [1240]|CHAMP VA [124000]|617.00||||617.00|462.75|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|617.00||||617.00|19.9|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|617.00||||617.00|15.59|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|CORESOURCE [1315]|CORESOURCE [131500]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|GEHA [1415]|GEHA [141500]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|617.00||||617.00|555.3|617|9.22 30585303|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN C ACTIVITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|617.00||||617.00||| 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|469.00||||469.00|13.06|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|469.00||||469.00|16.69|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469.00||||469.00|11.57|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469.00||||469.00|12.57|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|||469.00||||469.00|140.7|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469.00||||469.00|304.85|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469.00||||469.00|469|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469.00||||469.00|16.95|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|UMR [2035]|UMR OPTIONS [203501]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469.00||||469.00|11.84|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|469.00||||469.00|14.37|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469.00||||469.00|14.33|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MULTIPLAN [1680]|IHC HS [168011]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|469.00||||469.00|16.69|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MULTIPLAN [1680]|HMA [168003]|469.00||||469.00|17.42|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469.00||||469.00|98.49|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469.00||||469.00|224.89|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|469.00||||469.00|18.35|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|TRUSTMARK [2030]|STARMARK [203000]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|469.00||||469.00|7.74|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469.00||||469.00|12.15|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|469.00||||469.00|351.75|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469.00||||469.00|12.77|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469.00||||469.00|12.57|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469.00||||469.00|281.4|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|GEHA [1415]|GEHA [141500]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469.00||||469.00|12.19|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|469.00||||469.00|234.97|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469.00||||469.00|164.62|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|469.00||||469.00|199.79|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469.00||||469.00|14.33|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469.00||||469.00|234.5|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469.00||||469.00|11.61|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469.00||||469.00|422.1|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469.00||||469.00|12.77|469|7.74 30585305|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|469.00||||469.00||| 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|853.00||||853.00|16.85|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|853.00||||853.00|427.35|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|853.00||||853.00|18.92|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|853.00||||853.00|299.4|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|853.00||||853.00|16.09|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|853.00||||853.00|511.8|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|853.00||||853.00|16.6|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|853.00||||853.00|16.85|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|853.00||||853.00|16.03|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|853.00||||853.00|10.22|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|AETNA [1015]|AETNA ACO WILCO [101532]|853.00||||853.00|24.23|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MULTIPLAN [1680]|IHC HS [168011]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|853.00||||853.00|22.02|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|853.00||||853.00|18.92|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MULTIPLAN [1680]|HMA [168003]|853.00||||853.00|22.98|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|HEALTHNET [1495]|HEALTHNET [149500]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|853.00||||853.00|18.98|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|853.00||||853.00|15.63|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|TRUSTMARK [2030]|STARMARK [203000]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|UMR [2035]|UMR OPTIONS [203501]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|853.00||||853.00|22.37|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|853.00||||853.00|179.13|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|853.00||||853.00|853|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|853.00||||853.00|409.01|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|853.00||||853.00|554.45|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|853.00||||853.00|363.38|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|853.00||||853.00|426.5|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|||853.00||||853.00|255.9|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|853.00||||853.00|16.6|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|853.00||||853.00|15.32|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|853.00||||853.00|15.27|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|CHAMPVA [1240]|CHAMP VA [124000]|853.00||||853.00|639.75|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|853.00||||853.00|22.02|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|853.00||||853.00|17.25|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|CORESOURCE [1315]|CORESOURCE [131500]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|GEHA [1415]|GEHA [141500]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|853.00||||853.00|767.7|853|10.22 30585306|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTEIN S FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|853.00||||853.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|GEHA [1415]|GEHA [141500]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|CORESOURCE [1315]|CORESOURCE [131500]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|248.00||||248.00|17.25|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|CHAMPVA [1240]|CHAMP VA [124000]|248.00||||248.00|186|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248.00||||248.00|15.27|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248.00||||248.00|16.6|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|||248.00||||248.00|74.4|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248.00||||248.00|161.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248.00||||248.00|118.92|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248.00||||248.00|248|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248.00||||248.00|52.08|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|UMR [2035]|UMR OPTIONS [203501]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|248.00||||248.00|18.98|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248.00||||248.00|18.92|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MULTIPLAN [1680]|IHC HS [168011]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|HEALTHNET [1495]|HEALTHNET [149500]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|AETNA [1015]|AETNA ACO WILCO [101532]|248.00||||248.00|24.23|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|TRUSTMARK [2030]|STARMARK [203000]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|248.00||||248.00|10.22|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248.00||||248.00|16.03|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248.00||||248.00|16.6|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248.00||||248.00|148.8|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|248.00||||248.00|124.25|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248.00||||248.00|87.05|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|248.00||||248.00|105.65|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248.00||||248.00|18.92|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248.00||||248.00|124|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248.00||||248.00|223.2|248|10.22 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MULTIPLAN [1680]|HMA [168003]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248.00||||248.00||| 30585307|EAP|0305 - LABORATORY-HEMATOLOGY|HC ACTIV PROTEIN C RESIST ASSAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248.00||||248.00||| 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|207.00||||207.00|14.16|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|207.00||||207.00|103.5|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|207.00||||207.00|103.71|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|207.00||||207.00|15.89|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|207.00||||207.00|72.66|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|207.00||||207.00|88.18|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|207.00||||207.00|13.51|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|207.00||||207.00|13.95|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|207.00||||207.00|14.16|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|207.00||||207.00|13.47|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|207.00||||207.00|8.58|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|TRUSTMARK [2030]|STARMARK [203000]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|AETNA [1015]|AETNA ACO WILCO [101532]|207.00||||207.00|20.34|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|HEALTHNET [1495]|HEALTHNET [149500]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|207.00||||207.00|18.5|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MULTIPLAN [1680]|HMA [168003]|207.00||||207.00|19.31|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|FMH BENEFIT SERVICES [1390]|FMH [139000]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|FIRST HEALTH [1375]|QUALCHOICE [137513]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MULTIPLAN [1680]|IHC HS [168011]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|207.00||||207.00|15.89|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|207.00||||207.00|15.95|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|207.00||||207.00|13.13|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|UMR [2035]|UMR OPTIONS [203501]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|207.00||||207.00|18.79|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|207.00||||207.00|43.47|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|207.00||||207.00|124.2|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|207.00||||207.00|207|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|207.00||||207.00|99.26|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|207.00||||207.00|134.55|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|||207.00||||207.00|62.1|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|207.00||||207.00|13.95|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|207.00||||207.00|12.87|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|207.00||||207.00|12.83|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|CHAMPVA [1240]|CHAMP VA [124000]|207.00||||207.00|155.25|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|207.00||||207.00|18.5|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|207.00||||207.00|14.5|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|CORESOURCE [1315]|CORESOURCE [131500]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|GEHA [1415]|GEHA [141500]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|207.00||||207.00|186.3|207|8.58 30585335|EAP|0305 - LABORATORY-HEMATOLOGY|HC FACTOR INHIBITOR TEST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|207.00||||207.00||| 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|CORESOURCE [1315]|CORESOURCE [131500]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|114.00||||114.00|4.81|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|114.00||||114.00|6.15|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114.00||||114.00|4.26|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|||114.00||||114.00|34.2|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114.00||||114.00|74.1|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114.00||||114.00|114|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114.00||||114.00|6.25|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|UMR [2035]|UMR OPTIONS [203501]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|114.00||||114.00|5.29|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114.00||||114.00|5.26|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114.00||||114.00|4.37|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|FIRST HEALTH [1375]|QUALCHOICE [137513]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|FMH BENEFIT SERVICES [1390]|FMH [139000]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MULTIPLAN [1680]|IHC HS [168011]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114.00||||114.00|23.94|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|114.00||||114.00|6.15|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MULTIPLAN [1680]|HMA [168003]|114.00||||114.00|6.42|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|HEALTHNET [1495]|HEALTHNET [149500]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|AETNA [1015]|AETNA ACO WILCO [101532]|114.00||||114.00|6.73|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114.00||||114.00|54.66|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114.00||||114.00|4.63|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|TRUSTMARK [2030]|STARMARK [203000]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|114.00||||114.00|2.84|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114.00||||114.00|4.47|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|CHAMPVA [1240]|CHAMP VA [124000]|114.00||||114.00|85.5|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114.00||||114.00|4.71|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|GEHA [1415]|GEHA [141500]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114.00||||114.00|4.63|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114.00||||114.00|68.4|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114.00||||114.00|4.49|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114.00||||114.00|5.26|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|114.00||||114.00|48.56|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|114.00||||114.00|57.11|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114.00||||114.00|40.01|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114.00||||114.00|57|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114.00||||114.00|4.28|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114.00||||114.00|102.6|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114.00||||114.00|4.71|114|2.84 30585347|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG TIME ACTIVATED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|114.00||||114.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.00||||119.00|59.62|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.00||||119.00|10.38|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.00||||119.00|50.69|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.00||||119.00|71.4|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.00||||119.00|9.12|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.00||||119.00|8.81|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.00||||119.00|5.6|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|AETNA [1015]|AETNA ACO WILCO [101532]|119.00||||119.00|13.28|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MULTIPLAN [1680]|IHC HS [168011]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.00||||119.00|10.38|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|HEALTHNET [1495]|HEALTHNET [149500]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.00||||119.00|10.42|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|TRUSTMARK [2030]|STARMARK [203000]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|UMR [2035]|UMR OPTIONS [203501]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.00||||119.00|24.99|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.00||||119.00|119|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.00||||119.00|57.06|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.00||||119.00|41.77|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.00||||119.00|77.35|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.00||||119.00|59.5|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|||119.00||||119.00|35.7|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.00||||119.00|9.12|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.00||||119.00|8.39|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|CHAMPVA [1240]|CHAMP VA [124000]|119.00||||119.00|89.25|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.00||||119.00|9.48|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|CORESOURCE [1315]|CORESOURCE [131500]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|GEHA [1415]|GEHA [141500]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.00||||119.00|107.1|119|5.6 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|MULTIPLAN [1680]|HMA [168003]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.00||||119.00||| 30585360|EAP|0305 - LABORATORY-HEMATOLOGY|HC EUGLOBULIN LYSIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.00||||119.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|GEHA [1415]|GEHA [141500]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|CORESOURCE [1315]|CORESOURCE [131500]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|CHAMPVA [1240]|CHAMP VA [124000]|399.00||||399.00|299.25|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|399.00||||399.00|6.87|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|399.00||||399.00|7.47|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|||399.00||||399.00|119.7|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|399.00||||399.00|259.35|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|399.00||||399.00|191.32|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|399.00||||399.00|83.79|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|UMR [2035]|UMR OPTIONS [203501]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|399.00||||399.00|8.54|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|399.00||||399.00|8.51|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MULTIPLAN [1680]|IHC HS [168011]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|399.00||||399.00|399|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|HEALTHNET [1495]|HEALTHNET [149500]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|AETNA [1015]|AETNA ACO WILCO [101532]|399.00||||399.00|10.89|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|TRUSTMARK [2030]|STARMARK [203000]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|399.00||||399.00|4.59|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|399.00||||399.00|7.21|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|399.00||||399.00|7.76|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|399.00||||399.00|7.47|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|399.00||||399.00|239.4|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|399.00||||399.00|199.9|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|399.00||||399.00|8.51|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|399.00||||399.00|169.97|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|399.00||||399.00|140.05|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|399.00||||399.00|199.5|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|399.00||||399.00|359.1|399|4.59 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MULTIPLAN [1680]|HMA [168003]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|399.00||||399.00||| 30585362|EAP|0305 - LABORATORY-HEMATOLOGY|HC FDP/FSP AGGLUTINATION SQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|399.00||||399.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169.00||||169.00|84.5|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169.00||||169.00|9.72|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169.00||||169.00|59.32|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|169.00||||169.00|71.99|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169.00||||169.00|10.53|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169.00||||169.00|10.17|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|169.00||||169.00|5.83|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|TRUSTMARK [2030]|STARMARK [203000]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|AETNA [1015]|AETNA ACO WILCO [101532]|169.00||||169.00|13.82|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|HEALTHNET [1495]|HEALTHNET [149500]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MULTIPLAN [1680]|IHC HS [168011]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169.00||||169.00|9.72|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|169.00||||169.00|12.04|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|UMR [2035]|UMR OPTIONS [203501]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169.00||||169.00|35.49|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169.00||||169.00|101.4|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169.00||||169.00|169|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169.00||||169.00|81.04|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169.00||||169.00|109.85|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|||169.00||||169.00|50.7|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169.00||||169.00|10.53|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|169.00||||169.00|84.67|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169.00||||169.00|9.69|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|CHAMPVA [1240]|CHAMP VA [124000]|169.00||||169.00|126.75|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|169.00||||169.00|10.94|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|CORESOURCE [1315]|CORESOURCE [131500]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|GEHA [1415]|GEHA [141500]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169.00||||169.00|152.1|169|5.83 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|MULTIPLAN [1680]|HMA [168003]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169.00||||169.00||| 30585378|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER SQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|169.00||||169.00||| 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|CORESOURCE [1315]|CORESOURCE [131500]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|240.00||||240.00|11.46|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|240.00||||240.00|14.63|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|CHAMPVA [1240]|CHAMP VA [124000]|240.00||||240.00|180|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|240.00||||240.00|10.14|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|||240.00||||240.00|72|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|240.00||||240.00|156|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|240.00||||240.00|240|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|240.00||||240.00|50.4|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|240.00||||240.00|14.86|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|UMR [2035]|UMR OPTIONS [203501]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|240.00||||240.00|12.61|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|240.00||||240.00|12.56|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|240.00||||240.00|10.38|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MULTIPLAN [1680]|IHC HS [168011]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|240.00||||240.00|14.63|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MULTIPLAN [1680]|HMA [168003]|240.00||||240.00|15.27|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|240.00||||240.00|115.08|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|HEALTHNET [1495]|HEALTHNET [149500]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|AETNA [1015]|AETNA ACO WILCO [101532]|240.00||||240.00|16.08|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|240.00||||240.00|11.03|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|TRUSTMARK [2030]|STARMARK [203000]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|240.00||||240.00|6.79|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|240.00||||240.00|10.65|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|240.00||||240.00|11.2|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|240.00||||240.00|11.03|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|240.00||||240.00|144|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|GEHA [1415]|GEHA [141500]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|240.00||||240.00|10.69|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|240.00||||240.00|12.56|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|240.00||||240.00|84.24|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|240.00||||240.00|120.24|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|240.00||||240.00|102.24|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|240.00||||240.00|120|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|240.00||||240.00|10.18|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|240.00||||240.00|216|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|240.00||||240.00|11.2|240|6.79 30585379|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRIN DEGRADATION D-DIMER QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|240.00||||240.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|276.00||||276.00|9.72|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|276.00||||276.00|9.72|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|276.00||||276.00|10.49|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|276.00||||276.00|138.28|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|276.00||||276.00|96.88|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|276.00||||276.00|117.58|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|276.00||||276.00|10.21|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|276.00||||276.00|165.6|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|276.00||||276.00|10.53|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|276.00||||276.00|9.72|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|276.00||||276.00|10.17|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|276.00||||276.00|5.83|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|276.00||||276.00|9.72|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|AETNA [1015]|AETNA ACO WILCO [101532]|276.00||||276.00|13.82|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|HEALTHNET [1495]|HEALTHNET [149500]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MULTIPLAN [1680]|IHC HS [168011]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|276.00||||276.00|13.97|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MULTIPLAN [1680]|HMA [168003]|276.00||||276.00|14.58|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|276.00||||276.00|9.72|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|276.00||||276.00|10.49|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|276.00||||276.00|12.04|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|276.00||||276.00|9.91|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|TRUSTMARK [2030]|STARMARK [203000]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|UMR [2035]|UMR OPTIONS [203501]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|276.00||||276.00|171.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|276.00||||276.00|57.96|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|276.00||||276.00|276|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|276.00||||276.00|132.34|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|276.00||||276.00|179.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|276.00||||276.00|138|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|||276.00||||276.00|82.8|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|276.00||||276.00|10.53|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|276.00||||276.00|9.72|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|276.00||||276.00|9.69|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|CHAMPVA [1240]|CHAMP VA [124000]|276.00||||276.00|207|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|276.00||||276.00|171.12|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|276.00||||276.00|10.94|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|CORESOURCE [1315]|CORESOURCE [131500]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|GEHA [1415]|GEHA [141500]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|276.00||||276.00|248.4|276|5.83 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|276.00||||276.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|276.00||||276.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|276.00||||276.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|276.00||||276.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|276.00||||276.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|276.00||||276.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|276.00||||276.00||| 30585384|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOGEN ACTIVITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|276.00||||276.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|GEHA [1415]|GEHA [141500]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|CORESOURCE [1315]|CORESOURCE [131500]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|CHAMPVA [1240]|CHAMP VA [124000]|120.00||||120.00|90|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120.00||||120.00|14.41|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120.00||||120.00|15.66|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|||120.00||||120.00|36|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120.00||||120.00|78|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120.00||||120.00|57.54|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120.00||||120.00|25.2|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|UMR [2035]|UMR OPTIONS [203501]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|120.00||||120.00|17.91|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120.00||||120.00|14.46|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MULTIPLAN [1680]|IHC HS [168011]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120.00||||120.00|120|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|HEALTHNET [1495]|HEALTHNET [149500]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|AETNA [1015]|AETNA ACO WILCO [101532]|120.00||||120.00|20.56|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|TRUSTMARK [2030]|STARMARK [203000]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|120.00||||120.00|8.68|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120.00||||120.00|15.13|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|120.00||||120.00|16.28|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120.00||||120.00|15.66|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120.00||||120.00|72|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120.00||||120.00|42.12|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120.00||||120.00|14.46|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|120.00||||120.00|60.12|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|120.00||||120.00|51.12|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120.00||||120.00|60|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120.00||||120.00|108|120|8.68 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MULTIPLAN [1680]|HMA [168003]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120.00||||120.00||| 30585385|EAP|0305 - LABORATORY-HEMATOLOGY|HC AG FIBRINOGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120.00||||120.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|347.00||||347.00|173.5|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|347.00||||347.00|30.86|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|347.00||||347.00|147.82|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|347.00||||347.00|121.8|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|347.00||||347.00|33.44|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|347.00||||347.00|32.29|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|347.00||||347.00|18.52|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|TRUSTMARK [2030]|STARMARK [203000]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|AETNA [1015]|AETNA ACO WILCO [101532]|347.00||||347.00|43.89|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|HEALTHNET [1495]|HEALTHNET [149500]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MULTIPLAN [1680]|IHC HS [168011]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|FMH BENEFIT SERVICES [1390]|FMH [139000]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|FIRST HEALTH [1375]|QUALCHOICE [137513]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|347.00||||347.00|30.86|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|347.00||||347.00|38.23|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|UMR [2035]|UMR OPTIONS [203501]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|347.00||||347.00|72.87|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|347.00||||347.00|347|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|347.00||||347.00|166.39|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|347.00||||347.00|208.2|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|347.00||||347.00|173.85|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|347.00||||347.00|225.55|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|||347.00||||347.00|104.1|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|347.00||||347.00|33.44|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|347.00||||347.00|30.76|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|CHAMPVA [1240]|CHAMP VA [124000]|347.00||||347.00|260.25|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|347.00||||347.00|34.76|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|CORESOURCE [1315]|CORESOURCE [131500]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|GEHA [1415]|GEHA [141500]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|347.00||||347.00|312.3|347|18.52 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|MULTIPLAN [1680]|HMA [168003]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|347.00||||347.00||| 30585397|EAP|0305 - LABORATORY-HEMATOLOGY|HC COAG FIBRIN EACH ANALYTE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|347.00||||347.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|GEHA [1415]|GEHA [141500]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00|8.69|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18.00||||18.00|7.69|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|||18.00||||18.00|5.4|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|11.7|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|8.63|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18.00||||18.00|18|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18.00||||18.00|9.56|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|9.51|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|FIRST HEALTH [1375]|QUALCHOICE [137513]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18.00||||18.00|3.78|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MULTIPLAN [1680]|IHC HS [168011]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00|12.17|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18.00||||18.00|8.36|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18.00||||18.00|5.14|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18.00||||18.00|8.08|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|13.5|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18.00||||18.00|8.36|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|10.8|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18.00||||18.00|9.51|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18.00||||18.00|9.02|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18.00||||18.00|7.67|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18.00||||18.00|6.32|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18.00||||18.00|9|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18.00||||18.00|16.2|18|3.78 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 30585410|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC ALPHA-2 ANTI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18.00||||18.00||| 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|254.00||||254.00|127|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|254.00||||254.00|108.2|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|254.00||||254.00|21.22|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|254.00||||254.00|127.25|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|254.00||||254.00|18.05|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|254.00||||254.00|152.4|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|254.00||||254.00|18.63|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|254.00||||254.00|18.91|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|254.00||||254.00|17.99|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|254.00||||254.00|11.46|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|TRUSTMARK [2030]|STARMARK [203000]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|AETNA [1015]|AETNA ACO WILCO [101532]|254.00||||254.00|27.17|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MULTIPLAN [1680]|IHC HS [168011]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|254.00||||254.00|24.71|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MULTIPLAN [1680]|HMA [168003]|254.00||||254.00|25.79|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|FMH BENEFIT SERVICES [1390]|FMH [139000]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|FIRST HEALTH [1375]|QUALCHOICE [137513]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|254.00||||254.00|21.22|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|254.00||||254.00|21.3|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|254.00||||254.00|17.53|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|HEALTHNET [1495]|HEALTHNET [149500]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|UMR [2035]|UMR OPTIONS [203501]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|254.00||||254.00|25.1|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|254.00||||254.00|53.34|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|254.00||||254.00|254|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|254.00||||254.00|89.15|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|254.00||||254.00|121.79|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|254.00||||254.00|165.1|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|||254.00||||254.00|76.2|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|254.00||||254.00|18.63|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|254.00||||254.00|18.91|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|254.00||||254.00|17.19|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|254.00||||254.00|17.13|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|CHAMPVA [1240]|CHAMP VA [124000]|254.00||||254.00|190.5|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|254.00||||254.00|24.71|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|254.00||||254.00|19.36|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|CORESOURCE [1315]|CORESOURCE [131500]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|GEHA [1415]|GEHA [141500]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|254.00||||254.00|228.6|254|11.46 30585415|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN ACTV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|254.00||||254.00||| 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|GEHA [1415]|GEHA [141500]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|CORESOURCE [1315]|CORESOURCE [131500]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|302.00||||302.00|9.39|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|CHAMPVA [1240]|CHAMP VA [124000]|302.00||||302.00|226.5|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|302.00||||302.00|6.51|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|302.00||||302.00|7.08|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|||302.00||||302.00|90.6|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|302.00||||302.00|196.3|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|302.00||||302.00|144.81|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|302.00||||302.00|63.42|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|302.00||||302.00|9.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|UMR [2035]|UMR OPTIONS [203501]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|302.00||||302.00|6.66|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|302.00||||302.00|8.1|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|302.00||||302.00|8.06|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MULTIPLAN [1680]|IHC HS [168011]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|302.00||||302.00|9.39|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MULTIPLAN [1680]|HMA [168003]|302.00||||302.00|9.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|HEALTHNET [1495]|HEALTHNET [149500]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|302.00||||302.00|302|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|AETNA [1015]|AETNA ACO WILCO [101532]|302.00||||302.00|10.33|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|TRUSTMARK [2030]|STARMARK [203000]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|302.00||||302.00|4.36|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|302.00||||302.00|6.83|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|302.00||||302.00|7.36|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|302.00||||302.00|7.18|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|302.00||||302.00|7.08|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|302.00||||302.00|181.2|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|302.00||||302.00|6.86|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|302.00||||302.00|106|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|302.00||||302.00|128.65|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|302.00||||302.00|151.3|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|302.00||||302.00|8.06|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|302.00||||302.00|151|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|302.00||||302.00|6.53|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|302.00||||302.00|271.8|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|302.00||||302.00|7.18|302|4.36 30585420|EAP|0305 - LABORATORY-HEMATOLOGY|HC FIBRINOLYTIC PLASMINOGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|302.00||||302.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00|47.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|5.18|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00|4.55|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00|4.4|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00|2.8|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00|6.64|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|5.18|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00|5.21|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|||95.00||||95.00|28.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00|4.55|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00|4.19|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00|4.73|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|2.8 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00||| 30585441|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEINZ BODIES DIRECT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00||| 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|CORESOURCE [1315]|CORESOURCE [131500]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|170.00||||170.00|8.71|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|170.00||||170.00|11.11|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170.00||||170.00|7.71|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170.00||||170.00|8.38|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|||170.00||||170.00|51|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170.00||||170.00|110.5|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170.00||||170.00|170|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170.00||||170.00|11.29|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|UMR [2035]|UMR OPTIONS [203501]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170.00||||170.00|7.88|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|170.00||||170.00|9.58|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170.00||||170.00|9.55|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MULTIPLAN [1680]|IHC HS [168011]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|170.00||||170.00|11.11|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MULTIPLAN [1680]|HMA [168003]|170.00||||170.00|11.6|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170.00||||170.00|35.7|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170.00||||170.00|81.52|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|HEALTHNET [1495]|HEALTHNET [149500]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|AETNA [1015]|AETNA ACO WILCO [101532]|170.00||||170.00|12.22|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|TRUSTMARK [2030]|STARMARK [203000]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|170.00||||170.00|5.15|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170.00||||170.00|8.1|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|CHAMPVA [1240]|CHAMP VA [124000]|170.00||||170.00|127.5|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170.00||||170.00|8.5|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170.00||||170.00|8.38|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170.00||||170.00|102|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|GEHA [1415]|GEHA [141500]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170.00||||170.00|8.12|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|170.00||||170.00|72.42|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|170.00||||170.00|85.17|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170.00||||170.00|9.55|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170.00||||170.00|59.67|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170.00||||170.00|85|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170.00||||170.00|7.73|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170.00||||170.00|153|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170.00||||170.00|8.5|170|5.15 30585460|EAP|0305 - LABORATORY-HEMATOLOGY|HC HGB/RBCS FETAL FETOMATERN HEMRRG DIFRNTL LYSIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|170.00||||170.00||| 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00|10.3|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00|9.83|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00|10.14|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00|10.3|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00|9.8|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00|5.62|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00|13.32|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00|13.46|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00|14.04|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00|11.59|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00|9.55|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|13.67|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00|90|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00|45|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|||90.00||||90.00|27|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00|10.14|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00|9.36|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00|9.33|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00|13.46|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00|10.54|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|90|5.62 30585461|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEMOGLOBIN/RBC FETAL ROSETTE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|GEHA [1415]|GEHA [141500]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|CORESOURCE [1315]|CORESOURCE [131500]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|186.00||||186.00|14.74|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|186.00||||186.00|18.82|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|CHAMPVA [1240]|CHAMP VA [124000]|186.00||||186.00|139.5|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186.00||||186.00|13.04|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186.00||||186.00|14.18|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|||186.00||||186.00|55.8|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186.00||||186.00|120.9|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186.00||||186.00|89.19|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186.00||||186.00|186|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186.00||||186.00|39.06|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|UMR [2035]|UMR OPTIONS [203501]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186.00||||186.00|13.35|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|186.00||||186.00|16.21|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186.00||||186.00|16.16|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MULTIPLAN [1680]|IHC HS [168011]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186.00||||186.00|19.11|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|186.00||||186.00|18.82|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MULTIPLAN [1680]|HMA [168003]|186.00||||186.00|19.64|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|HEALTHNET [1495]|HEALTHNET [149500]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|AETNA [1015]|AETNA ACO WILCO [101532]|186.00||||186.00|20.7|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|TRUSTMARK [2030]|STARMARK [203000]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|186.00||||186.00|8.73|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186.00||||186.00|13.7|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186.00||||186.00|14.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186.00||||186.00|14.18|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186.00||||186.00|111.6|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186.00||||186.00|13.74|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|186.00||||186.00|79.24|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|186.00||||186.00|93.19|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186.00||||186.00|65.29|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186.00||||186.00|16.16|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186.00||||186.00|93|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186.00||||186.00|13.09|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186.00||||186.00|167.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186.00||||186.00|14.4|186|8.73 30585520|EAP|0305 - LABORATORY-HEMATOLOGY|HC HEPARIN ASSAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|186.00||||186.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|465.00||||465.00|232.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|465.00||||465.00|198.09|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|465.00||||465.00|163.22|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|465.00||||465.00|232.97|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|465.00||||465.00|10.62|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|465.00||||465.00|9.31|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|465.00||||465.00|8.99|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|465.00||||465.00|5.74|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|TRUSTMARK [2030]|STARMARK [203000]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|AETNA [1015]|AETNA ACO WILCO [101532]|465.00||||465.00|13.6|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|HEALTHNET [1495]|HEALTHNET [149500]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MULTIPLAN [1680]|IHC HS [168011]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|465.00||||465.00|10.62|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|465.00||||465.00|10.64|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|UMR [2035]|UMR OPTIONS [203501]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|465.00||||465.00|97.65|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|465.00||||465.00|279|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|465.00||||465.00|465|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|465.00||||465.00|222.97|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|465.00||||465.00|302.25|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|||465.00||||465.00|139.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|465.00||||465.00|9.31|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|465.00||||465.00|8.56|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|CHAMPVA [1240]|CHAMP VA [124000]|465.00||||465.00|348.75|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|465.00||||465.00|9.68|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|CORESOURCE [1315]|CORESOURCE [131500]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|GEHA [1415]|GEHA [141500]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|465.00||||465.00|418.5|465|5.74 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|MULTIPLAN [1680]|HMA [168003]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|465.00||||465.00||| 30585540|EAP|0305 - LABORATORY-HEMATOLOGY|HC LEUKO ALKALINE PHOSPHATASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|465.00||||465.00||| 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|CORESOURCE [1315]|CORESOURCE [131500]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|211.00||||211.00|21.12|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|211.00||||211.00|26.96|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211.00||||211.00|18.69|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|||211.00||||211.00|63.3|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211.00||||211.00|137.15|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211.00||||211.00|211|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211.00||||211.00|27.38|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|UMR [2035]|UMR OPTIONS [203501]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|211.00||||211.00|23.23|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.00||||211.00|23.15|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.00||||211.00|19.13|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MULTIPLAN [1680]|IHC HS [168011]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211.00||||211.00|44.31|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|211.00||||211.00|26.96|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MULTIPLAN [1680]|HMA [168003]|211.00||||211.00|28.13|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|HEALTHNET [1495]|HEALTHNET [149500]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211.00||||211.00|101.17|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211.00||||211.00|20.32|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|AETNA [1015]|AETNA ACO WILCO [101532]|211.00||||211.00|29.62|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|TRUSTMARK [2030]|STARMARK [203000]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|211.00||||211.00|12.5|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211.00||||211.00|19.62|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|CHAMPVA [1240]|CHAMP VA [124000]|211.00||||211.00|158.25|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211.00||||211.00|20.63|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|GEHA [1415]|GEHA [141500]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211.00||||211.00|20.32|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211.00||||211.00|126.6|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211.00||||211.00|19.69|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211.00||||211.00|23.15|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|211.00||||211.00|105.71|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|211.00||||211.00|89.89|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211.00||||211.00|74.06|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211.00||||211.00|105.5|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211.00||||211.00|18.75|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211.00||||211.00|189.9|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211.00||||211.00|20.63|211|12.5 30585549|EAP|0305 - LABORATORY-HEMATOLOGY|HC MURAMIDASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|211.00||||211.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72.00||||72.00|36.07|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72.00||||72.00|8.25|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72.00||||72.00|25.27|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72.00||||72.00|43.2|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72.00||||72.00|8.09|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72.00||||72.00|7.81|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72.00||||72.00|4.48|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|AETNA [1015]|AETNA ACO WILCO [101532]|72.00||||72.00|10.63|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MULTIPLAN [1680]|IHC HS [168011]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|FMH BENEFIT SERVICES [1390]|FMH [139000]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|FIRST HEALTH [1375]|QUALCHOICE [137513]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72.00||||72.00|8.25|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|HEALTHNET [1495]|HEALTHNET [149500]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72.00||||72.00|9.25|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|TRUSTMARK [2030]|STARMARK [203000]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|UMR [2035]|UMR OPTIONS [203501]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72.00||||72.00|15.12|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72.00||||72.00|72|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72.00||||72.00|34.52|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72.00||||72.00|30.67|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72.00||||72.00|46.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72.00||||72.00|36|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|||72.00||||72.00|21.6|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72.00||||72.00|8.09|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72.00||||72.00|7.44|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|CHAMPVA [1240]|CHAMP VA [124000]|72.00||||72.00|54|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72.00||||72.00|8.41|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|CORESOURCE [1315]|CORESOURCE [131500]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|GEHA [1415]|GEHA [141500]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72.00||||72.00|64.8|72|4.48 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|MULTIPLAN [1680]|HMA [168003]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72.00||||72.00||| 30585555|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72.00||||72.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|GEHA [1415]|GEHA [141500]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|CORESOURCE [1315]|CORESOURCE [131500]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|CHAMPVA [1240]|CHAMP VA [124000]|213.00||||213.00|159.75|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213.00||||213.00|13.31|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213.00||||213.00|14.48|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|||213.00||||213.00|63.9|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213.00||||213.00|138.45|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213.00||||213.00|102.13|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213.00||||213.00|44.73|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|UMR [2035]|UMR OPTIONS [203501]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|213.00||||213.00|16.56|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213.00||||213.00|16.49|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MULTIPLAN [1680]|IHC HS [168011]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213.00||||213.00|213|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|HEALTHNET [1495]|HEALTHNET [149500]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|AETNA [1015]|AETNA ACO WILCO [101532]|213.00||||213.00|21.11|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|TRUSTMARK [2030]|STARMARK [203000]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|213.00||||213.00|8.9|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213.00||||213.00|13.98|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|213.00||||213.00|15.05|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213.00||||213.00|14.48|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213.00||||213.00|127.8|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213.00||||213.00|74.76|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213.00||||213.00|16.49|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|213.00||||213.00|106.71|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|213.00||||213.00|90.74|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213.00||||213.00|106.5|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213.00||||213.00|191.7|213|8.9 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MULTIPLAN [1680]|HMA [168003]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213.00||||213.00||| 30585557|EAP|0305 - LABORATORY-HEMATOLOGY|HC OSMOTIC FRAGILITY RBC INCUBAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213.00||||213.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146.00||||146.00|73|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146.00||||146.00|73.15|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146.00||||146.00|51.25|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146.00||||146.00|26.52|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146.00||||146.00|26.99|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146.00||||146.00|26.07|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146.00||||146.00|14.95|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|TRUSTMARK [2030]|STARMARK [203000]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|HEALTHNET [1495]|HEALTHNET [149500]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146.00||||146.00|26.52|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146.00||||146.00|30.86|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MULTIPLAN [1680]|IHC HS [168011]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|AETNA [1015]|AETNA ACO WILCO [101532]|146.00||||146.00|35.44|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|UMR [2035]|UMR OPTIONS [203501]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146.00||||146.00|30.66|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146.00||||146.00|87.6|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146.00||||146.00|146|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146.00||||146.00|70.01|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146.00||||146.00|62.2|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146.00||||146.00|94.9|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|||146.00||||146.00|43.8|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146.00||||146.00|26.99|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146.00||||146.00|24.83|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|CHAMPVA [1240]|CHAMP VA [124000]|146.00||||146.00|109.5|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146.00||||146.00|28.05|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|CORESOURCE [1315]|CORESOURCE [131500]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|GEHA [1415]|GEHA [141500]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146.00||||146.00|131.4|146|14.95 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|MULTIPLAN [1680]|HMA [168003]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146.00||||146.00||| 30585576|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET AGGREGATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146.00||||146.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|CORESOURCE [1315]|CORESOURCE [131500]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|209.00||||209.00|20.25|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|CHAMPVA [1240]|CHAMP VA [124000]|209.00||||209.00|156.75|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209.00||||209.00|17.92|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|||209.00||||209.00|62.7|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209.00||||209.00|135.85|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209.00||||209.00|209|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209.00||||209.00|43.89|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|UMR [2035]|UMR OPTIONS [203501]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|209.00||||209.00|22.27|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209.00||||209.00|22.19|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MULTIPLAN [1680]|IHC HS [168011]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209.00||||209.00|100.22|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|HEALTHNET [1495]|HEALTHNET [149500]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209.00||||209.00|19.48|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|209.00||||209.00|28.4|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|TRUSTMARK [2030]|STARMARK [203000]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|209.00||||209.00|11.98|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209.00||||209.00|18.82|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209.00||||209.00|19.48|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209.00||||209.00|125.4|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|GEHA [1415]|GEHA [141500]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209.00||||209.00|73.36|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|209.00||||209.00|89.03|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209.00||||209.00|22.19|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|209.00||||209.00|104.71|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209.00||||209.00|104.5|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209.00||||209.00|188.1|209|11.98 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MULTIPLAN [1680]|HMA [168003]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209.00||||209.00||| 30585597|EAP|0305 - LABORATORY-HEMATOLOGY|HC PLATELET NEUTRALIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209.00||||209.00||| 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|185.00||||185.00|4.85|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|185.00||||185.00|92.69|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|185.00||||185.00|78.81|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|185.00||||185.00|64.94|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|185.00||||185.00|4.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|185.00||||185.00|111|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|185.00||||185.00|4.64|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|185.00||||185.00|4.72|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|185.00||||185.00|4.49|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|185.00||||185.00|2.62|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|AETNA [1015]|AETNA ACO WILCO [101532]|185.00||||185.00|6.22|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|HEALTHNET [1495]|HEALTHNET [149500]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MULTIPLAN [1680]|IHC HS [168011]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|185.00||||185.00|6.17|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|FMH BENEFIT SERVICES [1390]|FMH [139000]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|FIRST HEALTH [1375]|QUALCHOICE [137513]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|185.00||||185.00|4.85|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MULTIPLAN [1680]|HMA [168003]|185.00||||185.00|6.44|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|185.00||||185.00|5.3|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|185.00||||185.00|4.38|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|UMR [2035]|UMR OPTIONS [203501]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|185.00||||185.00|6.26|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|TRUSTMARK [2030]|STARMARK [203000]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|185.00||||185.00|38.85|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|185.00||||185.00|185|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|185.00||||185.00|88.71|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|185.00||||185.00|120.25|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|||185.00||||185.00|55.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|185.00||||185.00|4.64|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|185.00||||185.00|92.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|185.00||||185.00|4.27|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|CHAMPVA [1240]|CHAMP VA [124000]|185.00||||185.00|138.75|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|185.00||||185.00|6.17|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|185.00||||185.00|4.82|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|CORESOURCE [1315]|CORESOURCE [131500]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|GEHA [1415]|GEHA [141500]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|185.00||||185.00|4.72|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|185.00||||185.00|4.29|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|185.00||||185.00|166.5|185|2.62 30585610|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME (PT)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|185.00||||185.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242.00||||242.00|121.24|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.00||||242.00|84.94|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242.00||||242.00|4.87|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.00||||242.00|4.87|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MULTIPLAN [1680]|IHC HS [168011]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|HEALTHNET [1495]|HEALTHNET [149500]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.00||||242.00|4.11|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.00||||242.00|50.82|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.00||||242.00|121|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|AETNA [1015]|AETNA ACO WILCO [101532]|242.00||||242.00|6.23|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.00||||242.00|4.26|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.00||||242.00|145.2|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.00||||242.00|116.04|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|CORESOURCE [1315]|CORESOURCE [131500]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242.00||||242.00|4.43|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|TRUSTMARK [2030]|STARMARK [203000]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.00||||242.00|4.87|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242.00||||242.00|2.63|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.00||||242.00|157.3|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|||242.00||||242.00|72.6|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|GEHA [1415]|GEHA [141500]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|CHAMPVA [1240]|CHAMP VA [124000]|242.00||||242.00|181.5|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.00||||242.00|4.26|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.00||||242.00|3.92|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|UMR [2035]|UMR OPTIONS [203501]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.00||||242.00|242|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242.00||||242.00|103.09|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.00||||242.00|217.8|242|2.63 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MULTIPLAN [1680]|HMA [168003]|242.00||||242.00||| 30585611|EAP|0305 - LABORATORY-HEMATOLOGY|HC PROTHROMBIN TIME SUBSTITUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.00||||242.00||| 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|TRUSTMARK [2030]|STARMARK [203000]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|301.00||||301.00|10.54|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|AETNA [1015]|AETNA ACO WILCO [101532]|301.00||||301.00|15.13|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|301.00||||301.00|13.77|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|HEALTHNET [1495]|HEALTHNET [149500]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|301.00||||301.00|10.38|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|FMH BENEFIT SERVICES [1390]|FMH [139000]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|301.00||||301.00|63.21|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|301.00||||301.00|11.83|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|||301.00||||301.00|90.3|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|301.00||||301.00|13.99|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|301.00||||301.00|11.87|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|FIRST HEALTH [1375]|QUALCHOICE [137513]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MULTIPLAN [1680]|IHC HS [168011]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|301.00||||301.00|195.65|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|301.00||||301.00|144.33|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MULTIPLAN [1680]|HMA [168003]|301.00||||301.00|14.37|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|301.00||||301.00|13.77|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|301.00||||301.00|9.55|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|301.00||||301.00|150.5|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|301.00||||301.00|6.38|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|301.00||||301.00|301|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|301.00||||301.00|11.83|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|301.00||||301.00|10.79|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|301.00||||301.00|9.77|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|CHAMPVA [1240]|CHAMP VA [124000]|301.00||||301.00|225.75|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|301.00||||301.00|10.03|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|GEHA [1415]|GEHA [141500]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|301.00||||301.00|150.8|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|301.00||||301.00|10.06|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|CORESOURCE [1315]|CORESOURCE [131500]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|301.00||||301.00|128.23|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|301.00||||301.00|105.65|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|301.00||||301.00|10.38|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|UMR [2035]|UMR OPTIONS [203501]|301.00||||301.00|270.9|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|301.00||||301.00|9.58|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|301.00||||301.00|10.54|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|301.00||||301.00|180.6|301|6.38 30585613|EAP|0305 - LABORATORY-HEMATOLOGY|HC RUSSELL VIPER VENOM DILUTED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|301.00||||301.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|CORESOURCE [1315]|CORESOURCE [131500]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|137.00||||137.00|11.09|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137.00||||137.00|137|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137.00||||137.00|89.05|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137.00||||137.00|9.82|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137.00||||137.00|10.67|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|UMR [2035]|UMR OPTIONS [203501]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|||137.00||||137.00|41.1|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137.00||||137.00|65.69|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|137.00||||137.00|12.2|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|CHAMPVA [1240]|CHAMP VA [124000]|137.00||||137.00|102.75|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|GEHA [1415]|GEHA [141500]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137.00||||137.00|12.16|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|HEALTHNET [1495]|HEALTHNET [149500]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|TRUSTMARK [2030]|STARMARK [203000]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|137.00||||137.00|68.64|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|AETNA [1015]|AETNA ACO WILCO [101532]|137.00||||137.00|15.56|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137.00||||137.00|82.2|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137.00||||137.00|10.31|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137.00||||137.00|68.5|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137.00||||137.00|10.67|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|137.00||||137.00|6.56|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137.00||||137.00|12.16|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MULTIPLAN [1680]|IHC HS [168011]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|137.00||||137.00|58.36|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137.00||||137.00|28.77|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137.00||||137.00|48.09|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137.00||||137.00|123.3|137|6.56 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MULTIPLAN [1680]|HMA [168003]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137.00||||137.00||| 30585635|EAP|0305 - LABORATORY-HEMATOLOGY|HC REPTILASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137.00||||137.00||| 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|AETNA [1015]|AETNA ACO WILCO [101532]|104.00||||104.00|6.07|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104.00||||104.00|6.14|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.00||||104.00|4.38|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MULTIPLAN [1680]|HMA [168003]|104.00||||104.00|6.41|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104.00||||104.00|5.28|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.00||||104.00|4.36|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|TRUSTMARK [2030]|STARMARK [203000]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|UMR [2035]|UMR OPTIONS [203501]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.00||||104.00|67.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.00||||104.00|6.23|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MULTIPLAN [1680]|IHC HS [168011]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|||104.00||||104.00|31.2|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.00||||104.00|21.84|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|HEALTHNET [1495]|HEALTHNET [149500]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.00||||104.00|49.87|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.00||||104.00|104|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104.00||||104.00|4.8|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.00||||104.00|4.25|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|CHAMPVA [1240]|CHAMP VA [124000]|104.00||||104.00|78|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104.00||||104.00|6.14|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|GEHA [1415]|GEHA [141500]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|CORESOURCE [1315]|CORESOURCE [131500]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.00||||104.00|4.48|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.00||||104.00|4.62|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104.00||||104.00|2.56|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.00||||104.00|4.7|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.00||||104.00|4.62|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.00||||104.00|4.7|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104.00||||104.00|62.4|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104.00||||104.00|52.1|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104.00||||104.00|44.3|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.00||||104.00|4.38|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.00||||104.00|36.5|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.00||||104.00|52|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.00||||104.00|4.27|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.00||||104.00|4.46|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.00||||104.00|93.6|104|2.56 30585651|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC NON AUTO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104.00||||104.00||| 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|CORESOURCE [1315]|CORESOURCE [131500]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|GEHA [1415]|GEHA [141500]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104.00||||104.00|2.69|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|||104.00||||104.00|31.2|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104.00||||104.00|67.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104.00||||104.00|2.93|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104.00||||104.00|3.05|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104.00||||104.00|49.87|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104.00||||104.00|2.75|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|FMH BENEFIT SERVICES [1390]|FMH [139000]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|FIRST HEALTH [1375]|QUALCHOICE [137513]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104.00||||104.00|3.94|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104.00||||104.00|3.33|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104.00||||104.00|3.88|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104.00||||104.00|3.88|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MULTIPLAN [1680]|IHC HS [168011]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104.00||||104.00|2.83|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104.00||||104.00|104|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|UMR [2035]|UMR OPTIONS [203501]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|CHAMPVA [1240]|CHAMP VA [124000]|104.00||||104.00|78|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104.00||||104.00|3.35|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|HEALTHNET [1495]|HEALTHNET [149500]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104.00||||104.00|36.5|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104.00||||104.00|2.93|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104.00||||104.00|62.4|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104.00||||104.00|2.84|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|AETNA [1015]|AETNA ACO WILCO [101532]|104.00||||104.00|4.27|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104.00||||104.00|2.97|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104.00||||104.00|2.97|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104.00||||104.00|21.84|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104.00||||104.00|52.1|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|TRUSTMARK [2030]|STARMARK [203000]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104.00||||104.00|52|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104.00||||104.00|1.8|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|MULTIPLAN [1680]|HMA [168003]|104.00||||104.00|4.05|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104.00||||104.00|3.33|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104.00||||104.00|2.7|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104.00||||104.00|93.6|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104.00||||104.00|44.3|104|1.8 30585652|EAP|0305 - LABORATORY-HEMATOLOGY|HC SED RATE RBC AUTO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104.00||||104.00||| 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98.00||||98.00|6.06|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|98.00||||98.00|49.1|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98.00||||98.00|5.97|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98.00||||98.00|6.8|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98.00||||98.00|49|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98.00||||98.00|34.4|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MULTIPLAN [1680]|HMA [168003]|98.00||||98.00|8.27|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|98.00||||98.00|7.92|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|HEALTHNET [1495]|HEALTHNET [149500]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|AETNA [1015]|AETNA ACO WILCO [101532]|98.00||||98.00|8.7|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98.00||||98.00|6.06|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|FIRST HEALTH [1375]|QUALCHOICE [137513]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|98.00||||98.00|6.83|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|TRUSTMARK [2030]|STARMARK [203000]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|FMH BENEFIT SERVICES [1390]|FMH [139000]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|98.00||||98.00|41.75|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98.00||||98.00|58.8|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|UMR [2035]|UMR OPTIONS [203501]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98.00||||98.00|5.76|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98.00||||98.00|6.8|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|98.00||||98.00|3.67|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98.00||||98.00|98|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98.00||||98.00|5.97|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98.00||||98.00|20.58|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98.00||||98.00|5.62|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98.00||||98.00|46.99|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98.00||||98.00|5.79|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MULTIPLAN [1680]|IHC HS [168011]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|||98.00||||98.00|29.4|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98.00||||98.00|5.49|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98.00||||98.00|8.04|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98.00||||98.00|5.51|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|98.00||||98.00|6.21|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|98.00||||98.00|7.92|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98.00||||98.00|63.7|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|CORESOURCE [1315]|CORESOURCE [131500]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|CHAMPVA [1240]|CHAMP VA [124000]|98.00||||98.00|73.5|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|GEHA [1415]|GEHA [141500]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98.00||||98.00|88.2|98|3.67 30585660|EAP|0305 - LABORATORY-HEMATOLOGY|HC SICKLE CELL RBC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|98.00||||98.00||| 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|CORESOURCE [1315]|CORESOURCE [131500]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|CHAMPVA [1240]|CHAMP VA [124000]|170.00||||170.00|127.5|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170.00||||170.00|81.52|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|170.00||||170.00|7.15|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170.00||||170.00|170|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|||170.00||||170.00|51|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|GEHA [1415]|GEHA [141500]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170.00||||170.00|8.42|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170.00||||170.00|7.12|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170.00||||170.00|5.89|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|170.00||||170.00|6.5|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|UMR [2035]|UMR OPTIONS [203501]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|170.00||||170.00|8.29|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|170.00||||170.00|3.85|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MULTIPLAN [1680]|HMA [168003]|170.00||||170.00|8.66|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170.00||||170.00|6.25|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170.00||||170.00|110.5|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|170.00||||170.00|8.29|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|TRUSTMARK [2030]|STARMARK [203000]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170.00||||170.00|35.7|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|AETNA [1015]|AETNA ACO WILCO [101532]|170.00||||170.00|9.12|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170.00||||170.00|59.67|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170.00||||170.00|5.75|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|170.00||||170.00|85.17|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170.00||||170.00|6.25|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170.00||||170.00|102|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170.00||||170.00|6.35|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170.00||||170.00|6.04|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170.00||||170.00|85|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170.00||||170.00|5.77|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170.00||||170.00|7.12|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170.00||||170.00|6.35|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|HEALTHNET [1495]|HEALTHNET [149500]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MULTIPLAN [1680]|IHC HS [168011]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170.00||||170.00|6.06|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170.00||||170.00|153|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|170.00||||170.00|72.42|170|3.85 30585670|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBIN TIME PLASMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|FMH BENEFIT SERVICES [1390]|FMH [139000]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170.00||||170.00|11.89|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|170.00||||170.00|11.92|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|UMR [2035]|UMR OPTIONS [203501]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170.00||||170.00|110.5|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|||170.00||||170.00|51|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170.00||||170.00|35.7|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170.00||||170.00|10.43|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170.00||||170.00|81.52|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170.00||||170.00|170|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|170.00||||170.00|10.84|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|FIRST HEALTH [1375]|QUALCHOICE [137513]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|GEHA [1415]|GEHA [141500]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|CHAMPVA [1240]|CHAMP VA [124000]|170.00||||170.00|127.5|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|CORESOURCE [1315]|CORESOURCE [131500]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170.00||||170.00|9.59|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170.00||||170.00|59.67|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|TRUSTMARK [2030]|STARMARK [203000]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170.00||||170.00|10.07|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170.00||||170.00|10.43|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|170.00||||170.00|85.17|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|170.00||||170.00|6.42|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170.00||||170.00|85|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170.00||||170.00|11.89|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|170.00||||170.00|72.42|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170.00||||170.00|102|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|HEALTHNET [1495]|HEALTHNET [149500]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|AETNA [1015]|AETNA ACO WILCO [101532]|170.00||||170.00|15.22|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MULTIPLAN [1680]|IHC HS [168011]|170.00||||170.00|153|170|6.42 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|170.00||||170.00||| 30585705|EAP|0305 - LABORATORY-HEMATOLOGY|HC THROMBOPLASTIN INHIBITION|MULTIPLAN [1680]|HMA [168003]|170.00||||170.00||| 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|GEHA [1415]|GEHA [141500]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|CORESOURCE [1315]|CORESOURCE [131500]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177.00||||177.00|84.87|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|177.00||||177.00|8.64|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177.00||||177.00|115.05|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|||177.00||||177.00|53.1|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177.00||||177.00|6.51|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177.00||||177.00|177|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|CHAMPVA [1240]|CHAMP VA [124000]|177.00||||177.00|132.75|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|FIRST HEALTH [1375]|QUALCHOICE [137513]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|UMR [2035]|UMR OPTIONS [203501]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177.00||||177.00|6.13|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|177.00||||177.00|7.44|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177.00||||177.00|7.42|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|177.00||||177.00|6.77|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|FMH BENEFIT SERVICES [1390]|FMH [139000]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177.00||||177.00|5.99|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MULTIPLAN [1680]|IHC HS [168011]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177.00||||177.00|8.77|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177.00||||177.00|37.17|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MULTIPLAN [1680]|HMA [168003]|177.00||||177.00|9.02|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177.00||||177.00|62.13|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177.00||||177.00|106.2|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|177.00||||177.00|8.64|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177.00||||177.00|6.61|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177.00||||177.00|6.29|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177.00||||177.00|6.61|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|177.00||||177.00|75.4|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|TRUSTMARK [2030]|STARMARK [203000]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177.00||||177.00|6.31|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177.00||||177.00|7.42|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|177.00||||177.00|4|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|AETNA [1015]|AETNA ACO WILCO [101532]|177.00||||177.00|9.49|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177.00||||177.00|88.5|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|HEALTHNET [1495]|HEALTHNET [149500]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177.00||||177.00|6.51|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177.00||||177.00|159.3|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|177.00||||177.00|88.68|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177.00||||177.00|6.01|177|4 30585730|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|177.00||||177.00||| 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|238.00||||238.00|7.12|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|238.00||||238.00|6.77|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|238.00||||238.00|7.12|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|238.00||||238.00|6.79|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|AETNA [1015]|AETNA ACO WILCO [101532]|238.00||||238.00|10.21|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|238.00||||238.00|119.24|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|238.00||||238.00|4.31|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|238.00||||238.00|83.54|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|HEALTHNET [1495]|HEALTHNET [149500]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MULTIPLAN [1680]|HMA [168003]|238.00||||238.00|9.71|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|238.00||||238.00|9.3|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|238.00||||238.00|119|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|238.00||||238.00|142.8|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|238.00||||238.00|7.98|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|238.00||||238.00|6.6|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|238.00||||238.00|7.01|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MULTIPLAN [1680]|IHC HS [168011]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|238.00||||238.00|238|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|238.00||||238.00|7.98|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|238.00||||238.00|9.45|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|238.00||||238.00|49.98|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|238.00||||238.00|6.44|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|238.00||||238.00|154.7|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|||238.00||||238.00|71.4|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|238.00||||238.00|7.01|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|UMR [2035]|UMR OPTIONS [203501]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|238.00||||238.00|101.39|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|238.00||||238.00|7.29|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|238.00||||238.00|9.3|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|CHAMPVA [1240]|CHAMP VA [124000]|238.00||||238.00|178.5|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|TRUSTMARK [2030]|STARMARK [203000]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|238.00||||238.00|114.12|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|CORESOURCE [1315]|CORESOURCE [131500]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|GEHA [1415]|GEHA [141500]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|238.00||||238.00|6.47|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|238.00||||238.00|8.01|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|238.00||||238.00|214.2|238|4.31 30585732|EAP|0305 - LABORATORY-HEMATOLOGY|HC PTT SUBSTITUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|238.00||||238.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|GEHA [1415]|GEHA [141500]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|257.00||||257.00|13.14|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|CORESOURCE [1315]|CORESOURCE [131500]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|||257.00||||257.00|77.1|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|257.00||||257.00|12.64|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|257.00||||257.00|257|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|257.00||||257.00|53.97|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|UMR [2035]|UMR OPTIONS [203501]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|257.00||||257.00|14.45|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|257.00||||257.00|14.41|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|CHAMPVA [1240]|CHAMP VA [124000]|257.00||||257.00|192.75|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|257.00||||257.00|167.05|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|HEALTHNET [1495]|HEALTHNET [149500]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MULTIPLAN [1680]|IHC HS [168011]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|AETNA [1015]|AETNA ACO WILCO [101532]|257.00||||257.00|18.45|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|257.00||||257.00|7.78|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|257.00||||257.00|12.21|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|257.00||||257.00|12.64|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|257.00||||257.00|11.63|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|257.00||||257.00|154.2|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|257.00||||257.00|128.76|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|257.00||||257.00|90.21|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|257.00||||257.00|128.5|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|257.00||||257.00|109.48|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|257.00||||257.00|14.41|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|TRUSTMARK [2030]|STARMARK [203000]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|257.00||||257.00|123.23|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|257.00||||257.00|231.3|257|7.78 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MULTIPLAN [1680]|HMA [168003]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|257.00||||257.00||| 30585810|EAP|0305 - LABORATORY-HEMATOLOGY|HC VISCOSITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|257.00||||257.00||| 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200.00||||200.00|56.44|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200.00||||200.00|57.15|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|200.00||||200.00|73.76|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200.00||||200.00|59.16|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200.00||||200.00|70.2|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200.00||||200.00|86|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|FIRST HEALTH [1375]|QUALCHOICE [137513]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200.00||||200.00|120|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|HEALTHNET [1495]|HEALTHNET [149500]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MULTIPLAN [1680]|IHC HS [168011]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MULTIPLAN [1680]|HMA [168003]|200.00||||200.00|76.97|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|200.00||||200.00|100.2|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|FMH BENEFIT SERVICES [1390]|FMH [139000]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200.00||||200.00|56.44|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200.00||||200.00|86|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|200.00||||200.00|67.64|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200.00||||200.00|52.34|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200.00||||200.00|53.88|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|200.00||||200.00|85.2|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|CHAMPVA [1240]|CHAMP VA [124000]|200.00||||200.00|150|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200.00||||200.00|200|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|200.00||||200.00|51.33|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200.00||||200.00|42|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|UMR [2035]|UMR OPTIONS [203501]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200.00||||200.00|130|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200.00||||200.00|59.16|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|||200.00||||200.00|60|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|GEHA [1415]|GEHA [141500]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|200.00||||200.00|61.49|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|200.00||||200.00|73.76|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200.00||||200.00|74.91|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|CORESOURCE [1315]|CORESOURCE [131500]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|TRUSTMARK [2030]|STARMARK [203000]|200.00||||200.00|180|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|200.00||||200.00|51.31|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200.00||||200.00|95.9|200|42 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200.00||||200.00||| 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|AETNA [1015]|AETNA ACO WILCO [101532]|200.00||||200.00||| 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|200.00||||200.00||| 30600002|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CORONAVIRUS SARS-COV-2/2019-NCOV (COVID-19)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200.00||||200.00||| 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|GEHA [1415]|GEHA [141500]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|300.00||||300.00|143.76|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|300.00||||300.00|195|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|CHAMPVA [1240]|CHAMP VA [124000]|300.00||||300.00|225|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|300.00||||300.00|300|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|||300.00||||300.00|90|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|FIRST HEALTH [1375]|QUALCHOICE [137513]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|300.00||||300.00|131.25|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|300.00||||300.00|146|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|300.00||||300.00|102|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|300.00||||300.00|129|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|FMH BENEFIT SERVICES [1390]|FMH [139000]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|300.00||||300.00|143.85|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|300.00||||300.00|119.8|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|UMR [2035]|UMR OPTIONS [203501]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|CORESOURCE [1315]|CORESOURCE [131500]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MULTIPLAN [1680]|IHC HS [168011]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|300.00||||300.00|115.26|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|300.00||||300.00|63|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|300.00||||300.00|127.8|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|300.00||||300.00|111.32|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|300.00||||300.00|110|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|300.00||||300.00|180|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|300.00||||300.00|110|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|HEALTHNET [1495]|HEALTHNET [149500]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MULTIPLAN [1680]|HMA [168003]|300.00||||300.00|150|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|300.00||||300.00|105|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|300.00||||300.00|150.3|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|300.00||||300.00|105.3|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|300.00||||300.00|129|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|300.00||||300.00|143.76|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|TRUSTMARK [2030]|STARMARK [203000]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|300.00||||300.00|115.26|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|300.00||||300.00|270|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|300.00||||300.00|100|300|63 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|300.00||||300.00||| 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|300.00||||300.00||| 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|AETNA [1015]|AETNA ACO WILCO [101532]|300.00||||300.00||| 30600003|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DNA/RNA SARS-COV-2/COVID-19 AMP;HIGH THROUGHPUT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|300.00||||300.00||| 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65.00||||65.00|7.35|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65.00||||65.00|4.45|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65.00||||65.00|7|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65.00||||65.00|7.35|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65.00||||65.00|32.57|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65.00||||65.00|7.24|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65.00||||65.00|7.01|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65.00||||65.00|8.24|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|HEALTHNET [1495]|HEALTHNET [149500]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|TRUSTMARK [2030]|STARMARK [203000]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MULTIPLAN [1680]|HMA [168003]|65.00||||65.00|10.02|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65.00||||65.00|39|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65.00||||65.00|9.6|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65.00||||65.00|22.82|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65.00||||65.00|8.24|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65.00||||65.00|6.81|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65.00||||65.00|32.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MULTIPLAN [1680]|IHC HS [168011]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65.00||||65.00|65|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|UMR [2035]|UMR OPTIONS [203501]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65.00||||65.00|13.65|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|AETNA [1015]|AETNA ACO WILCO [101532]|65.00||||65.00|10.55|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65.00||||65.00|27.69|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65.00||||65.00|42.25|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65.00||||65.00|6.66|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65.00||||65.00|7.24|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|GEHA [1415]|GEHA [141500]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65.00||||65.00|7.53|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|CHAMPVA [1240]|CHAMP VA [124000]|65.00||||65.00|48.75|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65.00||||65.00|9.6|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|CORESOURCE [1315]|CORESOURCE [131500]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65.00||||65.00|31.17|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|||65.00||||65.00|19.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65.00||||65.00|6.68|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65.00||||65.00|9.75|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65.00||||65.00|58.5|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65.00||||65.00|8.27|65|4.45 30687015|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CONCENTRATION INFECTIOUS AGNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65.00||||65.00||| 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|GEHA [1415]|GEHA [141500]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|CORESOURCE [1315]|CORESOURCE [131500]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|580.00||||580.00|377|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|580.00||||580.00|11.18|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|580.00||||580.00|278.11|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|580.00||||580.00|580|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|580.00||||580.00|121.8|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|580.00||||580.00|14.84|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|580.00||||580.00|10.28|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|580.00||||580.00|12.78|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|580.00||||580.00|10.53|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|580.00||||580.00|12.74|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|||580.00||||580.00|174|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|580.00||||580.00|11.62|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|FIRST HEALTH [1375]|QUALCHOICE [137513]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|CHAMPVA [1240]|CHAMP VA [124000]|580.00||||580.00|435|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MULTIPLAN [1680]|IHC HS [168011]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|UMR [2035]|UMR OPTIONS [203501]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|580.00||||580.00|15.07|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|FMH BENEFIT SERVICES [1390]|FMH [139000]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|AETNA [1015]|AETNA ACO WILCO [101532]|580.00||||580.00|16.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|HEALTHNET [1495]|HEALTHNET [149500]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|580.00||||580.00|11.35|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|580.00||||580.00|11.18|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|580.00||||580.00|10.79|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|580.00||||580.00|11.35|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|580.00||||580.00|348|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|580.00||||580.00|12.74|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|580.00||||580.00|203.58|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|580.00||||580.00|247.08|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|580.00||||580.00|10.32|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|580.00||||580.00|290|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|TRUSTMARK [2030]|STARMARK [203000]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|580.00||||580.00|290.58|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MULTIPLAN [1680]|HMA [168003]|580.00||||580.00|15.48|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|580.00||||580.00|6.88|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|580.00||||580.00|522|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|580.00||||580.00|10.84|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|580.00||||580.00|14.84|580|6.88 30687040|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BLD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|580.00||||580.00||| 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297.00||||297.00|9.41|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|CHAMPVA [1240]|CHAMP VA [124000]|297.00||||297.00|222.75|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|297.00||||297.00|13.57|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|297.00||||297.00|10.62|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|CORESOURCE [1315]|CORESOURCE [131500]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|GEHA [1415]|GEHA [141500]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297.00||||297.00|10.22|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297.00||||297.00|10.38|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297.00||||297.00|148.5|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|297.00||||297.00|126.52|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|297.00||||297.00|148.8|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297.00||||297.00|9.91|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297.00||||297.00|9.88|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297.00||||297.00|10.38|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|TRUSTMARK [2030]|STARMARK [203000]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297.00||||297.00|10.22|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|HEALTHNET [1495]|HEALTHNET [149500]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|AETNA [1015]|AETNA ACO WILCO [101532]|297.00||||297.00|14.92|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MULTIPLAN [1680]|IHC HS [168011]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|297.00||||297.00|13.57|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297.00||||297.00|178.2|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297.00||||297.00|104.25|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MULTIPLAN [1680]|HMA [168003]|297.00||||297.00|14.16|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297.00||||297.00|11.66|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297.00||||297.00|11.66|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|297.00||||297.00|11.68|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297.00||||297.00|13.78|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297.00||||297.00|62.37|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297.00||||297.00|9.44|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297.00||||297.00|297|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297.00||||297.00|9.63|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297.00||||297.00|142.41|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297.00||||297.00|193.05|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|UMR [2035]|UMR OPTIONS [203501]|297.00||||297.00|267.3|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|||297.00||||297.00|89.1|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|297.00||||297.00|6.29|297|6.29 30687045|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|297.00||||297.00||| 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|GEHA [1415]|GEHA [141500]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|124.00||||124.00|10.62|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|CHAMPVA [1240]|CHAMP VA [124000]|124.00||||124.00|93|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|||124.00||||124.00|37.2|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124.00||||124.00|59.46|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124.00||||124.00|124|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124.00||||124.00|26.04|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124.00||||124.00|80.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124.00||||124.00|13.78|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|UMR [2035]|UMR OPTIONS [203501]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124.00||||124.00|9.63|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124.00||||124.00|9.41|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|124.00||||124.00|11.68|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124.00||||124.00|11.66|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|FIRST HEALTH [1375]|QUALCHOICE [137513]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|CORESOURCE [1315]|CORESOURCE [131500]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|FMH BENEFIT SERVICES [1390]|FMH [139000]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|124.00||||124.00|13.57|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MULTIPLAN [1680]|IHC HS [168011]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|124.00||||124.00|13.57|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MULTIPLAN [1680]|HMA [168003]|124.00||||124.00|14.16|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|AETNA [1015]|AETNA ACO WILCO [101532]|124.00||||124.00|14.92|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|HEALTHNET [1495]|HEALTHNET [149500]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124.00||||124.00|9.88|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124.00||||124.00|10.38|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|124.00||||124.00|6.29|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124.00||||124.00|10.22|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124.00||||124.00|10.22|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124.00||||124.00|74.4|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|TRUSTMARK [2030]|STARMARK [203000]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124.00||||124.00|9.91|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124.00||||124.00|43.52|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|124.00||||124.00|52.82|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124.00||||124.00|11.66|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|124.00||||124.00|62.12|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124.00||||124.00|62|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124.00||||124.00|9.44|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124.00||||124.00|10.38|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124.00||||124.00|111.6|124|6.29 30687046|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE STOOL/ADD PATHOGENS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|124.00||||124.00||| 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|290.00||||290.00|9.48|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|290.00||||290.00|145|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|290.00||||290.00|145.29|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|290.00||||290.00|123.54|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|290.00||||290.00|9.05|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|290.00||||290.00|174|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|290.00||||290.00|9.34|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|TRUSTMARK [2030]|STARMARK [203000]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|290.00||||290.00|9.01|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|AETNA [1015]|AETNA ACO WILCO [101532]|290.00||||290.00|13.61|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|290.00||||290.00|9.48|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MULTIPLAN [1680]|IHC HS [168011]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MULTIPLAN [1680]|HMA [168003]|290.00||||290.00|12.93|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|290.00||||290.00|101.79|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|290.00||||290.00|10.64|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|290.00||||290.00|12.39|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|290.00||||290.00|10.64|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|290.00||||290.00|10.67|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|290.00||||290.00|8.79|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|HEALTHNET [1495]|HEALTHNET [149500]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|290.00||||290.00|5.74|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|UMR [2035]|UMR OPTIONS [203501]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|290.00||||290.00|290|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|290.00||||290.00|188.5|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|||290.00||||290.00|87|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|290.00||||290.00|139.06|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|290.00||||290.00|9.34|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|290.00||||290.00|8.62|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|290.00||||290.00|8.59|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|CHAMPVA [1240]|CHAMP VA [124000]|290.00||||290.00|217.5|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|290.00||||290.00|12.59|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|290.00||||290.00|12.39|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|290.00||||290.00|9.71|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|CORESOURCE [1315]|CORESOURCE [131500]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|GEHA [1415]|GEHA [141500]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|290.00||||290.00|261|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|290.00||||290.00|60.9|290|5.74 30687070|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANY OTHER SOURCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|290.00||||290.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00|11.14|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00|10.72|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|||95.00||||95.00|28.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|11.66|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00|12.25|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00|9.86|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00|10.36|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00|10.72|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|11.66|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00|6.29|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00|47.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00|14.92|95|6.29 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00||| 30687071|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AEROBIC OTHER QN|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|327.00||||327.00|10.42|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|327.00||||327.00|163.83|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|327.00||||327.00|114.78|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|327.00||||327.00|139.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|327.00||||327.00|163.5|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|327.00||||327.00|9.94|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|327.00||||327.00|10.26|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|327.00||||327.00|9.91|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|327.00||||327.00|6.31|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|TRUSTMARK [2030]|STARMARK [203000]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|HEALTHNET [1495]|HEALTHNET [149500]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MULTIPLAN [1680]|IHC HS [168011]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|327.00||||327.00|13.61|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|327.00||||327.00|11.69|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|327.00||||327.00|196.2|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MULTIPLAN [1680]|HMA [168003]|327.00||||327.00|14.21|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|327.00||||327.00|11.73|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|327.00||||327.00|11.69|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|AETNA [1015]|AETNA ACO WILCO [101532]|327.00||||327.00|14.96|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|327.00||||327.00|10.42|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|UMR [2035]|UMR OPTIONS [203501]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|327.00||||327.00|68.67|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|327.00||||327.00|327|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|327.00||||327.00|156.8|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|||327.00||||327.00|98.1|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|327.00||||327.00|10.26|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|327.00||||327.00|212.55|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|327.00||||327.00|13.83|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|327.00||||327.00|9.44|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|CHAMPVA [1240]|CHAMP VA [124000]|327.00||||327.00|245.25|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|327.00||||327.00|13.61|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|CORESOURCE [1315]|CORESOURCE [131500]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|327.00||||327.00|10.66|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|GEHA [1415]|GEHA [141500]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|327.00||||327.00|9.66|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|327.00||||327.00|294.3|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|327.00||||327.00|9.47|327|6.31 30687075|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ANY SOURCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|327.00||||327.00||| 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|GEHA [1415]|GEHA [141500]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|258.00||||258.00|9.1|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|CORESOURCE [1315]|CORESOURCE [131500]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|CHAMPVA [1240]|CHAMP VA [124000]|258.00||||258.00|193.5|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|258.00||||258.00|167.7|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|||258.00||||258.00|77.4|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|258.00||||258.00|258|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|258.00||||258.00|54.18|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|258.00||||258.00|8.76|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|258.00||||258.00|11.8|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|UMR [2035]|UMR OPTIONS [203501]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|258.00||||258.00|8.24|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|258.00||||258.00|9.97|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|258.00||||258.00|10.02|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|FIRST HEALTH [1375]|QUALCHOICE [137513]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|FMH BENEFIT SERVICES [1390]|FMH [139000]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|258.00||||258.00|11.62|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|258.00||||258.00|11.62|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|258.00||||258.00|123.71|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|AETNA [1015]|AETNA ACO WILCO [101532]|258.00||||258.00|12.76|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|TRUSTMARK [2030]|STARMARK [203000]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|258.00||||258.00|5.38|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|258.00||||258.00|8.46|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|258.00||||258.00|8.89|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|258.00||||258.00|8.76|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|258.00||||258.00|8.06|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|258.00||||258.00|154.8|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|258.00||||258.00|8.48|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|258.00||||258.00|129|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|HEALTHNET [1495]|HEALTHNET [149500]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|258.00||||258.00|109.91|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MULTIPLAN [1680]|HMA [168003]|258.00||||258.00|12.12|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|258.00||||258.00|9.97|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|MULTIPLAN [1680]|IHC HS [168011]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|258.00||||258.00|90.56|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|258.00||||258.00|129.26|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|258.00||||258.00|232.2|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|258.00||||258.00|8.08|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|258.00||||258.00|8.89|258|5.38 30687076|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE ANAEROBIC ID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|258.00||||258.00||| 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|209.00||||209.00|8.89|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|209.00||||209.00|104.71|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|209.00||||209.00|89.03|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|209.00||||209.00|73.36|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|209.00||||209.00|104.5|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|209.00||||209.00|125.4|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|209.00||||209.00|8.46|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|TRUSTMARK [2030]|STARMARK [203000]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|HEALTHNET [1495]|HEALTHNET [149500]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|AETNA [1015]|AETNA ACO WILCO [101532]|209.00||||209.00|12.76|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MULTIPLAN [1680]|IHC HS [168011]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MULTIPLAN [1680]|HMA [168003]|209.00||||209.00|12.12|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|209.00||||209.00|8.89|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|209.00||||209.00|9.97|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|209.00||||209.00|10.02|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|209.00||||209.00|8.24|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|209.00||||209.00|11.62|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|209.00||||209.00|8.48|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|209.00||||209.00|8.76|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|UMR [2035]|UMR OPTIONS [203501]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|209.00||||209.00|209|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|209.00||||209.00|5.38|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|209.00||||209.00|135.85|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|209.00||||209.00|9.97|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|||209.00||||209.00|62.7|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|209.00||||209.00|8.76|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|209.00||||209.00|43.89|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|209.00||||209.00|8.08|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|209.00||||209.00|8.06|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|209.00||||209.00|11.8|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|CHAMPVA [1240]|CHAMP VA [124000]|209.00||||209.00|156.75|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|209.00||||209.00|11.62|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|CORESOURCE [1315]|CORESOURCE [131500]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|209.00||||209.00|9.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|GEHA [1415]|GEHA [141500]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|209.00||||209.00|188.1|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|209.00||||209.00|100.22|209|5.38 30687077|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AER ORGANISM ID EA ISOLATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|209.00||||209.00||| 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|GEHA [1415]|GEHA [141500]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|CORESOURCE [1315]|CORESOURCE [131500]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|CHAMPVA [1240]|CHAMP VA [124000]|429.00||||429.00|321.75|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|429.00||||429.00|6.6|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|429.00||||429.00|7.18|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|429.00||||429.00|205.71|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|429.00||||429.00|429|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|||429.00||||429.00|128.7|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|429.00||||429.00|90.09|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|429.00||||429.00|9.68|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|UMR [2035]|UMR OPTIONS [203501]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|429.00||||429.00|6.76|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|429.00||||429.00|8.21|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|429.00||||429.00|9.53|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|FIRST HEALTH [1375]|QUALCHOICE [137513]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|429.00||||429.00|7.46|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|429.00||||429.00|8.18|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|FMH BENEFIT SERVICES [1390]|FMH [139000]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MULTIPLAN [1680]|IHC HS [168011]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MULTIPLAN [1680]|HMA [168003]|429.00||||429.00|9.95|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|429.00||||429.00|278.85|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|HEALTHNET [1495]|HEALTHNET [149500]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|429.00||||429.00|4.42|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|429.00||||429.00|6.93|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|429.00||||429.00|7.29|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|429.00||||429.00|7.18|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|429.00||||429.00|257.4|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|429.00||||429.00|6.96|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|429.00||||429.00|214.5|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|AETNA [1015]|AETNA ACO WILCO [101532]|429.00||||429.00|10.47|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|429.00||||429.00|214.93|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|429.00||||429.00|150.58|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|429.00||||429.00|8.18|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|429.00||||429.00|9.53|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|429.00||||429.00|182.75|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|429.00||||429.00|6.63|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|429.00||||429.00|7.29|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|TRUSTMARK [2030]|STARMARK [203000]|429.00||||429.00|386.1|429|4.42 30687081|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PATHOGENIC IS ORG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|429.00||||429.00||| 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|315.00||||315.00|8.88|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|315.00||||315.00|110.57|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|315.00||||315.00|134.19|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|315.00||||315.00|157.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|315.00||||315.00|8.47|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|315.00||||315.00|189|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|315.00||||315.00|8.75|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|315.00||||315.00|8.88|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|315.00||||315.00|5.38|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|TRUSTMARK [2030]|STARMARK [203000]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|HEALTHNET [1495]|HEALTHNET [149500]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|AETNA [1015]|AETNA ACO WILCO [101532]|315.00||||315.00|12.76|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MULTIPLAN [1680]|IHC HS [168011]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|315.00||||315.00|11.6|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MULTIPLAN [1680]|HMA [168003]|315.00||||315.00|12.11|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|315.00||||315.00|9.96|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|315.00||||315.00|10.01|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|315.00||||315.00|9.96|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|315.00||||315.00|8.45|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|UMR [2035]|UMR OPTIONS [203501]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|315.00||||315.00|11.78|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|315.00||||315.00|151.04|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|315.00||||315.00|8.75|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|315.00||||315.00|204.75|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|315.00||||315.00|315|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|315.00||||315.00|157.82|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|315.00||||315.00|66.15|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|||315.00||||315.00|94.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|315.00||||315.00|8.04|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|CHAMPVA [1240]|CHAMP VA [124000]|315.00||||315.00|236.25|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|315.00||||315.00|8.07|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|315.00||||315.00|11.6|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|315.00||||315.00|8.23|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|CORESOURCE [1315]|CORESOURCE [131500]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|315.00||||315.00|9.09|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|GEHA [1415]|GEHA [141500]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|315.00||||315.00|283.5|315|5.38 30687086|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE URINE W/COLONY CNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|315.00||||315.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|GEHA [1415]|GEHA [141500]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|CORESOURCE [1315]|CORESOURCE [131500]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|CHAMPVA [1240]|CHAMP VA [124000]|186.00||||186.00|139.5|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186.00||||186.00|8.76|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|||186.00||||186.00|55.8|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186.00||||186.00|120.9|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186.00||||186.00|89.19|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186.00||||186.00|186|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186.00||||186.00|39.06|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|UMR [2035]|UMR OPTIONS [203501]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186.00||||186.00|8.06|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186.00||||186.00|9.99|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|186.00||||186.00|10.02|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|186.00||||186.00|9.1|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|TRUSTMARK [2030]|STARMARK [203000]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|186.00||||186.00|5.39|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186.00||||186.00|8.46|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186.00||||186.00|8.76|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186.00||||186.00|111.6|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186.00||||186.00|93|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|HEALTHNET [1495]|HEALTHNET [149500]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186.00||||186.00|9.99|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|AETNA [1015]|AETNA ACO WILCO [101532]|186.00||||186.00|12.79|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|186.00||||186.00|93.19|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186.00||||186.00|65.29|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|186.00||||186.00|79.24|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MULTIPLAN [1680]|IHC HS [168011]|186.00||||186.00|167.4|186|5.39 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MULTIPLAN [1680]|HMA [168003]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186.00||||186.00||| 30687088|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE BACT URINE ISOL&PRSMPTV ID ISOLATE EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186.00||||186.00||| 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435.00||||435.00|8.48|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|435.00||||435.00|217.94|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|435.00||||435.00|185.31|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435.00||||435.00|261|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|435.00||||435.00|5.14|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|TRUSTMARK [2030]|STARMARK [203000]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435.00||||435.00|8.08|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|HEALTHNET [1495]|HEALTHNET [149500]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435.00||||435.00|8.1|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MULTIPLAN [1680]|IHC HS [168011]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MULTIPLAN [1680]|HMA [168003]|435.00||||435.00|11.57|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435.00||||435.00|9.51|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|FMH BENEFIT SERVICES [1390]|FMH [139000]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435.00||||435.00|152.69|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|FIRST HEALTH [1375]|QUALCHOICE [137513]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435.00||||435.00|217.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|435.00||||435.00|11.08|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|435.00||||435.00|9.56|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435.00||||435.00|8.48|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435.00||||435.00|8.36|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|AETNA [1015]|AETNA ACO WILCO [101532]|435.00||||435.00|12.17|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435.00||||435.00|9.51|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|UMR [2035]|UMR OPTIONS [203501]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435.00||||435.00|435|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435.00||||435.00|208.58|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435.00||||435.00|282.75|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|||435.00||||435.00|130.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435.00||||435.00|8.36|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435.00||||435.00|7.71|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435.00||||435.00|91.35|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435.00||||435.00|7.69|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|CHAMPVA [1240]|CHAMP VA [124000]|435.00||||435.00|326.25|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435.00||||435.00|11.26|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|435.00||||435.00|11.08|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435.00||||435.00|7.86|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|CORESOURCE [1315]|CORESOURCE [131500]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|435.00||||435.00|8.69|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|GEHA [1415]|GEHA [141500]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435.00||||435.00|391.5|435|5.14 30687101|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT FUNGI ID ISOLATES SKIN/HAIR/NAIL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|435.00||||435.00||| 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|GEHA [1415]|GEHA [141500]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|CORESOURCE [1315]|CORESOURCE [131500]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|222.00||||222.00|12.09|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|CHAMPVA [1240]|CHAMP VA [124000]|222.00||||222.00|166.5|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222.00||||222.00|9.12|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222.00||||222.00|106.45|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222.00||||222.00|222|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222.00||||222.00|46.62|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222.00||||222.00|12.28|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|UMR [2035]|UMR OPTIONS [203501]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222.00||||222.00|8.58|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|222.00||||222.00|10.42|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|FIRST HEALTH [1375]|QUALCHOICE [137513]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|FMH BENEFIT SERVICES [1390]|FMH [139000]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|222.00||||222.00|9.48|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222.00||||222.00|10.38|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222.00||||222.00|8.39|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MULTIPLAN [1680]|IHC HS [168011]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|AETNA [1015]|AETNA ACO WILCO [101532]|222.00||||222.00|13.28|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|||222.00||||222.00|66.6|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222.00||||222.00|9.25|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222.00||||222.00|9.12|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222.00||||222.00|133.2|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|TRUSTMARK [2030]|STARMARK [203000]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222.00||||222.00|8.83|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222.00||||222.00|111|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|222.00||||222.00|5.6|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|HEALTHNET [1495]|HEALTHNET [149500]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|222.00||||222.00|111.22|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222.00||||222.00|10.38|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222.00||||222.00|77.92|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|222.00||||222.00|94.57|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|222.00||||222.00|12.09|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222.00||||222.00|8.41|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222.00||||222.00|199.8|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MULTIPLAN [1680]|HMA [168003]|222.00||||222.00|12.62|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222.00||||222.00|144.3|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222.00||||222.00|9.25|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222.00||||222.00|8.81|222|5.6 30687102|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS OTHER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|222.00||||222.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|170.00||||170.00|85.17|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|170.00||||170.00|20.46|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170.00||||170.00|85|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|170.00||||170.00|22.16|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|170.00||||170.00|12.28|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|TRUSTMARK [2030]|STARMARK [203000]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|HEALTHNET [1495]|HEALTHNET [149500]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|170.00||||170.00|72.42|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|AETNA [1015]|AETNA ACO WILCO [101532]|170.00||||170.00|29.1|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|170.00||||170.00|21.4|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MULTIPLAN [1680]|IHC HS [168011]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|FMH BENEFIT SERVICES [1390]|FMH [139000]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|170.00||||170.00|59.67|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|170.00||||170.00|102|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|FIRST HEALTH [1375]|QUALCHOICE [137513]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|170.00||||170.00|25.34|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170.00||||170.00|20.46|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|UMR [2035]|UMR OPTIONS [203501]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|170.00||||170.00|35.7|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170.00||||170.00|81.52|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|||170.00||||170.00|51|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|170.00||||170.00|22.16|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|170.00||||170.00|110.5|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|170.00||||170.00|20.38|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|CHAMPVA [1240]|CHAMP VA [124000]|170.00||||170.00|127.5|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|CORESOURCE [1315]|CORESOURCE [131500]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|170.00||||170.00|23.03|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|GEHA [1415]|GEHA [141500]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|170.00||||170.00|153|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|170.00||||170.00|170|170|12.28 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MULTIPLAN [1680]|HMA [168003]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170.00||||170.00||| 30687103|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS BLD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|170.00||||170.00||| 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|GEHA [1415]|GEHA [141500]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|163.00||||163.00|11.62|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|CORESOURCE [1315]|CORESOURCE [131500]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|163.00||||163.00|10.28|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|CHAMPVA [1240]|CHAMP VA [124000]|163.00||||163.00|122.25|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|163.00||||163.00|105.95|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|||163.00||||163.00|48.9|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|163.00||||163.00|163|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|163.00||||163.00|34.23|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|163.00||||163.00|11.18|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|163.00||||163.00|15.07|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|UMR [2035]|UMR OPTIONS [203501]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|163.00||||163.00|78.16|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|163.00||||163.00|10.53|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|163.00||||163.00|12.74|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|163.00||||163.00|12.78|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|FIRST HEALTH [1375]|QUALCHOICE [137513]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|FMH BENEFIT SERVICES [1390]|FMH [139000]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|163.00||||163.00|14.84|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|163.00||||163.00|14.84|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|AETNA [1015]|AETNA ACO WILCO [101532]|163.00||||163.00|16.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|TRUSTMARK [2030]|STARMARK [203000]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|163.00||||163.00|10.79|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|163.00||||163.00|11.35|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|163.00||||163.00|11.18|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|163.00||||163.00|6.88|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|163.00||||163.00|97.8|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|163.00||||163.00|10.84|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|163.00||||163.00|81.5|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|163.00||||163.00|12.74|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MULTIPLAN [1680]|HMA [168003]|163.00||||163.00|15.48|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|163.00||||163.00|57.21|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|MULTIPLAN [1680]|IHC HS [168011]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|163.00||||163.00|81.66|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|163.00||||163.00|69.44|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|163.00||||163.00|11.35|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|163.00||||163.00|10.32|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|HEALTHNET [1495]|HEALTHNET [149500]|163.00||||163.00|146.7|163|6.88 30687106|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|163.00||||163.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|102.00||||102.00|43.45|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102.00||||102.00|51|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102.00||||102.00|61.2|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|TRUSTMARK [2030]|STARMARK [203000]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|HEALTHNET [1495]|HEALTHNET [149500]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|AETNA [1015]|AETNA ACO WILCO [101532]|102.00||||102.00|16.32|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MULTIPLAN [1680]|IHC HS [168011]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|FMH BENEFIT SERVICES [1390]|FMH [139000]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102.00||||102.00|35.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|FIRST HEALTH [1375]|QUALCHOICE [137513]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|102.00||||102.00|12.78|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102.00||||102.00|12.74|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|UMR [2035]|UMR OPTIONS [203501]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102.00||||102.00|21.42|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102.00||||102.00|11.18|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102.00||||102.00|10.79|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102.00||||102.00|66.3|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|102.00||||102.00|6.88|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|||102.00||||102.00|30.6|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102.00||||102.00|48.91|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102.00||||102.00|11.18|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102.00||||102.00|12.74|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102.00||||102.00|10.28|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102.00||||102.00|102|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|CHAMPVA [1240]|CHAMP VA [124000]|102.00||||102.00|76.5|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|CORESOURCE [1315]|CORESOURCE [131500]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|102.00||||102.00|11.62|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|GEHA [1415]|GEHA [141500]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|102.00||||102.00|51.1|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102.00||||102.00|91.8|102|6.88 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MULTIPLAN [1680]|HMA [168003]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|102.00||||102.00||| 30687107|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE FUNGUS ID MOLD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102.00||||102.00||| 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|231.00||||231.00|22.12|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MULTIPLAN [1680]|HMA [168003]|231.00||||231.00|23.09|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|AETNA [1015]|AETNA ACO WILCO [101532]|231.00||||231.00|24.33|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|HEALTHNET [1495]|HEALTHNET [149500]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|TRUSTMARK [2030]|STARMARK [203000]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|231.00||||231.00|10.26|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231.00||||231.00|16.11|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231.00||||231.00|16.93|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MULTIPLAN [1680]|IHC HS [168011]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231.00||||231.00|16.68|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231.00||||231.00|138.6|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231.00||||231.00|16.16|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231.00||||231.00|115.5|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231.00||||231.00|81.08|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231.00||||231.00|19|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|231.00||||231.00|98.41|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231.00||||231.00|16.93|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|231.00||||231.00|115.73|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|GEHA [1415]|GEHA [141500]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|CORESOURCE [1315]|CORESOURCE [131500]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|231.00||||231.00|22.12|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|CHAMPVA [1240]|CHAMP VA [124000]|231.00||||231.00|173.25|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231.00||||231.00|16.68|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|||231.00||||231.00|69.3|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231.00||||231.00|150.15|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231.00||||231.00|110.76|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231.00||||231.00|15.34|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231.00||||231.00|231|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231.00||||231.00|48.51|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|231.00||||231.00|17.34|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231.00||||231.00|22.47|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|UMR [2035]|UMR OPTIONS [203501]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231.00||||231.00|15.7|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231.00||||231.00|19|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|231.00||||231.00|19.07|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231.00||||231.00|15.39|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|231.00||||231.00|207.9|231|10.26 30687109|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOPLASMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|231.00||||231.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|208.00||||208.00|73.01|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|208.00||||208.00|24.19|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|208.00||||208.00|88.61|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208.00||||208.00|104|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|208.00||||208.00|124.8|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|208.00||||208.00|21.23|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|208.00||||208.00|20.51|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|208.00||||208.00|13.06|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|TRUSTMARK [2030]|STARMARK [203000]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|HEALTHNET [1495]|HEALTHNET [149500]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MULTIPLAN [1680]|IHC HS [168011]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|208.00||||208.00|24.27|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208.00||||208.00|24.19|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|AETNA [1015]|AETNA ACO WILCO [101532]|208.00||||208.00|30.97|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|UMR [2035]|UMR OPTIONS [203501]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|208.00||||208.00|43.68|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|208.00||||208.00|208|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208.00||||208.00|99.74|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|208.00||||208.00|135.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|||208.00||||208.00|62.4|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|208.00||||208.00|104.21|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|208.00||||208.00|21.23|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|208.00||||208.00|19.53|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|CHAMPVA [1240]|CHAMP VA [124000]|208.00||||208.00|156|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|CORESOURCE [1315]|CORESOURCE [131500]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|208.00||||208.00|22.07|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|GEHA [1415]|GEHA [141500]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|208.00||||208.00|187.2|208|13.06 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MULTIPLAN [1680]|HMA [168003]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208.00||||208.00||| 30687110|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE CHLAMYDIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|208.00||||208.00||| 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|GEHA [1415]|GEHA [141500]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|256.00||||256.00|12.16|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|CORESOURCE [1315]|CORESOURCE [131500]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|256.00||||256.00|15.53|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|CHAMPVA [1240]|CHAMP VA [124000]|256.00||||256.00|192|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|256.00||||256.00|10.76|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|256.00||||256.00|11.7|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|||256.00||||256.00|76.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|256.00||||256.00|122.75|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|256.00||||256.00|256|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|256.00||||256.00|53.76|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|256.00||||256.00|15.77|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|UMR [2035]|UMR OPTIONS [203501]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|256.00||||256.00|11.02|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|256.00||||256.00|13.34|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|256.00||||256.00|13.38|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|FIRST HEALTH [1375]|QUALCHOICE [137513]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|FMH BENEFIT SERVICES [1390]|FMH [139000]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MULTIPLAN [1680]|IHC HS [168011]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|256.00||||256.00|15.53|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MULTIPLAN [1680]|HMA [168003]|256.00||||256.00|16.2|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|AETNA [1015]|AETNA ACO WILCO [101532]|256.00||||256.00|17.07|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|256.00||||256.00|166.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|HEALTHNET [1495]|HEALTHNET [149500]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|TRUSTMARK [2030]|STARMARK [203000]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|256.00||||256.00|7.2|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|256.00||||256.00|11.3|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|256.00||||256.00|11.88|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|256.00||||256.00|11.7|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|256.00||||256.00|153.6|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|256.00||||256.00|11.34|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|256.00||||256.00|128|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|256.00||||256.00|89.86|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|256.00||||256.00|13.34|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|256.00||||256.00|128.26|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|256.00||||256.00|109.06|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|256.00||||256.00|10.8|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|256.00||||256.00|230.4|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|256.00||||256.00|11.88|256|7.2 30687116|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE AFB/TB/MYCOB ISO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|256.00||||256.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118.00||||118.00|59.12|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118.00||||118.00|50.27|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118.00||||118.00|14.61|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118.00||||118.00|59|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118.00||||118.00|70.8|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118.00||||118.00|15.83|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118.00||||118.00|8.77|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|TRUSTMARK [2030]|STARMARK [203000]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|HEALTHNET [1495]|HEALTHNET [149500]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|AETNA [1015]|AETNA ACO WILCO [101532]|118.00||||118.00|20.78|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MULTIPLAN [1680]|IHC HS [168011]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|FMH BENEFIT SERVICES [1390]|FMH [139000]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|FIRST HEALTH [1375]|QUALCHOICE [137513]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118.00||||118.00|18.1|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118.00||||118.00|14.61|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|UMR [2035]|UMR OPTIONS [203501]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118.00||||118.00|15.28|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118.00||||118.00|24.78|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118.00||||118.00|118|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118.00||||118.00|56.58|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118.00||||118.00|76.7|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|||118.00||||118.00|35.4|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118.00||||118.00|41.42|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118.00||||118.00|15.83|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118.00||||118.00|14.55|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|CHAMPVA [1240]|CHAMP VA [124000]|118.00||||118.00|88.5|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|CORESOURCE [1315]|CORESOURCE [131500]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118.00||||118.00|16.45|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|GEHA [1415]|GEHA [141500]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118.00||||118.00|106.2|118|8.77 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MULTIPLAN [1680]|HMA [168003]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118.00||||118.00||| 30687118|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE MYCOBACTERIA ID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118.00||||118.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|GEHA [1415]|GEHA [141500]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|CORESOURCE [1315]|CORESOURCE [131500]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|CHAMPVA [1240]|CHAMP VA [124000]|60.00||||60.00|45|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.00||||60.00|6.04|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|||60.00||||60.00|18|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.00||||60.00|39|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.00||||60.00|28.77|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.00||||60.00|60|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.00||||60.00|12.6|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|UMR [2035]|UMR OPTIONS [203501]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.00||||60.00|6.88|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60.00||||60.00|6.9|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MULTIPLAN [1680]|IHC HS [168011]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|AETNA [1015]|AETNA ACO WILCO [101532]|60.00||||60.00|8.8|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|HEALTHNET [1495]|HEALTHNET [149500]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|TRUSTMARK [2030]|STARMARK [203000]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.00||||60.00|5.55|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60.00||||60.00|3.71|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.00||||60.00|5.83|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60.00||||60.00|6.28|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.00||||60.00|6.04|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.00||||60.00|36|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.00||||60.00|30|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60.00||||60.00|25.56|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.00||||60.00|6.88|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60.00||||60.00|30.06|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.00||||60.00|21.06|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.00||||60.00|54|60|3.71 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MULTIPLAN [1680]|HMA [168003]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.00||||60.00||| 30687140|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING FLOUR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.00||||60.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|176.00||||176.00|15.46|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|176.00||||176.00|88.18|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|176.00||||176.00|61.78|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|176.00||||176.00|88|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|176.00||||176.00|105.6|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|176.00||||176.00|13.57|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|176.00||||176.00|13.11|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|TRUSTMARK [2030]|STARMARK [203000]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|HEALTHNET [1495]|HEALTHNET [149500]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MULTIPLAN [1680]|IHC HS [168011]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|FMH BENEFIT SERVICES [1390]|FMH [139000]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|FIRST HEALTH [1375]|QUALCHOICE [137513]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|176.00||||176.00|15.52|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176.00||||176.00|15.46|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|AETNA [1015]|AETNA ACO WILCO [101532]|176.00||||176.00|19.8|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|176.00||||176.00|8.35|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|UMR [2035]|UMR OPTIONS [203501]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|176.00||||176.00|36.96|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|176.00||||176.00|176|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176.00||||176.00|84.39|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|176.00||||176.00|114.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|||176.00||||176.00|52.8|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|176.00||||176.00|74.98|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|176.00||||176.00|13.57|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|176.00||||176.00|12.48|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|CHAMPVA [1240]|CHAMP VA [124000]|176.00||||176.00|132|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|CORESOURCE [1315]|CORESOURCE [131500]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|176.00||||176.00|14.1|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|GEHA [1415]|GEHA [141500]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|176.00||||176.00|158.4|176|8.35 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MULTIPLAN [1680]|HMA [168003]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176.00||||176.00||| 30687143|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING CHROMATOGRAPHY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|176.00||||176.00||| 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|GEHA [1415]|GEHA [141500]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.00||||61.00|5.83|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|CORESOURCE [1315]|CORESOURCE [131500]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|CHAMPVA [1240]|CHAMP VA [124000]|61.00||||61.00|45.75|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.00||||61.00|5.17|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.00||||61.00|5.61|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|||61.00||||61.00|18.3|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.00||||61.00|39.65|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.00||||61.00|29.25|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.00||||61.00|61|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.00||||61.00|12.81|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.00||||61.00|7.56|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|UMR [2035]|UMR OPTIONS [203501]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.00||||61.00|5.28|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.00||||61.00|6.39|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.00||||61.00|6.41|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MULTIPLAN [1680]|IHC HS [168011]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.00||||61.00|7.45|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MULTIPLAN [1680]|HMA [168003]|61.00||||61.00|7.77|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|AETNA [1015]|AETNA ACO WILCO [101532]|61.00||||61.00|8.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|HEALTHNET [1495]|HEALTHNET [149500]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|TRUSTMARK [2030]|STARMARK [203000]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.00||||61.00|3.45|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.00||||61.00|5.42|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.00||||61.00|7.45|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.00||||61.00|5.7|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.00||||61.00|5.61|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.00||||61.00|36.6|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.00||||61.00|5.44|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.00||||61.00|30.5|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.00||||61.00|30.56|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.00||||61.00|6.39|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.00||||61.00|21.41|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.00||||61.00|25.99|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.00||||61.00|5.18|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.00||||61.00|54.9|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.00||||61.00|5.7|61|3.45 30687147|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING SEROLOGIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.00||||61.00||| 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|379.00||||379.00|22.06|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|379.00||||379.00|133.03|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|379.00||||379.00|161.45|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|379.00||||379.00|24.76|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|379.00||||379.00|189.5|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|379.00||||379.00|21.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|379.00||||379.00|227.4|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|379.00||||379.00|21.73|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|379.00||||379.00|22.06|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|379.00||||379.00|13.37|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|TRUSTMARK [2030]|STARMARK [203000]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|HEALTHNET [1495]|HEALTHNET [149500]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|379.00||||379.00|28.82|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MULTIPLAN [1680]|IHC HS [168011]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|FMH BENEFIT SERVICES [1390]|FMH [139000]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MULTIPLAN [1680]|HMA [168003]|379.00||||379.00|30.08|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|FIRST HEALTH [1375]|QUALCHOICE [137513]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|379.00||||379.00|24.84|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|379.00||||379.00|24.76|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|379.00||||379.00|20.45|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|AETNA [1015]|AETNA ACO WILCO [101532]|379.00||||379.00|31.7|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|UMR [2035]|UMR OPTIONS [203501]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|379.00||||379.00|20.99|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|379.00||||379.00|29.27|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|379.00||||379.00|79.59|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|379.00||||379.00|379|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|379.00||||379.00|189.88|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|379.00||||379.00|181.73|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|379.00||||379.00|246.35|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|||379.00||||379.00|113.7|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|379.00||||379.00|21.73|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|379.00||||379.00|20.05|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|379.00||||379.00|19.99|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|CHAMPVA [1240]|CHAMP VA [124000]|379.00||||379.00|284.25|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|379.00||||379.00|28.82|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|CORESOURCE [1315]|CORESOURCE [131500]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|379.00||||379.00|22.59|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|GEHA [1415]|GEHA [141500]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|379.00||||379.00|341.1|379|13.37 30687149|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING ID NA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|379.00||||379.00||| 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|GEHA [1415]|GEHA [141500]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|CORESOURCE [1315]|CORESOURCE [131500]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|428.00||||428.00|50.45|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|CHAMPVA [1240]|CHAMP VA [124000]|428.00||||428.00|321|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|428.00||||428.00|34.97|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|428.00||||428.00|38.01|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|||428.00||||428.00|128.4|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|428.00||||428.00|278.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|428.00||||428.00|205.23|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|428.00||||428.00|428|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|428.00||||428.00|89.88|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|428.00||||428.00|51.23|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|UMR [2035]|UMR OPTIONS [203501]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|428.00||||428.00|35.79|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|428.00||||428.00|43.33|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|428.00||||428.00|43.46|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MULTIPLAN [1680]|IHC HS [168011]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|428.00||||428.00|50.45|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MULTIPLAN [1680]|HMA [168003]|428.00||||428.00|52.64|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|AETNA [1015]|AETNA ACO WILCO [101532]|428.00||||428.00|55.46|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|HEALTHNET [1495]|HEALTHNET [149500]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|TRUSTMARK [2030]|STARMARK [203000]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|428.00||||428.00|23.39|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|428.00||||428.00|36.71|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|428.00||||428.00|38.6|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|428.00||||428.00|38.01|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|428.00||||428.00|256.8|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|428.00||||428.00|36.84|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|428.00||||428.00|39.51|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|428.00||||428.00|214|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|428.00||||428.00|43.33|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|428.00||||428.00|214.43|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|428.00||||428.00|150.23|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|428.00||||428.00|182.33|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|428.00||||428.00|35.09|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|428.00||||428.00|385.2|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|428.00||||428.00|38.6|428|23.39 30687150|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULT TYPING NUC ACID PROBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|428.00||||428.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.00||||75.00|37.58|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.00||||75.00|7.74|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.00||||75.00|31.95|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.00||||75.00|37.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.00||||75.00|45|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.00||||75.00|8.39|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.00||||75.00|8.11|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|TRUSTMARK [2030]|STARMARK [203000]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|HEALTHNET [1495]|HEALTHNET [149500]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|AETNA [1015]|AETNA ACO WILCO [101532]|75.00||||75.00|11.01|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MULTIPLAN [1680]|IHC HS [168011]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.00||||75.00|9.59|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.00||||75.00|7.74|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|UMR [2035]|UMR OPTIONS [203501]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.00||||75.00|4.64|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.00||||75.00|15.75|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.00||||75.00|75|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.00||||75.00|35.96|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.00||||75.00|48.75|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|||75.00||||75.00|22.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.00||||75.00|26.33|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.00||||75.00|8.39|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.00||||75.00|7.72|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|CHAMPVA [1240]|CHAMP VA [124000]|75.00||||75.00|56.25|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|CORESOURCE [1315]|CORESOURCE [131500]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.00||||75.00|8.72|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|GEHA [1415]|GEHA [141500]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.00||||75.00|67.5|75|4.64 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MULTIPLAN [1680]|HMA [168003]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.00||||75.00||| 30687152|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE PULSE FIELD GEL ID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.00||||75.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|GEHA [1415]|GEHA [141500]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1407.00||||1407.00|129.91|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|CORESOURCE [1315]|CORESOURCE [131500]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|CHAMPVA [1240]|CHAMP VA [124000]|1407.00||||1407.00|1055.25|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1407.00||||1407.00|114.97|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1407.00||||1407.00|124.99|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|||1407.00||||1407.00|422.1|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1407.00||||1407.00|674.66|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1407.00||||1407.00|1407|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1407.00||||1407.00|295.47|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|UMR [2035]|UMR OPTIONS [203501]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1407.00||||1407.00|142.42|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1407.00||||1407.00|142.9|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MULTIPLAN [1680]|IHC HS [168011]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|AETNA [1015]|AETNA ACO WILCO [101532]|1407.00||||1407.00|182.31|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1407.00||||1407.00|914.55|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|HEALTHNET [1495]|HEALTHNET [149500]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|TRUSTMARK [2030]|STARMARK [203000]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1407.00||||1407.00|76.9|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1407.00||||1407.00|120.72|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1407.00||||1407.00|124.99|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1407.00||||1407.00|844.2|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1407.00||||1407.00|703.5|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1407.00||||1407.00|142.42|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1407.00||||1407.00|704.91|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1407.00||||1407.00|493.86|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1407.00||||1407.00|599.38|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1407.00||||1407.00|1266.3|1407|76.9 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MULTIPLAN [1680]|HMA [168003]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1407.00||||1407.00||| 30687153|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE DNA RNA SEQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1407.00||||1407.00||| 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74.00||||74.00|8.51|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74.00||||74.00|25.97|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74.00||||74.00|31.52|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74.00||||74.00|8.13|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74.00||||74.00|44.4|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74.00||||74.00|8.39|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74.00||||74.00|8.51|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74.00||||74.00|8.11|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74.00||||74.00|4.64|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|TRUSTMARK [2030]|STARMARK [203000]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|HEALTHNET [1495]|HEALTHNET [149500]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|AETNA [1015]|AETNA ACO WILCO [101532]|74.00||||74.00|11.01|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MULTIPLAN [1680]|IHC HS [168011]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MULTIPLAN [1680]|HMA [168003]|74.00||||74.00|11.61|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|FMH BENEFIT SERVICES [1390]|FMH [139000]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|FIRST HEALTH [1375]|QUALCHOICE [137513]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74.00||||74.00|11.13|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74.00||||74.00|9.59|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74.00||||74.00|7.89|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|UMR [2035]|UMR OPTIONS [203501]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74.00||||74.00|11.3|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74.00||||74.00|15.54|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74.00||||74.00|74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74.00||||74.00|35.48|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74.00||||74.00|48.1|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74.00||||74.00|37|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|||74.00||||74.00|22.2|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74.00||||74.00|37.07|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74.00||||74.00|8.39|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74.00||||74.00|7.74|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74.00||||74.00|7.72|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|CHAMPVA [1240]|CHAMP VA [124000]|74.00||||74.00|55.5|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74.00||||74.00|11.13|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|CORESOURCE [1315]|CORESOURCE [131500]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74.00||||74.00|8.72|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|GEHA [1415]|GEHA [141500]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74.00||||74.00|66.6|74|4.64 30687158|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE TYPING OTHER METHOD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74.00||||74.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|GEHA [1415]|GEHA [141500]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.00||||63.00|4.8|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|CORESOURCE [1315]|CORESOURCE [131500]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|CHAMPVA [1240]|CHAMP VA [124000]|63.00||||63.00|47.25|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.00||||63.00|4.62|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|||63.00||||63.00|18.9|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.00||||63.00|40.95|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.00||||63.00|30.21|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.00||||63.00|63|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.00||||63.00|13.23|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|UMR [2035]|UMR OPTIONS [203501]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.00||||63.00|5.27|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.00||||63.00|5.28|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MULTIPLAN [1680]|IHC HS [168011]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|AETNA [1015]|AETNA ACO WILCO [101532]|63.00||||63.00|6.75|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|HEALTHNET [1495]|HEALTHNET [149500]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|TRUSTMARK [2030]|STARMARK [203000]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.00||||63.00|4.25|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.00||||63.00|2.85|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.00||||63.00|4.46|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.00||||63.00|4.62|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.00||||63.00|37.8|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.00||||63.00|31.5|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.00||||63.00|5.27|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.00||||63.00|31.56|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.00||||63.00|22.11|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.00||||63.00|26.84|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.00||||63.00|56.7|63|2.85 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MULTIPLAN [1680]|HMA [168003]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.00||||63.00||| 30687168|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM ARTHROPOD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.00||||63.00|31.56|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.00||||63.00|5.27|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.00||||63.00|22.11|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.00||||63.00|26.84|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.00||||63.00|31.5|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.00||||63.00|37.8|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.00||||63.00|4.67|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.00||||63.00|4.51|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|TRUSTMARK [2030]|STARMARK [203000]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|HEALTHNET [1495]|HEALTHNET [149500]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|AETNA [1015]|AETNA ACO WILCO [101532]|63.00||||63.00|6.75|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MULTIPLAN [1680]|IHC HS [168011]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.00||||63.00|5.34|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.00||||63.00|5.27|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.00||||63.00|2.85|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|UMR [2035]|UMR OPTIONS [203501]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.00||||63.00|13.23|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.00||||63.00|63|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.00||||63.00|30.21|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.00||||63.00|40.95|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|||63.00||||63.00|18.9|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.00||||63.00|4.67|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.00||||63.00|4.29|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|CHAMPVA [1240]|CHAMP VA [124000]|63.00||||63.00|47.25|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|CORESOURCE [1315]|CORESOURCE [131500]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.00||||63.00|4.85|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|GEHA [1415]|GEHA [141500]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.00||||63.00|56.7|63|2.85 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MULTIPLAN [1680]|HMA [168003]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.00||||63.00||| 30687169|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MACROSCOPIC EXAM PARASITE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.00||||63.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|GEHA [1415]|GEHA [141500]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.00||||96.00|4.8|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|CORESOURCE [1315]|CORESOURCE [131500]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|CHAMPVA [1240]|CHAMP VA [124000]|96.00||||96.00|72|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.00||||96.00|4.25|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.00||||96.00|4.62|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|||96.00||||96.00|28.8|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.00||||96.00|46.03|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.00||||96.00|96|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.00||||96.00|20.16|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|UMR [2035]|UMR OPTIONS [203501]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.00||||96.00|5.27|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.00||||96.00|5.28|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MULTIPLAN [1680]|IHC HS [168011]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|AETNA [1015]|AETNA ACO WILCO [101532]|96.00||||96.00|6.75|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.00||||96.00|62.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|HEALTHNET [1495]|HEALTHNET [149500]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|TRUSTMARK [2030]|STARMARK [203000]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.00||||96.00|2.85|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.00||||96.00|4.46|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.00||||96.00|4.62|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.00||||96.00|57.6|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.00||||96.00|48|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.00||||96.00|5.27|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.00||||96.00|48.1|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.00||||96.00|33.7|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.00||||96.00|40.9|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.00||||96.00|86.4|96|2.85 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MULTIPLAN [1680]|HMA [168003]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.00||||96.00||| 30687172|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR DRY SCOTCH TAPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.00||||96.00||| 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195.00||||195.00|9.79|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195.00||||195.00|10.99|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195.00||||195.00|68.45|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|195.00||||195.00|83.07|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195.00||||195.00|97.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195.00||||195.00|9.35|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195.00||||195.00|117|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195.00||||195.00|9.65|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195.00||||195.00|9.79|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|195.00||||195.00|5.93|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|TRUSTMARK [2030]|STARMARK [203000]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|HEALTHNET [1495]|HEALTHNET [149500]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|AETNA [1015]|AETNA ACO WILCO [101532]|195.00||||195.00|14.07|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MULTIPLAN [1680]|IHC HS [168011]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|195.00||||195.00|12.79|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MULTIPLAN [1680]|HMA [168003]|195.00||||195.00|13.35|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|FMH BENEFIT SERVICES [1390]|FMH [139000]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|FIRST HEALTH [1375]|QUALCHOICE [137513]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|195.00||||195.00|11.04|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195.00||||195.00|10.99|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195.00||||195.00|9.08|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|UMR [2035]|UMR OPTIONS [203501]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195.00||||195.00|9.32|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195.00||||195.00|12.99|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195.00||||195.00|40.95|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195.00||||195.00|195|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195.00||||195.00|93.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195.00||||195.00|126.75|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|||195.00||||195.00|58.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195.00||||195.00|9.65|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|195.00||||195.00|97.7|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195.00||||195.00|8.9|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195.00||||195.00|8.88|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|CHAMPVA [1240]|CHAMP VA [124000]|195.00||||195.00|146.25|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|195.00||||195.00|12.79|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|CORESOURCE [1315]|CORESOURCE [131500]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|195.00||||195.00|10.03|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|GEHA [1415]|GEHA [141500]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195.00||||195.00|175.5|195|5.93 30687177|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR OVA & PARASITE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|195.00||||195.00||| 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|GEHA [1415]|GEHA [141500]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|CORESOURCE [1315]|CORESOURCE [131500]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71.00||||71.00|6.83|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|CHAMPVA [1240]|CHAMP VA [124000]|71.00||||71.00|53.25|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71.00||||71.00|5.15|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|||71.00||||71.00|21.3|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71.00||||71.00|46.15|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71.00||||71.00|34.04|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71.00||||71.00|71|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71.00||||71.00|14.91|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71.00||||71.00|6.94|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|UMR [2035]|UMR OPTIONS [203501]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71.00||||71.00|4.85|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71.00||||71.00|5.86|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71.00||||71.00|5.89|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MULTIPLAN [1680]|IHC HS [168011]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71.00||||71.00|6.83|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MULTIPLAN [1680]|HMA [168003]|71.00||||71.00|7.13|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|AETNA [1015]|AETNA ACO WILCO [101532]|71.00||||71.00|7.49|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|HEALTHNET [1495]|HEALTHNET [149500]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|TRUSTMARK [2030]|STARMARK [203000]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71.00||||71.00|4.74|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71.00||||71.00|3.16|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71.00||||71.00|4.98|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71.00||||71.00|5.23|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71.00||||71.00|5.35|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71.00||||71.00|5.15|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71.00||||71.00|42.6|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71.00||||71.00|4.99|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71.00||||71.00|35.5|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71.00||||71.00|5.86|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71.00||||71.00|35.57|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71.00||||71.00|24.92|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71.00||||71.00|30.25|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71.00||||71.00|4.75|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71.00||||71.00|63.9|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71.00||||71.00|5.23|71|3.16 30687181|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTBILTY STDY AGAR EA ANTIMICRBIAL AGNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71.00||||71.00||| 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113.00||||113.00|8.23|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113.00||||113.00|56.61|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113.00||||113.00|8.51|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113.00||||113.00|48.14|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113.00||||113.00|56.5|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113.00||||113.00|67.8|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113.00||||113.00|8.1|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113.00||||113.00|7.83|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113.00||||113.00|4.6|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|TRUSTMARK [2030]|STARMARK [203000]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|HEALTHNET [1495]|HEALTHNET [149500]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|AETNA [1015]|AETNA ACO WILCO [101532]|113.00||||113.00|10.9|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MULTIPLAN [1680]|IHC HS [168011]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113.00||||113.00|10.75|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MULTIPLAN [1680]|HMA [168003]|113.00||||113.00|11.22|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|FMH BENEFIT SERVICES [1390]|FMH [139000]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|FIRST HEALTH [1375]|QUALCHOICE [137513]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113.00||||113.00|9.26|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113.00||||113.00|8.51|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113.00||||113.00|7.63|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|UMR [2035]|UMR OPTIONS [203501]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113.00||||113.00|10.92|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113.00||||113.00|8.23|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113.00||||113.00|23.73|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113.00||||113.00|113|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113.00||||113.00|7.85|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113.00||||113.00|54.18|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113.00||||113.00|73.45|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|||113.00||||113.00|33.9|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113.00||||113.00|39.66|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113.00||||113.00|8.1|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113.00||||113.00|7.48|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113.00||||113.00|7.45|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|CHAMPVA [1240]|CHAMP VA [124000]|113.00||||113.00|84.75|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113.00||||113.00|10.75|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|CORESOURCE [1315]|CORESOURCE [131500]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113.00||||113.00|8.42|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|GEHA [1415]|GEHA [141500]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113.00||||113.00|101.7|113|4.6 30687184|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY DISK KIRBY BAUER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113.00||||113.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|GEHA [1415]|GEHA [141500]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59.00||||59.00|5.35|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|CORESOURCE [1315]|CORESOURCE [131500]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|CHAMPVA [1240]|CHAMP VA [124000]|59.00||||59.00|44.25|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59.00||||59.00|4.74|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59.00||||59.00|5.15|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|||59.00||||59.00|17.7|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59.00||||59.00|28.29|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59.00||||59.00|59|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59.00||||59.00|12.39|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|UMR [2035]|UMR OPTIONS [203501]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59.00||||59.00|5.86|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59.00||||59.00|5.89|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MULTIPLAN [1680]|IHC HS [168011]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|AETNA [1015]|AETNA ACO WILCO [101532]|59.00||||59.00|7.49|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59.00||||59.00|38.35|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|HEALTHNET [1495]|HEALTHNET [149500]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|TRUSTMARK [2030]|STARMARK [203000]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59.00||||59.00|3.16|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59.00||||59.00|4.98|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59.00||||59.00|5.15|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59.00||||59.00|35.4|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59.00||||59.00|29.5|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59.00||||59.00|5.86|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59.00||||59.00|29.56|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59.00||||59.00|20.71|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59.00||||59.00|25.13|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59.00||||59.00|53.1|59|3.16 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MULTIPLAN [1680]|HMA [168003]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59.00||||59.00||| 30687185|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SUSCEPTIBILITY BETA LACTAMASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59.00||||59.00||| 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|313.00||||313.00|9.52|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|313.00||||313.00|10.67|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|313.00||||313.00|109.86|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|313.00||||313.00|133.34|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|313.00||||313.00|156.5|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|313.00||||313.00|9.08|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|313.00||||313.00|187.8|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|313.00||||313.00|9.37|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|313.00||||313.00|9.52|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|313.00||||313.00|5.77|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|TRUSTMARK [2030]|STARMARK [203000]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|HEALTHNET [1495]|HEALTHNET [149500]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|AETNA [1015]|AETNA ACO WILCO [101532]|313.00||||313.00|13.66|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MULTIPLAN [1680]|IHC HS [168011]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MULTIPLAN [1680]|HMA [168003]|313.00||||313.00|12.98|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|313.00||||313.00|12.44|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|313.00||||313.00|10.72|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|313.00||||313.00|10.67|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|313.00||||313.00|8.82|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|UMR [2035]|UMR OPTIONS [203501]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|313.00||||313.00|9.05|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|313.00||||313.00|12.63|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|313.00||||313.00|65.73|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|313.00||||313.00|313|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|313.00||||313.00|150.08|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|313.00||||313.00|203.45|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|||313.00||||313.00|93.9|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|313.00||||313.00|156.81|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|313.00||||313.00|9.37|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|313.00||||313.00|8.65|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|313.00||||313.00|8.62|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|CHAMPVA [1240]|CHAMP VA [124000]|313.00||||313.00|234.75|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|313.00||||313.00|12.44|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|CORESOURCE [1315]|CORESOURCE [131500]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|313.00||||313.00|9.74|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|GEHA [1415]|GEHA [141500]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|313.00||||313.00|281.7|313|5.77 30687186|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY MIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|313.00||||313.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|GEHA [1415]|GEHA [141500]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|CORESOURCE [1315]|CORESOURCE [131500]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|CHAMPVA [1240]|CHAMP VA [124000]|141.00||||141.00|105.75|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141.00||||141.00|7.19|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|||141.00||||141.00|42.3|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141.00||||141.00|91.65|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141.00||||141.00|67.61|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141.00||||141.00|141|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141.00||||141.00|29.61|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|UMR [2035]|UMR OPTIONS [203501]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141.00||||141.00|8.2|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|141.00||||141.00|8.22|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MULTIPLAN [1680]|IHC HS [168011]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|AETNA [1015]|AETNA ACO WILCO [101532]|141.00||||141.00|10.49|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|HEALTHNET [1495]|HEALTHNET [149500]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|TRUSTMARK [2030]|STARMARK [203000]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141.00||||141.00|6.61|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|141.00||||141.00|4.43|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141.00||||141.00|6.94|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|141.00||||141.00|7.47|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141.00||||141.00|7.19|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141.00||||141.00|84.6|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141.00||||141.00|70.5|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141.00||||141.00|49.49|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|141.00||||141.00|70.64|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141.00||||141.00|8.2|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|141.00||||141.00|60.07|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141.00||||141.00|126.9|141|4.43 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MULTIPLAN [1680]|HMA [168003]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141.00||||141.00||| 30687188|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141.00||||141.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.00||||63.00|31.56|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.00||||63.00|22.11|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.00||||63.00|26.84|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.00||||63.00|31.5|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.00||||63.00|37.8|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.00||||63.00|7.92|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.00||||63.00|7.65|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|TRUSTMARK [2030]|STARMARK [203000]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|HEALTHNET [1495]|HEALTHNET [149500]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|AETNA [1015]|AETNA ACO WILCO [101532]|63.00||||63.00|10.39|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MULTIPLAN [1680]|IHC HS [168011]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.00||||63.00|9.05|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.00||||63.00|7.31|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.00||||63.00|4.39|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|UMR [2035]|UMR OPTIONS [203501]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.00||||63.00|13.23|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.00||||63.00|63|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.00||||63.00|30.21|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.00||||63.00|40.95|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|||63.00||||63.00|18.9|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.00||||63.00|7.31|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.00||||63.00|7.92|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.00||||63.00|7.29|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|CHAMPVA [1240]|CHAMP VA [124000]|63.00||||63.00|47.25|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|CORESOURCE [1315]|CORESOURCE [131500]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.00||||63.00|8.23|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|GEHA [1415]|GEHA [141500]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.00||||63.00|56.7|63|4.39 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MULTIPLAN [1680]|HMA [168003]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.00||||63.00||| 30687190|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SENSITIVITY AFB/TB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.00||||63.00||| 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|GEHA [1415]|GEHA [141500]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|130.00||||130.00|4.8|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|CORESOURCE [1315]|CORESOURCE [131500]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|CHAMPVA [1240]|CHAMP VA [124000]|130.00||||130.00|97.5|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130.00||||130.00|4.25|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130.00||||130.00|4.62|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|||130.00||||130.00|39|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130.00||||130.00|84.5|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130.00||||130.00|62.34|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130.00||||130.00|130|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130.00||||130.00|27.3|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130.00||||130.00|6.23|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|UMR [2035]|UMR OPTIONS [203501]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130.00||||130.00|4.36|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130.00||||130.00|5.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|130.00||||130.00|5.28|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MULTIPLAN [1680]|IHC HS [168011]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MULTIPLAN [1680]|HMA [168003]|130.00||||130.00|6.41|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|130.00||||130.00|6.14|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|AETNA [1015]|AETNA ACO WILCO [101532]|130.00||||130.00|6.75|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|HEALTHNET [1495]|HEALTHNET [149500]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|TRUSTMARK [2030]|STARMARK [203000]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|130.00||||130.00|2.85|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130.00||||130.00|4.46|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|130.00||||130.00|6.14|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130.00||||130.00|4.7|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130.00||||130.00|4.62|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130.00||||130.00|78|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130.00||||130.00|4.48|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130.00||||130.00|65|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|130.00||||130.00|65.13|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130.00||||130.00|45.63|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130.00||||130.00|5.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|130.00||||130.00|55.38|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130.00||||130.00|4.27|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130.00||||130.00|117|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130.00||||130.00|4.7|130|2.85 30687205|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR GRAM STAIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|130.00||||130.00||| 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.00||||192.00|5.93|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.00||||192.00|96.19|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.00||||192.00|67.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.00||||192.00|6.65|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.00||||192.00|81.79|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.00||||192.00|5.66|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.00||||192.00|115.2|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.00||||192.00|5.84|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.00||||192.00|5.93|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.00||||192.00|3.59|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|TRUSTMARK [2030]|STARMARK [203000]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|HEALTHNET [1495]|HEALTHNET [149500]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|AETNA [1015]|AETNA ACO WILCO [101532]|192.00||||192.00|8.52|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MULTIPLAN [1680]|IHC HS [168011]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MULTIPLAN [1680]|HMA [168003]|192.00||||192.00|8.09|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.00||||192.00|6.67|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.00||||192.00|6.65|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.00||||192.00|5.5|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.00||||192.00|7.75|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|UMR [2035]|UMR OPTIONS [203501]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.00||||192.00|5.64|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.00||||192.00|7.87|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.00||||192.00|40.32|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.00||||192.00|192|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.00||||192.00|96|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.00||||192.00|92.06|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.00||||192.00|124.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|||192.00||||192.00|57.6|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.00||||192.00|5.84|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.00||||192.00|5.39|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.00||||192.00|5.37|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|CHAMPVA [1240]|CHAMP VA [124000]|192.00||||192.00|144|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.00||||192.00|7.75|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|CORESOURCE [1315]|CORESOURCE [131500]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.00||||192.00|6.07|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|GEHA [1415]|GEHA [141500]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.00||||192.00|172.8|192|3.59 30687206|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR FLUORESCENT &/OR AFS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.00||||192.00||| 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|GEHA [1415]|GEHA [141500]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|CORESOURCE [1315]|CORESOURCE [131500]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|151.00||||151.00|8.61|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|CHAMPVA [1240]|CHAMP VA [124000]|151.00||||151.00|113.25|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151.00||||151.00|5.97|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151.00||||151.00|6.49|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|||151.00||||151.00|45.3|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151.00||||151.00|98.15|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151.00||||151.00|72.4|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151.00||||151.00|151|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151.00||||151.00|31.71|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151.00||||151.00|8.75|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|UMR [2035]|UMR OPTIONS [203501]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151.00||||151.00|6.11|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151.00||||151.00|7.4|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|151.00||||151.00|7.42|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|FIRST HEALTH [1375]|QUALCHOICE [137513]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|FMH BENEFIT SERVICES [1390]|FMH [139000]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MULTIPLAN [1680]|IHC HS [168011]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|151.00||||151.00|8.61|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MULTIPLAN [1680]|HMA [168003]|151.00||||151.00|8.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|AETNA [1015]|AETNA ACO WILCO [101532]|151.00||||151.00|9.48|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|HEALTHNET [1495]|HEALTHNET [149500]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|TRUSTMARK [2030]|STARMARK [203000]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|151.00||||151.00|4|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151.00||||151.00|6.26|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151.00||||151.00|6.59|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|151.00||||151.00|6.75|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151.00||||151.00|6.49|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151.00||||151.00|90.6|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151.00||||151.00|6.29|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151.00||||151.00|75.5|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151.00||||151.00|53|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|151.00||||151.00|75.65|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151.00||||151.00|7.4|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|151.00||||151.00|64.33|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151.00||||151.00|5.99|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151.00||||151.00|135.9|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151.00||||151.00|6.59|151|4 30687207|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR PRIM SRC SPEC STAIN BODIES/PARASITS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|151.00||||151.00||| 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|247.00||||247.00|19.78|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|247.00||||247.00|86.7|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|247.00||||247.00|123.75|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|247.00||||247.00|105.22|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|247.00||||247.00|123.5|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|247.00||||247.00|18.88|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|247.00||||247.00|148.2|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|247.00||||247.00|19.48|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|247.00||||247.00|18.82|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|TRUSTMARK [2030]|STARMARK [203000]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|HEALTHNET [1495]|HEALTHNET [149500]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|AETNA [1015]|AETNA ACO WILCO [101532]|247.00||||247.00|28.4|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|AETNA [1015]|COVENTRY HEALTHCARE [101502]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MULTIPLAN [1680]|IHC HS [168011]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|247.00||||247.00|25.85|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MULTIPLAN [1680]|HMA [168003]|247.00||||247.00|26.97|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|FMH BENEFIT SERVICES [1390]|FMH [139000]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|FIRST HEALTH [1375]|QUALCHOICE [137513]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|247.00||||247.00|22.27|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|247.00||||247.00|22.19|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|247.00||||247.00|18.34|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|UMR [2035]|UMR OPTIONS [203501]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|247.00||||247.00|26.25|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|247.00||||247.00|11.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|247.00||||247.00|19.78|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|247.00||||247.00|51.87|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|247.00||||247.00|247|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|247.00||||247.00|118.44|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|247.00||||247.00|160.55|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|||247.00||||247.00|74.1|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|247.00||||247.00|22.19|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|247.00||||247.00|19.48|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|247.00||||247.00|17.98|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|247.00||||247.00|17.92|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|CHAMPVA [1240]|CHAMP VA [124000]|247.00||||247.00|185.25|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|247.00||||247.00|25.85|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|CORESOURCE [1315]|CORESOURCE [131500]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|247.00||||247.00|20.25|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|GEHA [1415]|GEHA [141500]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|247.00||||247.00|222.3|247|11.98 30687209|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHROME ST FOR O&P|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|247.00||||247.00||| 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|6.55|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|5.8|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|6.3|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|||150.00||||150.00|45|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00|8.5|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00|5.94|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|7.2|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00|8.37|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00|8.73|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00|8.28|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|3.49|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|6.09|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00|8.37|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00|6.4|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|6.3|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00|6.11|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00|5.82|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00|6.4|150|3.49 30687210|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC SMEAR WET MOUNT W/STAIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|177.00||||177.00|4.7|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|177.00||||177.00|75.4|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|177.00||||177.00|62.13|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|177.00||||177.00|88.68|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|177.00||||177.00|4.48|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|177.00||||177.00|106.2|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|177.00||||177.00|4.62|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|177.00||||177.00|4.7|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|177.00||||177.00|4.46|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|177.00||||177.00|2.85|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|TRUSTMARK [2030]|STARMARK [203000]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|HEALTHNET [1495]|HEALTHNET [149500]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|AETNA [1015]|AETNA ACO WILCO [101532]|177.00||||177.00|6.75|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MULTIPLAN [1680]|IHC HS [168011]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MULTIPLAN [1680]|HMA [168003]|177.00||||177.00|6.41|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|177.00||||177.00|6.14|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|177.00||||177.00|5.28|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|177.00||||177.00|5.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|177.00||||177.00|4.36|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|UMR [2035]|UMR OPTIONS [203501]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|177.00||||177.00|6.23|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|177.00||||177.00|37.17|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|177.00||||177.00|177|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|177.00||||177.00|84.87|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|177.00||||177.00|115.05|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|177.00||||177.00|88.5|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|||177.00||||177.00|53.1|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|177.00||||177.00|5.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|177.00||||177.00|4.62|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|177.00||||177.00|4.27|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|177.00||||177.00|4.25|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|CHAMPVA [1240]|CHAMP VA [124000]|177.00||||177.00|132.75|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|177.00||||177.00|6.14|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|CORESOURCE [1315]|CORESOURCE [131500]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|177.00||||177.00|4.8|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|GEHA [1415]|GEHA [141500]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|177.00||||177.00|159.3|177|2.85 30687220|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TISSUE EXAM FUNGUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|177.00||||177.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|GEHA [1415]|GEHA [141500]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242.00||||242.00|22.23|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|CORESOURCE [1315]|CORESOURCE [131500]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|CHAMPVA [1240]|CHAMP VA [124000]|242.00||||242.00|181.5|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.00||||242.00|21.39|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|||242.00||||242.00|72.6|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.00||||242.00|157.3|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.00||||242.00|116.04|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.00||||242.00|242|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.00||||242.00|50.82|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|UMR [2035]|UMR OPTIONS [203501]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.00||||242.00|24.37|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242.00||||242.00|24.46|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MULTIPLAN [1680]|IHC HS [168011]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|AETNA [1015]|AETNA ACO WILCO [101532]|242.00||||242.00|31.19|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|HEALTHNET [1495]|HEALTHNET [149500]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|TRUSTMARK [2030]|STARMARK [203000]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242.00||||242.00|13.16|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.00||||242.00|20.66|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.00||||242.00|19.68|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.00||||242.00|21.39|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.00||||242.00|145.2|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.00||||242.00|121|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.00||||242.00|24.37|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242.00||||242.00|103.09|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.00||||242.00|84.94|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242.00||||242.00|121.24|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.00||||242.00|217.8|242|13.16 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MULTIPLAN [1680]|HMA [168003]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.00||||242.00||| 30687230|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TOXIN/ANTI ASSAY C DIFFICILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.00||||242.00||| 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|466.00||||466.00|28.68|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|466.00||||466.00|32.18|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|466.00||||466.00|198.52|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|466.00||||466.00|233.47|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|466.00||||466.00|163.57|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|466.00||||466.00|233|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|466.00||||466.00|279.6|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|466.00||||466.00|28.25|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|466.00||||466.00|27.29|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|TRUSTMARK [2030]|STARMARK [203000]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|HEALTHNET [1495]|HEALTHNET [149500]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MULTIPLAN [1680]|IHC HS [168011]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|466.00||||466.00|37.48|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MULTIPLAN [1680]|HMA [168003]|466.00||||466.00|39.11|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|AETNA [1015]|AETNA ACO WILCO [101532]|466.00||||466.00|41.2|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|466.00||||466.00|32.3|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|466.00||||466.00|32.18|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|466.00||||466.00|26.59|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|466.00||||466.00|17.38|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|UMR [2035]|UMR OPTIONS [203501]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|466.00||||466.00|38.06|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|466.00||||466.00|28.68|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|466.00||||466.00|97.86|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|466.00||||466.00|466|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|466.00||||466.00|27.37|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|466.00||||466.00|223.45|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|466.00||||466.00|302.9|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|||466.00||||466.00|139.8|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|466.00||||466.00|28.25|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|466.00||||466.00|26.07|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|466.00||||466.00|25.99|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|CHAMPVA [1240]|CHAMP VA [124000]|466.00||||466.00|349.5|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|466.00||||466.00|37.48|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|CORESOURCE [1315]|CORESOURCE [131500]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|466.00||||466.00|29.36|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|GEHA [1415]|GEHA [141500]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|466.00||||466.00|419.4|466|17.38 30687252|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISO TISSUE INOCULATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|466.00||||466.00||| 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|194.00||||194.00|21.52|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|194.00||||194.00|21.2|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.00||||194.00|116.4|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|194.00||||194.00|20.54|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|194.00||||194.00|97|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|194.00||||194.00|24.15|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|194.00||||194.00|82.64|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|194.00||||194.00|68.09|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|194.00||||194.00|97.19|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|194.00||||194.00|21.52|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MULTIPLAN [1680]|IHC HS [168011]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|194.00||||194.00|24.24|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|GEHA [1415]|GEHA [141500]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|194.00||||194.00|28.12|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|194.00||||194.00|126.1|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|HEALTHNET [1495]|HEALTHNET [149500]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|194.00||||194.00|194|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|194.00||||194.00|19.5|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.00||||194.00|93.02|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|CHAMPVA [1240]|CHAMP VA [124000]|194.00||||194.00|145.5|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|194.00||||194.00|28.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|194.00||||194.00|28.12|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|194.00||||194.00|22.03|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|CORESOURCE [1315]|CORESOURCE [131500]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|194.00||||194.00|21.2|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MULTIPLAN [1680]|HMA [168003]|194.00||||194.00|29.34|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|194.00||||194.00|40.74|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|194.00||||194.00|24.15|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|||194.00||||194.00|58.2|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|194.00||||194.00|19.95|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|AETNA [1015]|AETNA ACO WILCO [101532]|194.00||||194.00|30.91|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|TRUSTMARK [2030]|STARMARK [203000]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|194.00||||194.00|13.04|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|194.00||||194.00|20.47|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|UMR [2035]|UMR OPTIONS [203501]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|194.00||||194.00|19.56|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|194.00||||194.00|174.6|194|13.04 30687254|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC VIRUS ISOL CENTRI ENHANCED EA VIRUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|194.00||||194.00||| 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|CHAMPVA [1240]|CHAMP VA [124000]|444.00||||444.00|333|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|444.00||||444.00|38.13|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|444.00||||444.00|37.25|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|444.00||||444.00|93.24|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|HEALTHNET [1495]|HEALTHNET [149500]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|444.00||||444.00|222.44|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|444.00||||444.00|35.55|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|444.00||||444.00|155.84|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|444.00||||444.00|35.44|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|GEHA [1415]|GEHA [141500]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|444.00||||444.00|266.4|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|444.00||||444.00|189.14|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|TRUSTMARK [2030]|STARMARK [203000]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|444.00||||444.00|222|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|444.00||||444.00|34.54|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|CORESOURCE [1315]|CORESOURCE [131500]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|444.00||||444.00|41.81|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|FMH BENEFIT SERVICES [1390]|FMH [139000]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|AETNA [1015]|AETNA ACO WILCO [101532]|444.00||||444.00|53.51|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MULTIPLAN [1680]|HMA [168003]|444.00||||444.00|50.79|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|444.00||||444.00|48.68|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|444.00||||444.00|288.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|444.00||||444.00|41.95|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|444.00||||444.00|33.75|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|444.00||||444.00|41.81|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|444.00||||444.00|22.57|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|UMR [2035]|UMR OPTIONS [203501]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|FIRST HEALTH [1375]|QUALCHOICE [137513]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|444.00||||444.00|212.9|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|||444.00||||444.00|133.2|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|444.00||||444.00|36.69|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|444.00||||444.00|36.69|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|444.00||||444.00|37.25|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|444.00||||444.00|33.86|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|444.00||||444.00|49.44|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|444.00||||444.00|48.68|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|444.00||||444.00|444|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|MULTIPLAN [1680]|IHC HS [168011]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|444.00||||444.00|399.6|444|22.57 30687255|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CULTURE VIRUS ID NON-IMMUNO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|444.00||||444.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141.00||||141.00|14.8|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|141.00||||141.00|60.07|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|CHAMPVA [1240]|CHAMP VA [124000]|141.00||||141.00|105.75|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141.00||||141.00|70.5|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141.00||||141.00|49.49|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|141.00||||141.00|16.25|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|||141.00||||141.00|42.3|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141.00||||141.00|14.37|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141.00||||141.00|67.61|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141.00||||141.00|91.65|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141.00||||141.00|15.63|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|CORESOURCE [1315]|CORESOURCE [131500]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|GEHA [1415]|GEHA [141500]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|141.00||||141.00|17.87|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141.00||||141.00|14.8|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|AETNA [1015]|AETNA ACO WILCO [101532]|141.00||||141.00|20.53|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141.00||||141.00|84.6|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|TRUSTMARK [2030]|STARMARK [203000]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141.00||||141.00|15.63|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|HEALTHNET [1495]|HEALTHNET [149500]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141.00||||141.00|29.61|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MULTIPLAN [1680]|IHC HS [168011]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141.00||||141.00|141|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141.00||||141.00|15.09|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|141.00||||141.00|70.64|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|141.00||||141.00|8.66|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|UMR [2035]|UMR OPTIONS [203501]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141.00||||141.00|126.9|141|8.66 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MULTIPLAN [1680]|HMA [168003]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|141.00||||141.00||| 30687260|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF ADENOVIRUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141.00||||141.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169.00||||169.00|59.32|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169.00||||169.00|101.4|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169.00||||169.00|84.5|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|HEALTHNET [1495]|HEALTHNET [149500]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|169.00||||169.00|7.99|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169.00||||169.00|14.8|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|169.00||||169.00|84.67|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169.00||||169.00|35.49|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169.00||||169.00|12.98|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|AETNA [1015]|AETNA ACO WILCO [101532]|169.00||||169.00|18.95|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|TRUSTMARK [2030]|STARMARK [203000]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169.00||||169.00|14.8|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169.00||||169.00|169|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|169.00||||169.00|14.84|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MULTIPLAN [1680]|IHC HS [168011]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|||169.00||||169.00|50.7|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|UMR [2035]|UMR OPTIONS [203501]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169.00||||169.00|12.98|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169.00||||169.00|81.04|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169.00||||169.00|12.54|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|169.00||||169.00|71.99|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169.00||||169.00|109.85|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|CHAMPVA [1240]|CHAMP VA [124000]|169.00||||169.00|126.75|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|FMH BENEFIT SERVICES [1390]|FMH [139000]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|FIRST HEALTH [1375]|QUALCHOICE [137513]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|169.00||||169.00|13.49|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169.00||||169.00|11.94|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|CORESOURCE [1315]|CORESOURCE [131500]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|GEHA [1415]|GEHA [141500]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169.00||||169.00|152.1|169|7.99 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MULTIPLAN [1680]|HMA [168003]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169.00||||169.00||| 30687265|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA BORDETELLA P|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169.00||||169.00||| 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147.00||||147.00|13.18|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147.00||||147.00|51.6|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|CORESOURCE [1315]|CORESOURCE [131500]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|147.00||||147.00|13.49|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147.00||||147.00|11.94|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|GEHA [1415]|GEHA [141500]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147.00||||147.00|147|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|147.00||||147.00|17.22|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147.00||||147.00|95.55|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147.00||||147.00|70.49|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147.00||||147.00|30.87|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|||147.00||||147.00|44.1|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|HEALTHNET [1495]|HEALTHNET [149500]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|TRUSTMARK [2030]|STARMARK [203000]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|UMR [2035]|UMR OPTIONS [203501]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147.00||||147.00|14.8|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147.00||||147.00|17.49|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|147.00||||147.00|17.22|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MULTIPLAN [1680]|IHC HS [168011]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147.00||||147.00|12.22|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147.00||||147.00|13.18|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|147.00||||147.00|7.99|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|AETNA [1015]|AETNA ACO WILCO [101532]|147.00||||147.00|18.95|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|CHAMPVA [1240]|CHAMP VA [124000]|147.00||||147.00|110.25|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147.00||||147.00|12.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|147.00||||147.00|14.84|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147.00||||147.00|14.8|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|147.00||||147.00|62.62|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147.00||||147.00|88.2|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147.00||||147.00|73.5|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147.00||||147.00|12.58|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147.00||||147.00|11.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|147.00||||147.00|73.65|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MULTIPLAN [1680]|HMA [168003]|147.00||||147.00|17.97|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147.00||||147.00|132.3|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147.00||||147.00|12.98|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147.00||||147.00|12.54|147|7.99 30687272|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA CRYPTOSPORIDIUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|147.00||||147.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|HEALTHNET [1495]|HEALTHNET [149500]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53.00||||53.00|14.8|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53.00||||53.00|22.58|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53.00||||53.00|18.6|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53.00||||53.00|12.54|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53.00||||53.00|7.99|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53.00||||53.00|31.8|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|TRUSTMARK [2030]|STARMARK [203000]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|AETNA [1015]|AETNA ACO WILCO [101532]|53.00||||53.00|18.95|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53.00||||53.00|14.84|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|FIRST HEALTH [1375]|QUALCHOICE [137513]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53.00||||53.00|11.13|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|||53.00||||53.00|15.9|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|UMR [2035]|UMR OPTIONS [203501]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53.00||||53.00|26.5|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53.00||||53.00|12.98|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53.00||||53.00|53|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.00||||53.00|25.41|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53.00||||53.00|26.55|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53.00||||53.00|34.45|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MULTIPLAN [1680]|IHC HS [168011]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53.00||||53.00|12.98|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.00||||53.00|14.8|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|FMH BENEFIT SERVICES [1390]|FMH [139000]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|CHAMPVA [1240]|CHAMP VA [124000]|53.00||||53.00|39.75|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|CORESOURCE [1315]|CORESOURCE [131500]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53.00||||53.00|11.94|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|GEHA [1415]|GEHA [141500]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53.00||||53.00|13.49|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53.00||||53.00|47.7|53|7.99 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|MULTIPLAN [1680]|HMA [168003]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.00||||53.00||| 30687273|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERP SIMPLEX TYPE II|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53.00||||53.00|13.49|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53.00||||53.00|11.13|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|CHAMPVA [1240]|CHAMP VA [124000]|53.00||||53.00|39.75|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|GEHA [1415]|GEHA [141500]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53.00||||53.00|34.45|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53.00||||53.00|53|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|CORESOURCE [1315]|CORESOURCE [131500]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53.00||||53.00|12.98|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|||53.00||||53.00|15.9|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|UMR [2035]|UMR OPTIONS [203501]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53.00||||53.00|11.94|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|FMH BENEFIT SERVICES [1390]|FMH [139000]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53.00||||53.00|12.54|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53.00||||53.00|7.99|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53.00||||53.00|14.84|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.00||||53.00|25.41|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|AETNA [1015]|AETNA ACO WILCO [101532]|53.00||||53.00|18.95|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|HEALTHNET [1495]|HEALTHNET [149500]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.00||||53.00|14.8|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|TRUSTMARK [2030]|STARMARK [203000]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53.00||||53.00|26.5|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53.00||||53.00|22.58|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|FIRST HEALTH [1375]|QUALCHOICE [137513]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53.00||||53.00|12.98|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53.00||||53.00|26.55|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53.00||||53.00|31.8|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MULTIPLAN [1680]|IHC HS [168011]|53.00||||53.00|47.7|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53.00||||53.00|18.6|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53.00||||53.00|14.8|53|7.99 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MULTIPLAN [1680]|HMA [168003]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.00||||53.00||| 30687274|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA HERPES SIMPLEX TYPE I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.00||||53.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133.00||||133.00|12.82|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133.00||||133.00|13.28|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|133.00||||133.00|7.99|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|FIRST HEALTH [1375]|QUALCHOICE [137513]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133.00||||133.00|14.8|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133.00||||133.00|27.93|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|FMH BENEFIT SERVICES [1390]|FMH [139000]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|||133.00||||133.00|39.9|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MULTIPLAN [1680]|IHC HS [168011]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133.00||||133.00|133|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|133.00||||133.00|15.19|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133.00||||133.00|63.77|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133.00||||133.00|13.28|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133.00||||133.00|86.45|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|HEALTHNET [1495]|HEALTHNET [149500]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133.00||||133.00|79.8|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|UMR [2035]|UMR OPTIONS [203501]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|TRUSTMARK [2030]|STARMARK [203000]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|CHAMPVA [1240]|CHAMP VA [124000]|133.00||||133.00|99.75|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|AETNA [1015]|AETNA ACO WILCO [101532]|133.00||||133.00|18.95|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|CORESOURCE [1315]|CORESOURCE [131500]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|133.00||||133.00|13.8|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|GEHA [1415]|GEHA [141500]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133.00||||133.00|12.21|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133.00||||133.00|119.7|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|133.00||||133.00|56.66|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133.00||||133.00|46.68|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133.00||||133.00|66.5|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133.00||||133.00|14.8|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|133.00||||133.00|66.63|133|7.99 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MULTIPLAN [1680]|HMA [168003]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133.00||||133.00||| 30687275|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA INFLUENZA B|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133.00||||133.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|CORESOURCE [1315]|CORESOURCE [131500]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|366.00||||366.00|18.11|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|GEHA [1415]|GEHA [141500]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|366.00||||366.00|366|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|366.00||||366.00|175.5|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|366.00||||366.00|17.42|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|CHAMPVA [1240]|CHAMP VA [124000]|366.00||||366.00|274.5|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|||366.00||||366.00|109.8|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|366.00||||366.00|237.9|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|UMR [2035]|UMR OPTIONS [203501]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|FIRST HEALTH [1375]|QUALCHOICE [137513]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|366.00||||366.00|19.91|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|366.00||||366.00|16.82|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|366.00||||366.00|76.86|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|AETNA [1015]|AETNA ACO WILCO [101532]|366.00||||366.00|22.86|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MULTIPLAN [1680]|IHC HS [168011]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|366.00||||366.00|9.64|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|AETNA [1015]|COVENTRY HEALTHCARE [101502]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|FMH BENEFIT SERVICES [1390]|FMH [139000]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|TRUSTMARK [2030]|STARMARK [203000]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|366.00||||366.00|16.02|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|366.00||||366.00|16.07|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|366.00||||366.00|17.42|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|366.00||||366.00|219.6|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|366.00||||366.00|155.92|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|HEALTHNET [1495]|HEALTHNET [149500]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|366.00||||366.00|16.07|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|366.00||||366.00|128.47|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|366.00||||366.00|329.4|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|366.00||||366.00|183|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|366.00||||366.00|183.37|366|9.64 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MULTIPLAN [1680]|HMA [168003]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|366.00||||366.00||| 30687276|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF INFLUENZA A|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|366.00||||366.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|AETNA [1015]|AETNA ACO WILCO [101532]|134.00||||134.00|22.19|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|134.00||||134.00|57.08|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134.00||||134.00|67|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|134.00||||134.00|67.13|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134.00||||134.00|47.03|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134.00||||134.00|80.4|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134.00||||134.00|16.32|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|134.00||||134.00|9.36|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|HEALTHNET [1495]|HEALTHNET [149500]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134.00||||134.00|16.9|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MULTIPLAN [1680]|IHC HS [168011]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134.00||||134.00|15.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134.00||||134.00|87.1|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134.00||||134.00|134|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134.00||||134.00|28.14|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134.00||||134.00|15.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134.00||||134.00|16.9|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134.00||||134.00|64.25|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|134.00||||134.00|19.32|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|||134.00||||134.00|40.2|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|UMR [2035]|UMR OPTIONS [203501]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|TRUSTMARK [2030]|STARMARK [203000]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|CORESOURCE [1315]|CORESOURCE [131500]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134.00||||134.00|15.54|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|CHAMPVA [1240]|CHAMP VA [124000]|134.00||||134.00|100.5|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|GEHA [1415]|GEHA [141500]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|134.00||||134.00|17.57|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134.00||||134.00|120.6|134|9.36 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MULTIPLAN [1680]|HMA [168003]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134.00||||134.00||| 30687278|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA LEGIONELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|134.00||||134.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|CORESOURCE [1315]|CORESOURCE [131500]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|GEHA [1415]|GEHA [141500]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|155.00||||155.00|16.37|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|155.00||||155.00|155|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|||155.00||||155.00|46.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|CHAMPVA [1240]|CHAMP VA [124000]|155.00||||155.00|116.25|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|155.00||||155.00|100.75|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|155.00||||155.00|74.32|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|155.00||||155.00|32.55|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|UMR [2035]|UMR OPTIONS [203501]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|FMH BENEFIT SERVICES [1390]|FMH [139000]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MULTIPLAN [1680]|IHC HS [168011]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|FIRST HEALTH [1375]|QUALCHOICE [137513]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|155.00||||155.00|17.19|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|AETNA [1015]|AETNA ACO WILCO [101532]|155.00||||155.00|23.37|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|TRUSTMARK [2030]|STARMARK [203000]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|155.00||||155.00|9.86|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|155.00||||155.00|16.43|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|155.00||||155.00|17.8|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|155.00||||155.00|20.35|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|155.00||||155.00|17.8|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|155.00||||155.00|93|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|155.00||||155.00|77.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|155.00||||155.00|54.41|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|155.00||||155.00|66.03|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|155.00||||155.00|16.43|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|155.00||||155.00|18.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|HEALTHNET [1495]|HEALTHNET [149500]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|155.00||||155.00|139.5|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|155.00||||155.00|77.66|155|9.86 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MULTIPLAN [1680]|HMA [168003]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|155.00||||155.00||| 30687279|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF PARAINFLUENZA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|155.00||||155.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135.00||||135.00|67.64|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135.00||||135.00|14.53|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135.00||||135.00|67.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135.00||||135.00|14.04|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135.00||||135.00|57.51|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135.00||||135.00|8.05|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135.00||||135.00|47.39|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|TRUSTMARK [2030]|STARMARK [203000]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|HEALTHNET [1495]|HEALTHNET [149500]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MULTIPLAN [1680]|IHC HS [168011]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|FMH BENEFIT SERVICES [1390]|FMH [139000]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135.00||||135.00|14.8|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135.00||||135.00|87.75|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135.00||||135.00|14.8|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|UMR [2035]|UMR OPTIONS [203501]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135.00||||135.00|28.35|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135.00||||135.00|135|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135.00||||135.00|64.73|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135.00||||135.00|16.61|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|||135.00||||135.00|40.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135.00||||135.00|14.53|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135.00||||135.00|81|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|AETNA [1015]|AETNA ACO WILCO [101532]|135.00||||135.00|19.08|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135.00||||135.00|13.37|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|CORESOURCE [1315]|CORESOURCE [131500]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|FIRST HEALTH [1375]|QUALCHOICE [137513]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135.00||||135.00|15.1|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|GEHA [1415]|GEHA [141500]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135.00||||135.00|121.5|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|CHAMPVA [1240]|CHAMP VA [124000]|135.00||||135.00|101.25|135|8.05 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MULTIPLAN [1680]|HMA [168003]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135.00||||135.00||| 30687280|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IF RSV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135.00||||135.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|CORESOURCE [1315]|CORESOURCE [131500]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118.00||||118.00|13.49|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|GEHA [1415]|GEHA [141500]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118.00||||118.00|24.78|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118.00||||118.00|118|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118.00||||118.00|56.58|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|||118.00||||118.00|35.4|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|CHAMPVA [1240]|CHAMP VA [124000]|118.00||||118.00|88.5|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118.00||||118.00|76.7|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|FMH BENEFIT SERVICES [1390]|FMH [139000]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|FIRST HEALTH [1375]|QUALCHOICE [137513]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118.00||||118.00|14.8|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MULTIPLAN [1680]|IHC HS [168011]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118.00||||118.00|14.84|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|UMR [2035]|UMR OPTIONS [203501]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118.00||||118.00|12.54|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|AETNA [1015]|AETNA ACO WILCO [101532]|118.00||||118.00|18.95|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118.00||||118.00|11.94|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|HEALTHNET [1495]|HEALTHNET [149500]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|TRUSTMARK [2030]|STARMARK [203000]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118.00||||118.00|7.99|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118.00||||118.00|12.98|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118.00||||118.00|12.98|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118.00||||118.00|70.8|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118.00||||118.00|59.12|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118.00||||118.00|50.27|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118.00||||118.00|106.2|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118.00||||118.00|59|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118.00||||118.00|41.42|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118.00||||118.00|14.8|118|7.99 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MULTIPLAN [1680]|HMA [168003]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118.00||||118.00||| 30687281|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PNEUMOCYSTIS DFA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118.00||||118.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|141.00||||141.00|70.64|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|141.00||||141.00|60.07|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141.00||||141.00|84.6|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141.00||||141.00|49.49|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141.00||||141.00|14.04|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141.00||||141.00|14.8|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|141.00||||141.00|8.05|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|HEALTHNET [1495]|HEALTHNET [149500]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141.00||||141.00|14.8|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MULTIPLAN [1680]|IHC HS [168011]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|141.00||||141.00|16.61|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|FIRST HEALTH [1375]|QUALCHOICE [137513]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141.00||||141.00|91.65|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141.00||||141.00|141|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141.00||||141.00|29.61|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141.00||||141.00|14.53|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141.00||||141.00|67.61|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|||141.00||||141.00|42.3|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|TRUSTMARK [2030]|STARMARK [203000]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141.00||||141.00|14.53|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|UMR [2035]|UMR OPTIONS [203501]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141.00||||141.00|70.5|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|FMH BENEFIT SERVICES [1390]|FMH [139000]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|CORESOURCE [1315]|CORESOURCE [131500]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|141.00||||141.00|15.1|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141.00||||141.00|13.37|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|CHAMPVA [1240]|CHAMP VA [124000]|141.00||||141.00|105.75|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|GEHA [1415]|GEHA [141500]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|AETNA [1015]|AETNA ACO WILCO [101532]|141.00||||141.00|19.08|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141.00||||141.00|126.9|141|8.05 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|MULTIPLAN [1680]|HMA [168003]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141.00||||141.00||| 30687290|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DFA VARICELLA Z|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|141.00||||141.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|CORESOURCE [1315]|CORESOURCE [131500]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|GEHA [1415]|GEHA [141500]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|CHAMPVA [1240]|CHAMP VA [124000]|127.00||||127.00|95.25|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.00||||127.00|60.9|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.00||||127.00|17.44|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|||127.00||||127.00|38.1|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.00||||127.00|82.55|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.00||||127.00|127|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.00||||127.00|26.67|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|UMR [2035]|UMR OPTIONS [203501]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.00||||127.00|16.1|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127.00||||127.00|18.13|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MULTIPLAN [1680]|IHC HS [168011]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.00||||127.00|16.84|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|AETNA [1015]|AETNA ACO WILCO [101532]|127.00||||127.00|22.9|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|TRUSTMARK [2030]|STARMARK [203000]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.00||||127.00|16.04|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|HEALTHNET [1495]|HEALTHNET [149500]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127.00||||127.00|9.66|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127.00||||127.00|19.94|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.00||||127.00|17.44|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.00||||127.00|76.2|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.00||||127.00|63.5|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.00||||127.00|16.1|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.00||||127.00|44.58|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127.00||||127.00|54.1|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.00||||127.00|114.3|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127.00||||127.00|63.63|127|9.66 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MULTIPLAN [1680]|HMA [168003]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.00||||127.00||| 30687299|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT NOS IF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.00||||127.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149.00||||149.00|14.8|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|UMR [2035]|UMR OPTIONS [203501]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149.00||||149.00|31.29|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149.00||||149.00|149|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149.00||||149.00|71.45|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149.00||||149.00|96.85|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|||149.00||||149.00|44.7|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149.00||||149.00|12.98|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|149.00||||149.00|14.84|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149.00||||149.00|11.94|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|CHAMPVA [1240]|CHAMP VA [124000]|149.00||||149.00|111.75|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|149.00||||149.00|13.49|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|GEHA [1415]|GEHA [141500]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|CORESOURCE [1315]|CORESOURCE [131500]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149.00||||149.00|14.8|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149.00||||149.00|52.3|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|149.00||||149.00|63.47|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149.00||||149.00|12.98|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|149.00||||149.00|74.65|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149.00||||149.00|74.5|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149.00||||149.00|89.4|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149.00||||149.00|12.54|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|149.00||||149.00|7.99|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|TRUSTMARK [2030]|STARMARK [203000]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|HEALTHNET [1495]|HEALTHNET [149500]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|AETNA [1015]|AETNA ACO WILCO [101532]|149.00||||149.00|18.95|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|FMH BENEFIT SERVICES [1390]|FMH [139000]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MULTIPLAN [1680]|IHC HS [168011]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|FIRST HEALTH [1375]|QUALCHOICE [137513]|149.00||||149.00|134.1|149|7.99 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MULTIPLAN [1680]|HMA [168003]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|149.00||||149.00||| 30687300|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG DETECT POLYVALENT IF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149.00||||149.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|CORESOURCE [1315]|CORESOURCE [131500]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|CHAMPVA [1240]|CHAMP VA [124000]|169.00||||169.00|126.75|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|GEHA [1415]|GEHA [141500]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169.00||||169.00|109.85|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|169.00||||169.00|13.49|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169.00||||169.00|169|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|UMR [2035]|UMR OPTIONS [203501]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|AETNA [1015]|AETNA ACO WILCO [101532]|169.00||||169.00|18.95|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|HEALTHNET [1495]|HEALTHNET [149500]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169.00||||169.00|35.49|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MULTIPLAN [1680]|IHC HS [168011]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|TRUSTMARK [2030]|STARMARK [203000]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169.00||||169.00|81.04|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|||169.00||||169.00|50.7|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169.00||||169.00|12.98|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|169.00||||169.00|7.99|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169.00||||169.00|12.54|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|169.00||||169.00|14.84|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169.00||||169.00|11.94|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169.00||||169.00|12.98|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169.00||||169.00|101.4|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169.00||||169.00|84.5|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169.00||||169.00|14.8|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169.00||||169.00|14.8|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|169.00||||169.00|71.99|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169.00||||169.00|59.32|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169.00||||169.00|152.1|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|169.00||||169.00|84.67|169|7.99 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MULTIPLAN [1680]|HMA [168003]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169.00||||169.00||| 30687301|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL ADENOVIRUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169.00||||169.00||| 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179.00||||179.00|13.18|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|179.00||||179.00|89.68|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179.00||||179.00|62.83|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179.00||||179.00|14.8|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179.00||||179.00|89.5|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179.00||||179.00|12.58|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179.00||||179.00|107.4|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179.00||||179.00|13.18|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|179.00||||179.00|76.25|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179.00||||179.00|12.54|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|179.00||||179.00|7.99|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|TRUSTMARK [2030]|STARMARK [203000]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|HEALTHNET [1495]|HEALTHNET [149500]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|AETNA [1015]|AETNA ACO WILCO [101532]|179.00||||179.00|18.95|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|179.00||||179.00|17.22|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|179.00||||179.00|14.84|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179.00||||179.00|12.22|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|UMR [2035]|UMR OPTIONS [203501]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179.00||||179.00|17.49|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179.00||||179.00|37.59|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179.00||||179.00|14.8|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179.00||||179.00|179|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179.00||||179.00|85.83|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179.00||||179.00|12.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179.00||||179.00|116.35|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|||179.00||||179.00|53.7|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MULTIPLAN [1680]|HMA [168003]|179.00||||179.00|17.97|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179.00||||179.00|12.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179.00||||179.00|11.98|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|MULTIPLAN [1680]|IHC HS [168011]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|CORESOURCE [1315]|CORESOURCE [131500]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|GEHA [1415]|GEHA [141500]|179.00||||179.00|161.1|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|179.00||||179.00|13.49|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|CHAMPVA [1240]|CHAMP VA [124000]|179.00||||179.00|134.25|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179.00||||179.00|11.94|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|179.00||||179.00|17.22|179|7.99 30687305|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ASPERGILLUS ANTIGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|179.00||||179.00||| 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|350.00||||350.00|13.49|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|350.00||||350.00|17.22|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|CHAMPVA [1240]|CHAMP VA [124000]|350.00||||350.00|262.5|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350.00||||350.00|11.94|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|CORESOURCE [1315]|CORESOURCE [131500]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350.00||||350.00|227.5|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350.00||||350.00|167.83|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350.00||||350.00|73.5|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350.00||||350.00|17.49|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|UMR [2035]|UMR OPTIONS [203501]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350.00||||350.00|14.8|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|350.00||||350.00|14.84|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MULTIPLAN [1680]|IHC HS [168011]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MULTIPLAN [1680]|HMA [168003]|350.00||||350.00|17.97|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|AETNA [1015]|AETNA ACO WILCO [101532]|350.00||||350.00|18.95|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|HEALTHNET [1495]|HEALTHNET [149500]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|350.00||||350.00|17.22|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|TRUSTMARK [2030]|STARMARK [203000]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350.00||||350.00|350|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|GEHA [1415]|GEHA [141500]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|||350.00||||350.00|105|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350.00||||350.00|12.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|350.00||||350.00|7.99|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350.00||||350.00|12.54|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350.00||||350.00|13.18|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350.00||||350.00|12.22|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350.00||||350.00|12.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350.00||||350.00|210|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350.00||||350.00|12.58|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350.00||||350.00|175|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350.00||||350.00|122.85|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350.00||||350.00|13.18|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350.00||||350.00|315|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350.00||||350.00|11.98|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|350.00||||350.00|149.1|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|350.00||||350.00|175.35|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350.00||||350.00|14.8|350|7.99 30687324|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG C DIFFICILE TOXIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|350.00||||350.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.00||||119.00|41.77|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.00||||119.00|50.69|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.00||||119.00|71.4|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.00||||119.00|59.5|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.00||||119.00|14.53|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.00||||119.00|14.04|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.00||||119.00|8.05|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|TRUSTMARK [2030]|STARMARK [203000]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|AETNA [1015]|AETNA ACO WILCO [101532]|119.00||||119.00|19.08|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.00||||119.00|14.8|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|UMR [2035]|UMR OPTIONS [203501]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.00||||119.00|59.62|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.00||||119.00|24.99|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|HEALTHNET [1495]|HEALTHNET [149500]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.00||||119.00|14.8|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.00||||119.00|16.61|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.00||||119.00|119|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.00||||119.00|57.06|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.00||||119.00|77.35|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|||119.00||||119.00|35.7|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.00||||119.00|14.53|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MULTIPLAN [1680]|IHC HS [168011]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.00||||119.00|13.37|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|CHAMPVA [1240]|CHAMP VA [124000]|119.00||||119.00|89.25|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|GEHA [1415]|GEHA [141500]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|CORESOURCE [1315]|CORESOURCE [131500]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.00||||119.00|15.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.00||||119.00|107.1|119|8.05 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|MULTIPLAN [1680]|HMA [168003]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.00||||119.00||| 30687327|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC CRYPTOCOCCUS NEOFORM AG EIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.00||||119.00||| 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122.00||||122.00|58.5|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|CORESOURCE [1315]|CORESOURCE [131500]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|122.00||||122.00|19.87|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|CHAMPVA [1240]|CHAMP VA [124000]|122.00||||122.00|91.5|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122.00||||122.00|13.77|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122.00||||122.00|14.97|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|||122.00||||122.00|36.6|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122.00||||122.00|79.3|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122.00||||122.00|122|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122.00||||122.00|20.18|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122.00||||122.00|14.1|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MULTIPLAN [1680]|IHC HS [168011]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MULTIPLAN [1680]|HMA [168003]|122.00||||122.00|20.73|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|AETNA [1015]|AETNA ACO WILCO [101532]|122.00||||122.00|19.66|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|HEALTHNET [1495]|HEALTHNET [149500]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|UMR [2035]|UMR OPTIONS [203501]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|TRUSTMARK [2030]|STARMARK [203000]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122.00||||122.00|14.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|122.00||||122.00|19.87|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|GEHA [1415]|GEHA [141500]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122.00||||122.00|25.62|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|122.00||||122.00|8.29|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122.00||||122.00|14.46|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|122.00||||122.00|17.12|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122.00||||122.00|15.2|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122.00||||122.00|14.97|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122.00||||122.00|73.2|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|122.00||||122.00|15.56|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122.00||||122.00|14.51|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122.00||||122.00|61|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122.00||||122.00|14.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|122.00||||122.00|51.97|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122.00||||122.00|15.2|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122.00||||122.00|109.8|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122.00||||122.00|42.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|122.00||||122.00|61.12|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122.00||||122.00|13.82|122|8.29 30687328|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL CRYPTOSPORIDIUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|122.00||||122.00||| 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158.00||||158.00|13.18|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158.00||||158.00|14.8|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158.00||||158.00|79|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158.00||||158.00|12.58|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|158.00||||158.00|67.31|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158.00||||158.00|94.8|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158.00||||158.00|13.18|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158.00||||158.00|12.54|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158.00||||158.00|55.46|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158.00||||158.00|7.99|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|158.00||||158.00|79.16|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|HEALTHNET [1495]|HEALTHNET [149500]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|AETNA [1015]|AETNA ACO WILCO [101532]|158.00||||158.00|18.95|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MULTIPLAN [1680]|IHC HS [168011]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|158.00||||158.00|17.22|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|158.00||||158.00|14.84|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158.00||||158.00|14.8|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158.00||||158.00|17.49|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158.00||||158.00|33.18|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158.00||||158.00|12.22|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158.00||||158.00|158|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|TRUSTMARK [2030]|STARMARK [203000]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.00||||158.00|75.76|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|UMR [2035]|UMR OPTIONS [203501]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158.00||||158.00|102.7|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|||158.00||||158.00|47.4|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158.00||||158.00|12.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MULTIPLAN [1680]|HMA [168003]|158.00||||158.00|17.97|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158.00||||158.00|12.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158.00||||158.00|11.98|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|CORESOURCE [1315]|CORESOURCE [131500]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|GEHA [1415]|GEHA [141500]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|158.00||||158.00|13.49|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|158.00||||158.00|17.22|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|CHAMPVA [1240]|CHAMP VA [124000]|158.00||||158.00|118.5|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158.00||||158.00|11.94|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|158.00||||158.00|142.2|158|7.99 30687329|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA GIARDIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|158.00||||158.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|182.00||||182.00|13.49|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|CHAMPVA [1240]|CHAMP VA [124000]|182.00||||182.00|136.5|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.00||||182.00|11.94|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|CORESOURCE [1315]|CORESOURCE [131500]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.00||||182.00|12.98|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.00||||182.00|118.3|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.00||||182.00|87.27|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.00||||182.00|182|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.00||||182.00|38.22|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|UMR [2035]|UMR OPTIONS [203501]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.00||||182.00|14.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MULTIPLAN [1680]|IHC HS [168011]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|AETNA [1015]|AETNA ACO WILCO [101532]|182.00||||182.00|18.95|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|HEALTHNET [1495]|HEALTHNET [149500]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|TRUSTMARK [2030]|STARMARK [203000]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|182.00||||182.00|7.99|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|||182.00||||182.00|54.6|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.00||||182.00|12.54|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|182.00||||182.00|14.84|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.00||||182.00|12.98|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.00||||182.00|109.2|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.00||||182.00|91|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.00||||182.00|63.88|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|GEHA [1415]|GEHA [141500]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.00||||182.00|163.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|182.00||||182.00|91.18|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.00||||182.00|14.8|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|182.00||||182.00|77.53|182|7.99 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MULTIPLAN [1680]|HMA [168003]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.00||||182.00||| 30687337|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DETECT ENTAMOEBA HISTO ANTI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.00||||182.00||| 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|159.00||||159.00|17.76|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|159.00||||159.00|55.81|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|159.00||||159.00|67.73|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|159.00||||159.00|15.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|159.00||||159.00|15.58|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|159.00||||159.00|15.82|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|159.00||||159.00|15.05|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|159.00||||159.00|9.59|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|TRUSTMARK [2030]|STARMARK [203000]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|HEALTHNET [1495]|HEALTHNET [149500]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|AETNA [1015]|AETNA ACO WILCO [101532]|159.00||||159.00|22.72|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|159.00||||159.00|14.67|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|159.00||||159.00|17.76|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|UMR [2035]|UMR OPTIONS [203501]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|159.00||||159.00|20.99|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|159.00||||159.00|33.39|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|159.00||||159.00|17.81|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|159.00||||159.00|159|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|159.00||||159.00|76.24|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|159.00||||159.00|15.82|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|159.00||||159.00|103.35|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|159.00||||159.00|79.66|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|159.00||||159.00|79.5|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|159.00||||159.00|95.4|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|||159.00||||159.00|47.7|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|159.00||||159.00|15.58|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MULTIPLAN [1680]|HMA [168003]|159.00||||159.00|21.57|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|159.00||||159.00|14.38|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|CHAMPVA [1240]|CHAMP VA [124000]|159.00||||159.00|119.25|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|GEHA [1415]|GEHA [141500]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|159.00||||159.00|16.19|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|CORESOURCE [1315]|CORESOURCE [131500]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|159.00||||159.00|20.67|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MULTIPLAN [1680]|IHC HS [168011]|159.00||||159.00|143.1|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|159.00||||159.00|20.67|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|159.00||||159.00|14.33|159|9.59 30687338|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC H PYLORI AG EIA STOOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|159.00||||159.00||| 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|308.00||||308.00|11.63|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|308.00||||308.00|14.85|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|CHAMPVA [1240]|CHAMP VA [124000]|308.00||||308.00|231|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|CORESOURCE [1315]|CORESOURCE [131500]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|308.00||||308.00|200.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|308.00||||308.00|308|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|308.00||||308.00|15.08|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|UMR [2035]|UMR OPTIONS [203501]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|308.00||||308.00|12.75|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|FIRST HEALTH [1375]|QUALCHOICE [137513]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MULTIPLAN [1680]|HMA [168003]|308.00||||308.00|15.5|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|308.00||||308.00|14.85|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|AETNA [1015]|AETNA ACO WILCO [101532]|308.00||||308.00|16.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|HEALTHNET [1495]|HEALTHNET [149500]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|308.00||||308.00|64.68|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MULTIPLAN [1680]|IHC HS [168011]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|TRUSTMARK [2030]|STARMARK [203000]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|308.00||||308.00|147.69|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|||308.00||||308.00|92.4|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|GEHA [1415]|GEHA [141500]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|308.00||||308.00|11.19|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|308.00||||308.00|6.89|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|308.00||||308.00|10.8|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|FMH BENEFIT SERVICES [1390]|FMH [139000]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|308.00||||308.00|12.79|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|308.00||||308.00|10.29|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|308.00||||308.00|11.36|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|308.00||||308.00|11.19|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|308.00||||308.00|10.54|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|308.00||||308.00|184.8|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|308.00||||308.00|10.85|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|308.00||||308.00|154|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|308.00||||308.00|12.75|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|308.00||||308.00|10.33|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|308.00||||308.00|11.36|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|308.00||||308.00|131.21|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|308.00||||308.00|108.11|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|308.00||||308.00|277.2|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|308.00||||308.00|154.31|308|6.89 30687340|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP B AG (HBSAG)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|308.00||||308.00||| 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131.00||||131.00|12.75|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|131.00||||131.00|65.63|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131.00||||131.00|65.5|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131.00||||131.00|10.85|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131.00||||131.00|78.6|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131.00||||131.00|11.36|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131.00||||131.00|45.98|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131.00||||131.00|10.8|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|131.00||||131.00|6.89|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131.00||||131.00|11.36|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|HEALTHNET [1495]|HEALTHNET [149500]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|131.00||||131.00|16.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|131.00||||131.00|14.85|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|131.00||||131.00|12.79|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|UMR [2035]|UMR OPTIONS [203501]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131.00||||131.00|15.08|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131.00||||131.00|27.51|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131.00||||131.00|10.54|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131.00||||131.00|131|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|TRUSTMARK [2030]|STARMARK [203000]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131.00||||131.00|62.81|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131.00||||131.00|85.15|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|||131.00||||131.00|39.3|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131.00||||131.00|11.19|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|131.00||||131.00|55.81|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MULTIPLAN [1680]|HMA [168003]|131.00||||131.00|15.5|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131.00||||131.00|11.19|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131.00||||131.00|12.75|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131.00||||131.00|10.33|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|MULTIPLAN [1680]|IHC HS [168011]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|CHAMPVA [1240]|CHAMP VA [124000]|131.00||||131.00|98.25|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|131.00||||131.00|14.85|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|CORESOURCE [1315]|CORESOURCE [131500]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|GEHA [1415]|GEHA [141500]|131.00||||131.00|117.9|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|131.00||||131.00|11.63|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131.00||||131.00|10.29|131|6.89 30687341|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B SURFACE AG NEUTRALIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|131.00||||131.00||| 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154.00||||154.00|32.34|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|GEHA [1415]|GEHA [141500]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|154.00||||154.00|12.98|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|154.00||||154.00|16.58|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154.00||||154.00|11.5|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154.00||||154.00|12.49|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|||154.00||||154.00|46.2|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154.00||||154.00|100.1|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154.00||||154.00|73.84|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|UMR [2035]|UMR OPTIONS [203501]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154.00||||154.00|14.23|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|154.00||||154.00|14.28|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MULTIPLAN [1680]|IHC HS [168011]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MULTIPLAN [1680]|HMA [168003]|154.00||||154.00|17.3|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|AETNA [1015]|AETNA ACO WILCO [101532]|154.00||||154.00|18.22|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|HEALTHNET [1495]|HEALTHNET [149500]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154.00||||154.00|16.83|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|154.00||||154.00|16.58|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|TRUSTMARK [2030]|STARMARK [203000]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154.00||||154.00|154|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|154.00||||154.00|7.69|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|CORESOURCE [1315]|CORESOURCE [131500]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154.00||||154.00|12.07|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154.00||||154.00|12.68|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154.00||||154.00|11.76|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154.00||||154.00|12.49|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|CHAMPVA [1240]|CHAMP VA [124000]|154.00||||154.00|115.5|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154.00||||154.00|92.4|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154.00||||154.00|12.11|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154.00||||154.00|77|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154.00||||154.00|54.05|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154.00||||154.00|11.53|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154.00||||154.00|138.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154.00||||154.00|12.68|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|154.00||||154.00|65.6|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|154.00||||154.00|77.15|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154.00||||154.00|14.23|154|7.69 30687350|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IAAD IA HEPATITIS BE ANTIGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|154.00||||154.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|531.00||||531.00|20.26|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|531.00||||531.00|266.03|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|531.00||||531.00|186.38|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|531.00||||531.00|226.21|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|531.00||||531.00|265.5|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|531.00||||531.00|19.89|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|531.00||||531.00|19.22|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|531.00||||531.00|11.02|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|TRUSTMARK [2030]|STARMARK [203000]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|531.00||||531.00|26.12|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|531.00||||531.00|20.26|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|UMR [2035]|UMR OPTIONS [203501]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|531.00||||531.00|111.51|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|HEALTHNET [1495]|HEALTHNET [149500]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|531.00||||531.00|22.74|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|531.00||||531.00|531|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|531.00||||531.00|254.61|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|531.00||||531.00|318.6|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|531.00||||531.00|345.15|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|||531.00||||531.00|159.3|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|531.00||||531.00|19.89|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MULTIPLAN [1680]|IHC HS [168011]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|CHAMPVA [1240]|CHAMP VA [124000]|531.00||||531.00|398.25|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|GEHA [1415]|GEHA [141500]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|CORESOURCE [1315]|CORESOURCE [131500]|531.00||||531.00|477.9|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|531.00||||531.00|18.3|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|531.00||||531.00|20.67|531|11.02 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|531.00||||531.00||| 30687380|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL HEP DELTA|MULTIPLAN [1680]|HMA [168003]|531.00||||531.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198.00||||198.00|94.94|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|198.00||||198.00|14.93|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|CORESOURCE [1315]|CORESOURCE [131500]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198.00||||198.00|13.21|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|||198.00||||198.00|59.4|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|GEHA [1415]|GEHA [141500]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198.00||||198.00|128.7|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198.00||||198.00|198|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198.00||||198.00|41.58|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198.00||||198.00|14.8|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MULTIPLAN [1680]|IHC HS [168011]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|UMR [2035]|UMR OPTIONS [203501]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|AETNA [1015]|AETNA ACO WILCO [101532]|198.00||||198.00|18.95|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|HEALTHNET [1495]|HEALTHNET [149500]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|TRUSTMARK [2030]|STARMARK [203000]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198.00||||198.00|14.36|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|198.00||||198.00|7.99|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|CHAMPVA [1240]|CHAMP VA [124000]|198.00||||198.00|148.5|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198.00||||198.00|13.87|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|198.00||||198.00|16.42|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198.00||||198.00|14.36|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198.00||||198.00|118.8|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198.00||||198.00|99|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198.00||||198.00|14.8|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198.00||||198.00|178.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|198.00||||198.00|84.35|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198.00||||198.00|69.5|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|198.00||||198.00|99.2|198|7.99 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MULTIPLAN [1680]|HMA [168003]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198.00||||198.00||| 30687385|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA HISTOPLASMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198.00||||198.00||| 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|328.00||||328.00|115.13|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|328.00||||328.00|164.33|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|328.00||||328.00|29.73|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|328.00||||328.00|164|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|328.00||||328.00|25.28|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|328.00||||328.00|196.8|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|328.00||||328.00|26.49|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|328.00||||328.00|25.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|328.00||||328.00|16.05|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|328.00||||328.00|26.49|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|HEALTHNET [1495]|HEALTHNET [149500]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|AETNA [1015]|AETNA ACO WILCO [101532]|328.00||||328.00|38.05|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MULTIPLAN [1680]|IHC HS [168011]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|328.00||||328.00|139.73|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|328.00||||328.00|34.62|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|328.00||||328.00|29.83|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|328.00||||328.00|29.73|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|328.00||||328.00|35.16|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|328.00||||328.00|68.88|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|TRUSTMARK [2030]|STARMARK [203000]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|328.00||||328.00|24.56|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|328.00||||328.00|328|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|328.00||||328.00|26.09|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|FIRST HEALTH [1375]|QUALCHOICE [137513]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|328.00||||328.00|157.28|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|UMR [2035]|UMR OPTIONS [203501]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|FMH BENEFIT SERVICES [1390]|FMH [139000]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|328.00||||328.00|213.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|||328.00||||328.00|98.4|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MULTIPLAN [1680]|HMA [168003]|328.00||||328.00|36.12|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|328.00||||328.00|26.09|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|328.00||||328.00|24.08|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|CORESOURCE [1315]|CORESOURCE [131500]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|GEHA [1415]|GEHA [141500]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|328.00||||328.00|27.12|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|328.00||||328.00|295.2|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|328.00||||328.00|34.62|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|CHAMPVA [1240]|CHAMP VA [124000]|328.00||||328.00|246|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|328.00||||328.00|24|328|16.05 30687389|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV1 AG EIA QL HIV1/HIV2 AB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|328.00||||328.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|340.00||||340.00|221|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|340.00||||340.00|163.03|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|340.00||||340.00|71.4|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|UMR [2035]|UMR OPTIONS [203501]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|340.00||||340.00|24.06|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|FIRST HEALTH [1375]|QUALCHOICE [137513]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|FMH BENEFIT SERVICES [1390]|FMH [139000]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MULTIPLAN [1680]|IHC HS [168011]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|TRUSTMARK [2030]|STARMARK [203000]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|340.00||||340.00|29.81|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|340.00||||340.00|14.44|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|340.00||||340.00|25.18|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|340.00||||340.00|26.07|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|340.00||||340.00|340|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|AETNA [1015]|AETNA ACO WILCO [101532]|340.00||||340.00|34.23|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|340.00||||340.00|204|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|340.00||||340.00|170|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|340.00||||340.00|170.34|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|340.00||||340.00|119.34|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|||340.00||||340.00|102|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|340.00||||340.00|144.84|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|HEALTHNET [1495]|HEALTHNET [149500]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|340.00||||340.00|24.06|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|GEHA [1415]|GEHA [141500]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|340.00||||340.00|27.1|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|CORESOURCE [1315]|CORESOURCE [131500]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|CHAMPVA [1240]|CHAMP VA [124000]|340.00||||340.00|255|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|340.00||||340.00|23.98|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|340.00||||340.00|306|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|340.00||||340.00|26.07|340|14.44 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MULTIPLAN [1680]|HMA [168003]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|340.00||||340.00||| 30687390|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AG EIA HIV-1|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|340.00||||340.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133.00||||133.00|14.8|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|133.00||||133.00|66.63|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133.00||||133.00|46.68|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133.00||||133.00|66.5|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133.00||||133.00|15.31|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133.00||||133.00|14.79|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|133.00||||133.00|8.48|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|TRUSTMARK [2030]|STARMARK [203000]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|AETNA [1015]|AETNA ACO WILCO [101532]|133.00||||133.00|20.1|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|FMH BENEFIT SERVICES [1390]|FMH [139000]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|FIRST HEALTH [1375]|QUALCHOICE [137513]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MULTIPLAN [1680]|IHC HS [168011]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|133.00||||133.00|17.5|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133.00||||133.00|14.8|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|HEALTHNET [1495]|HEALTHNET [149500]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|UMR [2035]|UMR OPTIONS [203501]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133.00||||133.00|27.93|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133.00||||133.00|133|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133.00||||133.00|63.77|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133.00||||133.00|79.8|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|133.00||||133.00|56.66|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133.00||||133.00|86.45|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|||133.00||||133.00|39.9|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133.00||||133.00|15.31|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133.00||||133.00|14.08|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|CHAMPVA [1240]|CHAMP VA [124000]|133.00||||133.00|99.75|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|CORESOURCE [1315]|CORESOURCE [131500]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|133.00||||133.00|15.91|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|GEHA [1415]|GEHA [141500]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133.00||||133.00|119.7|133|8.48 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|MULTIPLAN [1680]|HMA [168003]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133.00||||133.00||| 30687400|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ANTIGN EIA QL INFLUENZA A/B|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|133.00||||133.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|GEHA [1415]|GEHA [141500]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|149.00||||149.00|15.67|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|CORESOURCE [1315]|CORESOURCE [131500]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149.00||||149.00|13.87|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|||149.00||||149.00|44.7|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149.00||||149.00|96.85|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149.00||||149.00|71.45|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149.00||||149.00|149|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149.00||||149.00|14.8|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|149.00||||149.00|17.24|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|FIRST HEALTH [1375]|QUALCHOICE [137513]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|FMH BENEFIT SERVICES [1390]|FMH [139000]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|UMR [2035]|UMR OPTIONS [203501]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149.00||||149.00|31.29|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MULTIPLAN [1680]|IHC HS [168011]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|AETNA [1015]|AETNA ACO WILCO [101532]|149.00||||149.00|19.79|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|HEALTHNET [1495]|HEALTHNET [149500]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149.00||||149.00|15.08|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|TRUSTMARK [2030]|STARMARK [203000]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|149.00||||149.00|8.35|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149.00||||149.00|14.56|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|CHAMPVA [1240]|CHAMP VA [124000]|149.00||||149.00|111.75|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149.00||||149.00|15.08|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149.00||||149.00|89.4|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149.00||||149.00|74.5|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149.00||||149.00|14.8|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|149.00||||149.00|74.65|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149.00||||149.00|52.3|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|149.00||||149.00|63.47|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149.00||||149.00|134.1|149|8.35 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MULTIPLAN [1680]|HMA [168003]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149.00||||149.00||| 30687420|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL RSV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149.00||||149.00||| 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161.00||||161.00|14.8|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|161.00||||161.00|80.66|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161.00||||161.00|56.51|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|161.00||||161.00|68.59|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161.00||||161.00|80.5|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161.00||||161.00|12.58|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161.00||||161.00|96.6|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161.00||||161.00|13.18|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161.00||||161.00|12.54|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|161.00||||161.00|7.99|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|TRUSTMARK [2030]|STARMARK [203000]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|HEALTHNET [1495]|HEALTHNET [149500]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|AETNA [1015]|AETNA ACO WILCO [101532]|161.00||||161.00|18.95|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MULTIPLAN [1680]|IHC HS [168011]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|161.00||||161.00|17.22|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MULTIPLAN [1680]|HMA [168003]|161.00||||161.00|17.97|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|161.00||||161.00|14.84|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161.00||||161.00|14.8|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161.00||||161.00|12.22|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|UMR [2035]|UMR OPTIONS [203501]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161.00||||161.00|17.49|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161.00||||161.00|33.81|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161.00||||161.00|161|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161.00||||161.00|12.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161.00||||161.00|77.2|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161.00||||161.00|104.65|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|||161.00||||161.00|48.3|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161.00||||161.00|12.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161.00||||161.00|13.18|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161.00||||161.00|11.98|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161.00||||161.00|11.94|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|CHAMPVA [1240]|CHAMP VA [124000]|161.00||||161.00|120.75|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|161.00||||161.00|17.22|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|CORESOURCE [1315]|CORESOURCE [131500]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|161.00||||161.00|13.49|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|GEHA [1415]|GEHA [141500]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161.00||||161.00|144.9|161|7.99 30687425|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG IA ROTAVIRUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|161.00||||161.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|GEHA [1415]|GEHA [141500]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|164.00||||164.00|13.49|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|164.00||||164.00|101.68|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|CHAMPVA [1240]|CHAMP VA [124000]|164.00||||164.00|123|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|164.00||||164.00|11.94|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|164.00||||164.00|11.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|164.00||||164.00|12.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|164.00||||164.00|106.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|164.00||||164.00|78.64|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|164.00||||164.00|164|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|164.00||||164.00|34.44|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|164.00||||164.00|101.84|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|UMR [2035]|UMR OPTIONS [203501]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|164.00||||164.00|12.22|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|164.00||||164.00|14.8|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|164.00||||164.00|14.84|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|164.00||||164.00|11.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MULTIPLAN [1680]|IHC HS [168011]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|164.00||||164.00|17.22|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MULTIPLAN [1680]|HMA [168003]|164.00||||164.00|17.97|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|164.00||||164.00|11.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|||164.00||||164.00|49.2|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|AETNA [1015]|AETNA ACO WILCO [101532]|164.00||||164.00|18.95|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|HEALTHNET [1495]|HEALTHNET [149500]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|TRUSTMARK [2030]|STARMARK [203000]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|164.00||||164.00|7.99|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|164.00||||164.00|12.54|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|164.00||||164.00|11.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|CORESOURCE [1315]|CORESOURCE [131500]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|164.00||||164.00|12.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|164.00||||164.00|98.4|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|164.00||||164.00|12.58|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|164.00||||164.00|11.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|164.00||||164.00|82|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|164.00||||164.00|14.8|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|164.00||||164.00|82.16|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|164.00||||164.00|57.56|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|164.00||||164.00|69.86|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|164.00||||164.00|11.98|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|164.00||||164.00|147.6|164|7.99 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|164.00||||164.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|164.00||||164.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|164.00||||164.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|164.00||||164.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|164.00||||164.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|164.00||||164.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|164.00||||164.00||| 30687427|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG SHIGA-LIKE TOXIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|164.00||||164.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|16.81|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|91.68|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|64.23|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183.00||||183.00|109.8|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|18.21|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|17.59|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|183.00||||183.00|10.09|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|AETNA [1015]|AETNA ACO WILCO [101532]|183.00||||183.00|23.91|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|FIRST HEALTH [1375]|QUALCHOICE [137513]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|20.82|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|16.81|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|183|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183.00||||183.00|87.75|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|77.96|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|||183.00||||183.00|54.9|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|18.21|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|16.76|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|CHAMPVA [1240]|CHAMP VA [124000]|183.00||||183.00|137.25|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|18.93|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|GEHA [1415]|GEHA [141500]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|183|10.09 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|MULTIPLAN [1680]|HMA [168003]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00||| 30687430|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC AG EIA QL STREP GRP A|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00||| 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|752.00||||752.00|13.49|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|CORESOURCE [1315]|CORESOURCE [131500]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|752.00||||752.00|17.22|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|752.00||||752.00|11.94|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|752.00||||752.00|12.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|||752.00||||752.00|225.6|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|752.00||||752.00|488.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|752.00||||752.00|752|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|752.00||||752.00|17.49|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|752.00||||752.00|12.22|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|752.00||||752.00|14.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|752.00||||752.00|14.84|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|UMR [2035]|UMR OPTIONS [203501]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MULTIPLAN [1680]|IHC HS [168011]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|752.00||||752.00|17.22|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MULTIPLAN [1680]|HMA [168003]|752.00||||752.00|17.97|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|752.00||||752.00|157.92|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|752.00||||752.00|360.58|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|AETNA [1015]|AETNA ACO WILCO [101532]|752.00||||752.00|18.95|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|HEALTHNET [1495]|HEALTHNET [149500]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|TRUSTMARK [2030]|STARMARK [203000]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|752.00||||752.00|7.99|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|752.00||||752.00|12.54|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|CHAMPVA [1240]|CHAMP VA [124000]|752.00||||752.00|564|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|752.00||||752.00|13.18|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|752.00||||752.00|12.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|752.00||||752.00|451.2|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|GEHA [1415]|GEHA [141500]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|752.00||||752.00|12.58|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|752.00||||752.00|376|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|752.00||||752.00|14.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|752.00||||752.00|376.75|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|752.00||||752.00|263.95|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|752.00||||752.00|320.35|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|752.00||||752.00|11.98|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|752.00||||752.00|676.8|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|752.00||||752.00|13.18|752|7.99 30687449|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA AG DETECT MULTI-STEP NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|752.00||||752.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374.00||||374.00|43.33|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374.00||||374.00|131.27|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|374.00||||374.00|159.32|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374.00||||374.00|187|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374.00||||374.00|224.4|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374.00||||374.00|36.71|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|374.00||||374.00|23.39|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|HEALTHNET [1495]|HEALTHNET [149500]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|AETNA [1015]|AETNA ACO WILCO [101532]|374.00||||374.00|55.46|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MULTIPLAN [1680]|IHC HS [168011]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|374.00||||374.00|43.46|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374.00||||374.00|43.33|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|TRUSTMARK [2030]|STARMARK [203000]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|UMR [2035]|UMR OPTIONS [203501]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374.00||||374.00|78.54|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374.00||||374.00|38.01|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374.00||||374.00|374|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374.00||||374.00|179.33|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374.00||||374.00|243.1|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|||374.00||||374.00|112.2|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|374.00||||374.00|187.37|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374.00||||374.00|38.01|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374.00||||374.00|34.97|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|CHAMPVA [1240]|CHAMP VA [124000]|374.00||||374.00|280.5|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|CORESOURCE [1315]|CORESOURCE [131500]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|374.00||||374.00|39.51|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|GEHA [1415]|GEHA [141500]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374.00||||374.00|336.6|374|23.39 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MULTIPLAN [1680]|HMA [168003]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374.00||||374.00||| 30687471|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BARTONELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|374.00||||374.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|GEHA [1415]|GEHA [141500]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|349.00||||349.00|39.51|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|CORESOURCE [1315]|CORESOURCE [131500]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|CHAMPVA [1240]|CHAMP VA [124000]|349.00||||349.00|261.75|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349.00||||349.00|34.97|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349.00||||349.00|38.01|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349.00||||349.00|226.85|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349.00||||349.00|167.35|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349.00||||349.00|349|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349.00||||349.00|73.29|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|UMR [2035]|UMR OPTIONS [203501]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349.00||||349.00|43.33|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|349.00||||349.00|43.46|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MULTIPLAN [1680]|IHC HS [168011]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|||349.00||||349.00|104.7|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|AETNA [1015]|AETNA ACO WILCO [101532]|349.00||||349.00|55.46|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|HEALTHNET [1495]|HEALTHNET [149500]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|TRUSTMARK [2030]|STARMARK [203000]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|349.00||||349.00|23.39|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349.00||||349.00|36.71|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349.00||||349.00|38.01|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349.00||||349.00|209.4|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349.00||||349.00|174.5|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349.00||||349.00|43.33|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|349.00||||349.00|174.85|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349.00||||349.00|122.5|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|349.00||||349.00|148.67|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349.00||||349.00|314.1|349|23.39 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MULTIPLAN [1680]|HMA [168003]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349.00||||349.00||| 30687476|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP BORRELIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349.00||||349.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213.00||||213.00|24.76|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|213.00||||213.00|106.71|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213.00||||213.00|74.76|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|213.00||||213.00|90.74|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213.00||||213.00|106.5|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213.00||||213.00|21.73|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213.00||||213.00|20.99|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|213.00||||213.00|13.37|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|TRUSTMARK [2030]|STARMARK [203000]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|HEALTHNET [1495]|HEALTHNET [149500]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|AETNA [1015]|AETNA ACO WILCO [101532]|213.00||||213.00|31.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|FMH BENEFIT SERVICES [1390]|FMH [139000]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|FIRST HEALTH [1375]|QUALCHOICE [137513]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MULTIPLAN [1680]|IHC HS [168011]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|213.00||||213.00|24.84|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213.00||||213.00|24.76|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|UMR [2035]|UMR OPTIONS [203501]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213.00||||213.00|44.73|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213.00||||213.00|127.8|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213.00||||213.00|213|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213.00||||213.00|102.13|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213.00||||213.00|138.45|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|||213.00||||213.00|63.9|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213.00||||213.00|21.73|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213.00||||213.00|19.99|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|CHAMPVA [1240]|CHAMP VA [124000]|213.00||||213.00|159.75|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|CORESOURCE [1315]|CORESOURCE [131500]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|213.00||||213.00|22.59|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|GEHA [1415]|GEHA [141500]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213.00||||213.00|191.7|213|13.37 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|MULTIPLAN [1680]|HMA [168003]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213.00||||213.00||| 30687480|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT CANDIDA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|213.00||||213.00||| 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|151.00||||151.00|39.51|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|CORESOURCE [1315]|CORESOURCE [131500]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|151.00||||151.00|50.45|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151.00||||151.00|34.97|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|||151.00||||151.00|45.3|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151.00||||151.00|98.15|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151.00||||151.00|151|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151.00||||151.00|51.23|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|UMR [2035]|UMR OPTIONS [203501]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151.00||||151.00|43.33|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|151.00||||151.00|43.46|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151.00||||151.00|35.79|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|FIRST HEALTH [1375]|QUALCHOICE [137513]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|FMH BENEFIT SERVICES [1390]|FMH [139000]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MULTIPLAN [1680]|IHC HS [168011]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MULTIPLAN [1680]|HMA [168003]|151.00||||151.00|52.64|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|151.00||||151.00|50.45|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|AETNA [1015]|AETNA ACO WILCO [101532]|151.00||||151.00|55.46|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|HEALTHNET [1495]|HEALTHNET [149500]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151.00||||151.00|31.71|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151.00||||151.00|72.4|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151.00||||151.00|38.01|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|TRUSTMARK [2030]|STARMARK [203000]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|151.00||||151.00|23.39|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151.00||||151.00|36.71|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|CHAMPVA [1240]|CHAMP VA [124000]|151.00||||151.00|113.25|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151.00||||151.00|38.6|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151.00||||151.00|38.01|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|GEHA [1415]|GEHA [141500]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151.00||||151.00|90.6|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151.00||||151.00|36.84|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151.00||||151.00|75.5|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151.00||||151.00|43.33|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|151.00||||151.00|75.65|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151.00||||151.00|53|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|151.00||||151.00|64.33|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151.00||||151.00|35.09|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151.00||||151.00|135.9|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151.00||||151.00|38.6|151|23.39 30687481|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CANDIDA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|151.00||||151.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|628.00||||628.00|43.33|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|628.00||||628.00|220.43|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|628.00||||628.00|267.53|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|628.00||||628.00|314|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|628.00||||628.00|376.8|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|628.00||||628.00|38.01|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|628.00||||628.00|36.71|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|628.00||||628.00|23.39|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|HEALTHNET [1495]|HEALTHNET [149500]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|AETNA [1015]|AETNA ACO WILCO [101532]|628.00||||628.00|55.46|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MULTIPLAN [1680]|IHC HS [168011]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|628.00||||628.00|43.46|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|628.00||||628.00|43.33|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|TRUSTMARK [2030]|STARMARK [203000]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|UMR [2035]|UMR OPTIONS [203501]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|628.00||||628.00|131.88|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|628.00||||628.00|628|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|628.00||||628.00|301.13|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|628.00||||628.00|408.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|||628.00||||628.00|188.4|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|628.00||||628.00|314.63|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|628.00||||628.00|38.01|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|628.00||||628.00|34.97|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|CHAMPVA [1240]|CHAMP VA [124000]|628.00||||628.00|471|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|CORESOURCE [1315]|CORESOURCE [131500]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|628.00||||628.00|39.51|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|GEHA [1415]|GEHA [141500]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|628.00||||628.00|565.2|628|23.39 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MULTIPLAN [1680]|HMA [168003]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|628.00||||628.00||| 30687486|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IADNA CHLYMD PNEUM DNA AMP PROBE TQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|628.00||||628.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|GEHA [1415]|GEHA [141500]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|197.00||||197.00|25.62|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|CHAMPVA [1240]|CHAMP VA [124000]|197.00||||197.00|147.75|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|197.00||||197.00|22.68|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|197.00||||197.00|24.65|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|||197.00||||197.00|59.1|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|197.00||||197.00|128.05|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|197.00||||197.00|94.46|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|197.00||||197.00|41.37|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|UMR [2035]|UMR OPTIONS [203501]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|197.00||||197.00|24.76|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|197.00||||197.00|28.19|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MULTIPLAN [1680]|IHC HS [168011]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|197.00||||197.00|197|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|AETNA [1015]|AETNA ACO WILCO [101532]|197.00||||197.00|32.36|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|HEALTHNET [1495]|HEALTHNET [149500]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|TRUSTMARK [2030]|STARMARK [203000]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|197.00||||197.00|13.65|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|197.00||||197.00|23.81|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|CORESOURCE [1315]|CORESOURCE [131500]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|197.00||||197.00|24.65|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|197.00||||197.00|118.2|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|197.00||||197.00|98.5|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|197.00||||197.00|24.76|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|197.00||||197.00|98.7|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|197.00||||197.00|69.15|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|197.00||||197.00|83.92|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|197.00||||197.00|177.3|197|13.65 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MULTIPLAN [1680]|HMA [168003]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|197.00||||197.00||| 30687490|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE CHLAMYDIA TRACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|197.00||||197.00||| 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349.00||||349.00|38.6|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349.00||||349.00|43.33|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|349.00||||349.00|174.85|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349.00||||349.00|122.5|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349.00||||349.00|174.5|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349.00||||349.00|36.84|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349.00||||349.00|38.01|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349.00||||349.00|38.6|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349.00||||349.00|36.71|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|349.00||||349.00|23.39|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|TRUSTMARK [2030]|STARMARK [203000]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|AETNA [1015]|AETNA ACO WILCO [101532]|349.00||||349.00|55.46|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|349.00||||349.00|50.45|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MULTIPLAN [1680]|HMA [168003]|349.00||||349.00|52.64|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|FMH BENEFIT SERVICES [1390]|FMH [139000]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|FIRST HEALTH [1375]|QUALCHOICE [137513]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MULTIPLAN [1680]|IHC HS [168011]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|349.00||||349.00|43.46|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349.00||||349.00|43.33|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349.00||||349.00|35.79|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|HEALTHNET [1495]|HEALTHNET [149500]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|UMR [2035]|UMR OPTIONS [203501]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349.00||||349.00|51.23|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349.00||||349.00|73.29|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349.00||||349.00|209.4|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349.00||||349.00|349|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349.00||||349.00|167.35|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349.00||||349.00|226.85|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|||349.00||||349.00|104.7|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349.00||||349.00|38.01|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|349.00||||349.00|148.67|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349.00||||349.00|35.09|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349.00||||349.00|34.97|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|CHAMPVA [1240]|CHAMP VA [124000]|349.00||||349.00|261.75|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|349.00||||349.00|50.45|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|CORESOURCE [1315]|CORESOURCE [131500]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|349.00||||349.00|39.51|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|GEHA [1415]|GEHA [141500]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349.00||||349.00|314.1|349|23.39 30687491|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP CHLAMYD T|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|349.00||||349.00||| 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|425.00||||425.00|41.97|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|CORESOURCE [1315]|CORESOURCE [131500]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|425.00||||425.00|53.58|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|CHAMPVA [1240]|CHAMP VA [124000]|425.00||||425.00|318.75|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|425.00||||425.00|37.14|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|||425.00||||425.00|127.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|425.00||||425.00|276.25|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|425.00||||425.00|425|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|425.00||||425.00|89.25|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|425.00||||425.00|54.41|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|425.00||||425.00|43.33|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|425.00||||425.00|46.17|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|425.00||||425.00|38.02|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|FIRST HEALTH [1375]|QUALCHOICE [137513]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|FMH BENEFIT SERVICES [1390]|FMH [139000]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|UMR [2035]|UMR OPTIONS [203501]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MULTIPLAN [1680]|IHC HS [168011]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|425.00||||425.00|53.58|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MULTIPLAN [1680]|HMA [168003]|425.00||||425.00|55.91|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|425.00||||425.00|203.79|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|AETNA [1015]|AETNA ACO WILCO [101532]|425.00||||425.00|55.46|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|HEALTHNET [1495]|HEALTHNET [149500]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|425.00||||425.00|40.38|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|TRUSTMARK [2030]|STARMARK [203000]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|425.00||||425.00|23.39|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|425.00||||425.00|39|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|425.00||||425.00|41|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|425.00||||425.00|40.38|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|425.00||||425.00|255|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|GEHA [1415]|GEHA [141500]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|425.00||||425.00|39.13|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|425.00||||425.00|212.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|425.00||||425.00|43.33|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|425.00||||425.00|212.93|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|425.00||||425.00|149.18|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|425.00||||425.00|181.05|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|425.00||||425.00|37.27|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|425.00||||425.00|382.5|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|425.00||||425.00|41|425|23.39 30687493|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP C DIFF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|425.00||||425.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494.00||||494.00|43.33|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494.00||||494.00|173.39|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|494.00||||494.00|210.44|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494.00||||494.00|247|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494.00||||494.00|296.4|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494.00||||494.00|36.71|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|494.00||||494.00|23.39|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|HEALTHNET [1495]|HEALTHNET [149500]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|AETNA [1015]|AETNA ACO WILCO [101532]|494.00||||494.00|55.46|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MULTIPLAN [1680]|IHC HS [168011]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|494.00||||494.00|43.46|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494.00||||494.00|43.33|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|TRUSTMARK [2030]|STARMARK [203000]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|UMR [2035]|UMR OPTIONS [203501]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494.00||||494.00|103.74|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494.00||||494.00|38.01|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494.00||||494.00|494|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494.00||||494.00|236.87|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494.00||||494.00|321.1|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|||494.00||||494.00|148.2|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|494.00||||494.00|247.49|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494.00||||494.00|38.01|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494.00||||494.00|34.97|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|CHAMPVA [1240]|CHAMP VA [124000]|494.00||||494.00|370.5|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|CORESOURCE [1315]|CORESOURCE [131500]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|494.00||||494.00|39.51|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|GEHA [1415]|GEHA [141500]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494.00||||494.00|444.6|494|23.39 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|MULTIPLAN [1680]|HMA [168003]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494.00||||494.00||| 30687496|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV AMP PROBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|494.00||||494.00||| 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|GEHA [1415]|GEHA [141500]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|675.00||||675.00|48.25|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|675.00||||675.00|61.59|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|CHAMPVA [1240]|CHAMP VA [124000]|675.00||||675.00|506.25|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|675.00||||675.00|42.7|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|675.00||||675.00|46.42|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|675.00||||675.00|438.75|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|675.00||||675.00|323.66|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|675.00||||675.00|141.75|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|UMR [2035]|UMR OPTIONS [203501]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|675.00||||675.00|43.7|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|675.00||||675.00|52.88|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|675.00||||675.00|53.07|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MULTIPLAN [1680]|IHC HS [168011]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|675.00||||675.00|62.55|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|675.00||||675.00|675|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|675.00||||675.00|61.59|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MULTIPLAN [1680]|HMA [168003]|675.00||||675.00|64.26|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|||675.00||||675.00|202.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|AETNA [1015]|AETNA ACO WILCO [101532]|675.00||||675.00|67.7|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|HEALTHNET [1495]|HEALTHNET [149500]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|TRUSTMARK [2030]|STARMARK [203000]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|675.00||||675.00|28.56|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|675.00||||675.00|44.83|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|675.00||||675.00|47.12|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|675.00||||675.00|46.42|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|CORESOURCE [1315]|CORESOURCE [131500]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|675.00||||675.00|405|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|675.00||||675.00|44.98|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|675.00||||675.00|337.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|675.00||||675.00|52.88|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|675.00||||675.00|338.18|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|675.00||||675.00|236.93|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|675.00||||675.00|287.55|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|675.00||||675.00|42.84|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|675.00||||675.00|607.5|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|675.00||||675.00|47.12|675|28.56 30687497|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID CMV QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|675.00||||675.00||| 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494.00||||494.00|38.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494.00||||494.00|43.33|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|494.00||||494.00|247.49|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494.00||||494.00|173.39|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494.00||||494.00|247|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494.00||||494.00|36.84|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494.00||||494.00|38.01|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494.00||||494.00|38.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494.00||||494.00|36.71|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|494.00||||494.00|23.39|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|TRUSTMARK [2030]|STARMARK [203000]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|AETNA [1015]|AETNA ACO WILCO [101532]|494.00||||494.00|55.46|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|494.00||||494.00|50.45|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MULTIPLAN [1680]|HMA [168003]|494.00||||494.00|52.64|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|FMH BENEFIT SERVICES [1390]|FMH [139000]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|FIRST HEALTH [1375]|QUALCHOICE [137513]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MULTIPLAN [1680]|IHC HS [168011]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|494.00||||494.00|43.46|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494.00||||494.00|43.33|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494.00||||494.00|35.79|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|HEALTHNET [1495]|HEALTHNET [149500]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|UMR [2035]|UMR OPTIONS [203501]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494.00||||494.00|51.23|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494.00||||494.00|103.74|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494.00||||494.00|494|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494.00||||494.00|236.87|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494.00||||494.00|296.4|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|494.00||||494.00|210.44|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494.00||||494.00|321.1|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|||494.00||||494.00|148.2|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494.00||||494.00|38.01|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494.00||||494.00|35.09|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494.00||||494.00|34.97|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|CHAMPVA [1240]|CHAMP VA [124000]|494.00||||494.00|370.5|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|494.00||||494.00|50.45|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|CORESOURCE [1315]|CORESOURCE [131500]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|494.00||||494.00|39.51|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|GEHA [1415]|GEHA [141500]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494.00||||494.00|444.6|494|23.39 30687498|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ENTEROVIRUS BY PCR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|494.00||||494.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00|32.91|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00|29.12|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|||90.00||||90.00|27|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00|90|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|29.22|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00|36.2|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00|41.56|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00|31.66|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00|17.53|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00|30.58|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00|31.66|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00|45|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|29.22|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|90|17.53 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 30687503|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INFLUENZA DNA AMP PROBE ADDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|225.00||||225.00|141.12|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|225.00||||225.00|112.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|225.00||||225.00|158.38|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|225.00||||225.00|112.73|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|225.00||||225.00|78.98|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|225.00||||225.00|134.7|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|225.00||||225.00|135|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|225.00||||225.00|141.12|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|225.00||||225.00|85.52|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|TRUSTMARK [2030]|STARMARK [203000]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MULTIPLAN [1680]|IHC HS [168011]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|225.00||||225.00|184.43|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MULTIPLAN [1680]|HMA [168003]|225.00||||225.00|192.44|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|HEALTHNET [1495]|HEALTHNET [149500]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|FMH BENEFIT SERVICES [1390]|FMH [139000]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|FIRST HEALTH [1375]|QUALCHOICE [137513]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|225.00||||225.00|158.38|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|AETNA [1015]|AETNA ACO WILCO [101532]|225.00||||225.00|202.75|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|225.00||||225.00|130.86|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|UMR [2035]|UMR OPTIONS [203501]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|225.00||||225.00|187.3|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|225.00||||225.00|47.25|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|225.00||||225.00|225|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|225.00||||225.00|95.85|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|225.00||||225.00|107.89|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|225.00||||225.00|146.25|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|||225.00||||225.00|67.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|225.00||||225.00|128.29|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|CHAMPVA [1240]|CHAMP VA [124000]|225.00||||225.00|168.75|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|225.00||||225.00|184.43|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|CORESOURCE [1315]|CORESOURCE [131500]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|GEHA [1415]|GEHA [141500]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|225.00||||225.00|202.5|225|47.25 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|225.00||||225.00||| 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|225.00||||225.00||| 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|225.00||||225.00||| 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|225.00||||225.00||| 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|225.00||||225.00||| 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|225.00||||225.00||| 30687505|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NFCT AGENT DNA/RNA GI PATHOGENS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|225.00||||225.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|GEHA [1415]|GEHA [141500]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|CORESOURCE [1315]|CORESOURCE [131500]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|CHAMPVA [1240]|CHAMP VA [124000]|213.00||||213.00|159.75|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|213.00||||213.00|19.99|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|213.00||||213.00|21.73|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|213.00||||213.00|138.45|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|213.00||||213.00|102.13|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|213.00||||213.00|44.73|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|UMR [2035]|UMR OPTIONS [203501]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|213.00||||213.00|24.84|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|213.00||||213.00|24.76|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MULTIPLAN [1680]|IHC HS [168011]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|213.00||||213.00|213|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|||213.00||||213.00|63.9|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|AETNA [1015]|AETNA ACO WILCO [101532]|213.00||||213.00|31.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|HEALTHNET [1495]|HEALTHNET [149500]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|TRUSTMARK [2030]|STARMARK [203000]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|213.00||||213.00|13.37|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|213.00||||213.00|20.99|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|213.00||||213.00|22.59|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|213.00||||213.00|21.73|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|213.00||||213.00|127.8|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|213.00||||213.00|24.76|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|213.00||||213.00|106.71|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|213.00||||213.00|74.76|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|213.00||||213.00|90.74|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|213.00||||213.00|106.5|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|213.00||||213.00|191.7|213|13.37 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MULTIPLAN [1680]|HMA [168003]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|213.00||||213.00||| 30687510|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC DIRECT PROBE GARDNERELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|213.00||||213.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69.00||||69.00|34.5|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69.00||||69.00|51.55|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69.00||||69.00|24.22|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69.00||||69.00|29.39|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69.00||||69.00|41.4|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69.00||||69.00|45.24|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69.00||||69.00|43.7|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|TRUSTMARK [2030]|STARMARK [203000]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|HEALTHNET [1495]|HEALTHNET [149500]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|AETNA [1015]|AETNA ACO WILCO [101532]|69.00||||69.00|66|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MULTIPLAN [1680]|IHC HS [168011]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69.00||||69.00|51.55|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69.00||||69.00|51.72|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|UMR [2035]|UMR OPTIONS [203501]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69.00||||69.00|27.84|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69.00||||69.00|14.49|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69.00||||69.00|69|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69.00||||69.00|33.09|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69.00||||69.00|34.57|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69.00||||69.00|44.85|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|||69.00||||69.00|20.7|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69.00||||69.00|45.24|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69.00||||69.00|41.62|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|CHAMPVA [1240]|CHAMP VA [124000]|69.00||||69.00|51.75|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69.00||||69.00|47.02|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|CORESOURCE [1315]|CORESOURCE [131500]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|GEHA [1415]|GEHA [141500]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69.00||||69.00|62.1|69|14.49 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|MULTIPLAN [1680]|HMA [168003]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69.00||||69.00||| 30687512|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN GARDNERELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69.00||||69.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|CORESOURCE [1315]|CORESOURCE [131500]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|374.00||||374.00|39.51|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374.00||||374.00|34.97|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374.00||||374.00|38.01|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|||374.00||||374.00|112.2|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374.00||||374.00|243.1|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374.00||||374.00|374|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|374.00||||374.00|43.46|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374.00||||374.00|43.33|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|FIRST HEALTH [1375]|QUALCHOICE [137513]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|FMH BENEFIT SERVICES [1390]|FMH [139000]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|UMR [2035]|UMR OPTIONS [203501]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MULTIPLAN [1680]|IHC HS [168011]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374.00||||374.00|78.54|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374.00||||374.00|179.33|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|AETNA [1015]|AETNA ACO WILCO [101532]|374.00||||374.00|55.46|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|HEALTHNET [1495]|HEALTHNET [149500]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|TRUSTMARK [2030]|STARMARK [203000]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|374.00||||374.00|23.39|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374.00||||374.00|36.71|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|CHAMPVA [1240]|CHAMP VA [124000]|374.00||||374.00|280.5|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374.00||||374.00|38.01|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374.00||||374.00|224.4|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|GEHA [1415]|GEHA [141500]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374.00||||374.00|43.33|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|374.00||||374.00|187.37|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374.00||||374.00|131.27|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|374.00||||374.00|159.32|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374.00||||374.00|187|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374.00||||374.00|336.6|374|23.39 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MULTIPLAN [1680]|HMA [168003]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374.00||||374.00||| 30687516|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP B|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374.00||||374.00||| 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|548.00||||548.00|47.12|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|548.00||||548.00|274|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|548.00||||548.00|52.88|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|548.00||||548.00|274.55|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|548.00||||548.00|192.35|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|548.00||||548.00|44.98|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|548.00||||548.00|328.8|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|548.00||||548.00|46.42|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|548.00||||548.00|47.12|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|548.00||||548.00|44.83|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|548.00||||548.00|28.56|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|HEALTHNET [1495]|HEALTHNET [149500]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|AETNA [1015]|COVENTRY HEALTHCARE [101502]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|AETNA [1015]|AETNA ACO WILCO [101532]|548.00||||548.00|67.7|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MULTIPLAN [1680]|IHC HS [168011]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|548.00||||548.00|61.59|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MULTIPLAN [1680]|HMA [168003]|548.00||||548.00|64.26|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|FMH BENEFIT SERVICES [1390]|FMH [139000]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|FIRST HEALTH [1375]|QUALCHOICE [137513]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|548.00||||548.00|52.88|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|548.00||||548.00|53.07|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|548.00||||548.00|43.7|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|TRUSTMARK [2030]|STARMARK [203000]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|UMR [2035]|UMR OPTIONS [203501]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|548.00||||548.00|62.55|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|548.00||||548.00|115.08|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|548.00||||548.00|548|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|548.00||||548.00|262.77|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|548.00||||548.00|356.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|||548.00||||548.00|164.4|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|548.00||||548.00|233.45|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|548.00||||548.00|46.42|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|548.00||||548.00|42.84|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|548.00||||548.00|42.7|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|CHAMPVA [1240]|CHAMP VA [124000]|548.00||||548.00|411|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|548.00||||548.00|61.59|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|548.00||||548.00|48.25|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|CORESOURCE [1315]|CORESOURCE [131500]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|GEHA [1415]|GEHA [141500]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|548.00||||548.00|493.2|548|28.56 30687517|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID QN HEP B|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|548.00||||548.00||| 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|GEHA [1415]|GEHA [141500]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|CORESOURCE [1315]|CORESOURCE [131500]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|374.00||||374.00|39.51|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|374.00||||374.00|50.45|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|CHAMPVA [1240]|CHAMP VA [124000]|374.00||||374.00|280.5|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374.00||||374.00|34.97|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374.00||||374.00|38.01|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374.00||||374.00|243.1|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374.00||||374.00|179.33|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374.00||||374.00|374|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374.00||||374.00|78.54|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|UMR [2035]|UMR OPTIONS [203501]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374.00||||374.00|35.79|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|374.00||||374.00|43.46|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374.00||||374.00|43.33|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|FIRST HEALTH [1375]|QUALCHOICE [137513]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|FMH BENEFIT SERVICES [1390]|FMH [139000]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MULTIPLAN [1680]|IHC HS [168011]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374.00||||374.00|51.23|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|374.00||||374.00|50.45|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MULTIPLAN [1680]|HMA [168003]|374.00||||374.00|52.64|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|||374.00||||374.00|112.2|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|AETNA [1015]|AETNA ACO WILCO [101532]|374.00||||374.00|55.46|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|HEALTHNET [1495]|HEALTHNET [149500]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|TRUSTMARK [2030]|STARMARK [203000]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|374.00||||374.00|23.39|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374.00||||374.00|36.71|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374.00||||374.00|38.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374.00||||374.00|38.01|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374.00||||374.00|224.4|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374.00||||374.00|36.84|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374.00||||374.00|43.33|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|374.00||||374.00|187.37|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374.00||||374.00|131.27|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|374.00||||374.00|159.32|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374.00||||374.00|187|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374.00||||374.00|35.09|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374.00||||374.00|336.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374.00||||374.00|38.6|374|23.39 30687521|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HEP C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|374.00||||374.00||| 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1130.00||||1130.00|47.12|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1130.00||||1130.00|565|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1130.00||||1130.00|52.88|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1130.00||||1130.00|566.13|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1130.00||||1130.00|396.63|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1130.00||||1130.00|481.38|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1130.00||||1130.00|44.98|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1130.00||||1130.00|46.42|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1130.00||||1130.00|47.12|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1130.00||||1130.00|44.83|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|TRUSTMARK [2030]|STARMARK [203000]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|HEALTHNET [1495]|HEALTHNET [149500]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|AETNA [1015]|AETNA ACO WILCO [101532]|1130.00||||1130.00|67.7|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1130.00||||1130.00|61.59|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MULTIPLAN [1680]|HMA [168003]|1130.00||||1130.00|64.26|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|FMH BENEFIT SERVICES [1390]|FMH [139000]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|FIRST HEALTH [1375]|QUALCHOICE [137513]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MULTIPLAN [1680]|IHC HS [168011]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1130.00||||1130.00|52.88|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1130.00||||1130.00|53.07|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1130.00||||1130.00|43.7|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|UMR [2035]|UMR OPTIONS [203501]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1130.00||||1130.00|28.56|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1130.00||||1130.00|62.55|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1130.00||||1130.00|237.3|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1130.00||||1130.00|678|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1130.00||||1130.00|1130|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1130.00||||1130.00|541.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1130.00||||1130.00|734.5|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|||1130.00||||1130.00|339|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1130.00||||1130.00|46.42|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1130.00||||1130.00|42.84|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1130.00||||1130.00|42.7|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|CHAMPVA [1240]|CHAMP VA [124000]|1130.00||||1130.00|847.5|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1130.00||||1130.00|61.59|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1130.00||||1130.00|48.25|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|CORESOURCE [1315]|CORESOURCE [131500]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|GEHA [1415]|GEHA [141500]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1130.00||||1130.00|1017|1130|28.56 30687522|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HEP C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1130.00||||1130.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|CORESOURCE [1315]|CORESOURCE [131500]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|521.00||||521.00|44.2|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|521.00||||521.00|39.12|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|||521.00||||521.00|156.3|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|521.00||||521.00|338.65|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|521.00||||521.00|521|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|UMR [2035]|UMR OPTIONS [203501]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|521.00||||521.00|48.62|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|521.00||||521.00|43.33|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|FIRST HEALTH [1375]|QUALCHOICE [137513]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|FMH BENEFIT SERVICES [1390]|FMH [139000]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MULTIPLAN [1680]|IHC HS [168011]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|521.00||||521.00|109.41|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|AETNA [1015]|AETNA ACO WILCO [101532]|521.00||||521.00|55.84|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|521.00||||521.00|249.82|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|521.00||||521.00|42.53|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|HEALTHNET [1495]|HEALTHNET [149500]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|TRUSTMARK [2030]|STARMARK [203000]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|521.00||||521.00|23.56|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|521.00||||521.00|41.08|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|CHAMPVA [1240]|CHAMP VA [124000]|521.00||||521.00|390.75|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|GEHA [1415]|GEHA [141500]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|521.00||||521.00|42.53|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|521.00||||521.00|312.6|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|521.00||||521.00|43.33|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|521.00||||521.00|261.02|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|521.00||||521.00|182.87|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|521.00||||521.00|221.95|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|521.00||||521.00|260.5|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|521.00||||521.00|468.9|521|23.56 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MULTIPLAN [1680]|HMA [168003]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|521.00||||521.00||| 30687526|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEPATITIS G AMPLIF PROBE TECH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|521.00||||521.00||| 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|380.00||||380.00|190|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|380.00||||380.00|43.33|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|380.00||||380.00|190.38|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|380.00||||380.00|133.38|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|380.00||||380.00|36.84|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|380.00||||380.00|228|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|380.00||||380.00|38.01|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|380.00||||380.00|38.6|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|380.00||||380.00|36.71|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|380.00||||380.00|23.39|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|HEALTHNET [1495]|HEALTHNET [149500]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|AETNA [1015]|AETNA ACO WILCO [101532]|380.00||||380.00|55.46|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MULTIPLAN [1680]|IHC HS [168011]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MULTIPLAN [1680]|HMA [168003]|380.00||||380.00|52.64|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|380.00||||380.00|50.45|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|FMH BENEFIT SERVICES [1390]|FMH [139000]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|FIRST HEALTH [1375]|QUALCHOICE [137513]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|380.00||||380.00|43.33|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|380.00||||380.00|43.46|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|380.00||||380.00|35.79|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|TRUSTMARK [2030]|STARMARK [203000]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|UMR [2035]|UMR OPTIONS [203501]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|380.00||||380.00|51.23|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|380.00||||380.00|79.8|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|380.00||||380.00|380|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|380.00||||380.00|182.21|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|380.00||||380.00|161.88|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|380.00||||380.00|247|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|||380.00||||380.00|114|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|380.00||||380.00|38.01|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|380.00||||380.00|38.6|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|380.00||||380.00|35.09|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|380.00||||380.00|34.97|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|CHAMPVA [1240]|CHAMP VA [124000]|380.00||||380.00|285|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|380.00||||380.00|50.45|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|380.00||||380.00|39.51|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|CORESOURCE [1315]|CORESOURCE [131500]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|GEHA [1415]|GEHA [141500]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|380.00||||380.00|342|380|23.39 30687529|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HERPES SIM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|380.00||||380.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|GEHA [1415]|GEHA [141500]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|CORESOURCE [1315]|CORESOURCE [131500]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|CHAMPVA [1240]|CHAMP VA [124000]|185.00||||185.00|138.75|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|185.00||||185.00|42.7|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|185.00||||185.00|46.42|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|||185.00||||185.00|55.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|185.00||||185.00|120.25|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|185.00||||185.00|88.71|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|185.00||||185.00|38.85|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|UMR [2035]|UMR OPTIONS [203501]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|185.00||||185.00|53.07|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|185.00||||185.00|52.88|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|FIRST HEALTH [1375]|QUALCHOICE [137513]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|FMH BENEFIT SERVICES [1390]|FMH [139000]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MULTIPLAN [1680]|IHC HS [168011]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|185.00||||185.00|185|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|AETNA [1015]|AETNA ACO WILCO [101532]|185.00||||185.00|67.7|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|HEALTHNET [1495]|HEALTHNET [149500]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|TRUSTMARK [2030]|STARMARK [203000]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|185.00||||185.00|28.56|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|185.00||||185.00|44.83|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|185.00||||185.00|48.25|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|185.00||||185.00|46.42|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|185.00||||185.00|111|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|185.00||||185.00|52.88|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|185.00||||185.00|92.69|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|185.00||||185.00|64.94|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|185.00||||185.00|78.81|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|185.00||||185.00|92.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|185.00||||185.00|166.5|185|28.56 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MULTIPLAN [1680]|HMA [168003]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|185.00||||185.00||| 30687530|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HERPES SIMP VIRUS QN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|185.00||||185.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|631.00||||631.00|35.09|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|631.00||||631.00|315.5|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|631.00||||631.00|35.09|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|631.00||||631.00|43.33|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|631.00||||631.00|221.48|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|631.00||||631.00|268.81|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|631.00||||631.00|36.84|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|631.00||||631.00|38.01|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|631.00||||631.00|36.71|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|631.00||||631.00|23.39|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|TRUSTMARK [2030]|STARMARK [203000]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|HEALTHNET [1495]|HEALTHNET [149500]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|631.00||||631.00|35.09|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|AETNA [1015]|AETNA ACO WILCO [101532]|631.00||||631.00|55.46|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|631.00||||631.00|50.45|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MULTIPLAN [1680]|HMA [168003]|631.00||||631.00|52.64|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|FMH BENEFIT SERVICES [1390]|FMH [139000]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|FIRST HEALTH [1375]|QUALCHOICE [137513]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|631.00||||631.00|35.09|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|631.00||||631.00|43.33|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|631.00||||631.00|43.46|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|631.00||||631.00|35.79|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MULTIPLAN [1680]|IHC HS [168011]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|UMR [2035]|UMR OPTIONS [203501]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|631.00||||631.00|391.85|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|631.00||||631.00|132.51|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|631.00||||631.00|35.09|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|631.00||||631.00|378.6|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|631.00||||631.00|631|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|631.00||||631.00|302.56|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|631.00||||631.00|316.13|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|631.00||||631.00|410.15|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|||631.00||||631.00|189.3|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|631.00||||631.00|38.01|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|631.00||||631.00|35.09|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|631.00||||631.00|34.97|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|CHAMPVA [1240]|CHAMP VA [124000]|631.00||||631.00|473.25|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|631.00||||631.00|391.22|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|631.00||||631.00|39.51|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|CORESOURCE [1315]|CORESOURCE [131500]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|GEHA [1415]|GEHA [141500]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|631.00||||631.00|567.9|631|23.39 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|631.00||||631.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|631.00||||631.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|631.00||||631.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|631.00||||631.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|631.00||||631.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|631.00||||631.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|631.00||||631.00||| 30687535|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP HIV-1|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|631.00||||631.00||| 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MULTIPLAN [1680]|IHC HS [168011]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|843.00||||843.00|122.34|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MULTIPLAN [1680]|HMA [168003]|843.00||||843.00|127.65|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|AETNA [1015]|AETNA ACO WILCO [101532]|843.00||||843.00|134.49|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|HEALTHNET [1495]|HEALTHNET [149500]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|TRUSTMARK [2030]|STARMARK [203000]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|843.00||||843.00|56.73|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|843.00||||843.00|89.05|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|843.00||||843.00|93.61|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|843.00||||843.00|92.2|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|843.00||||843.00|505.8|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|843.00||||843.00|89.36|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|843.00||||843.00|105.06|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|843.00||||843.00|422.34|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|843.00||||843.00|295.89|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|843.00||||843.00|359.12|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|843.00||||843.00|421.5|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|843.00||||843.00|93.61|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|843.00||||843.00|86.8|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|843.00||||843.00|124.25|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|843.00||||843.00|84.8|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|GEHA [1415]|GEHA [141500]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|843.00||||843.00|547.95|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|843.00||||843.00|105.41|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|CHAMPVA [1240]|CHAMP VA [124000]|843.00||||843.00|632.25|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|843.00||||843.00|105.06|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|UMR [2035]|UMR OPTIONS [203501]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|||843.00||||843.00|252.9|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|843.00||||843.00|843|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|843.00||||843.00|177.03|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|843.00||||843.00|404.22|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|843.00||||843.00|92.2|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|843.00||||843.00|122.34|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|CORESOURCE [1315]|CORESOURCE [131500]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|843.00||||843.00|758.7|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|843.00||||843.00|95.83|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|843.00||||843.00|85.1|843|56.73 30687536|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HIV-1 BDNA QUANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|843.00||||843.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|991.00||||991.00|495.5|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|991.00||||991.00|208.11|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|||991.00||||991.00|297.3|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|991.00||||991.00|63.51|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|991.00||||991.00|991|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|UMR [2035]|UMR OPTIONS [203501]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|TRUSTMARK [2030]|STARMARK [203000]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|AETNA [1015]|COVENTRY HEALTHCARE [101502]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|991.00||||991.00|63.51|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|991.00||||991.00|644.15|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|991.00||||991.00|475.18|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|991.00||||991.00|347.84|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|991.00||||991.00|58.41|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MULTIPLAN [1680]|IHC HS [168011]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|CHAMPVA [1240]|CHAMP VA [124000]|991.00||||991.00|743.25|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|HEALTHNET [1495]|HEALTHNET [149500]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|FIRST HEALTH [1375]|QUALCHOICE [137513]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|AETNA [1015]|AETNA ACO WILCO [101532]|991.00||||991.00|83.38|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|991.00||||991.00|35.17|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|991.00||||991.00|58.62|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|991.00||||991.00|422.17|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|991.00||||991.00|66.01|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|FMH BENEFIT SERVICES [1390]|FMH [139000]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|CORESOURCE [1315]|CORESOURCE [131500]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|991.00||||991.00|72.61|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|991.00||||991.00|58.62|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|991.00||||991.00|61.34|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|991.00||||991.00|594.6|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|GEHA [1415]|GEHA [141500]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|991.00||||991.00|891.9|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|991.00||||991.00|496.49|991|35.17 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MULTIPLAN [1680]|HMA [168003]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|991.00||||991.00||| 30687539|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE QN HIV-2|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|991.00||||991.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|CORESOURCE [1315]|CORESOURCE [131500]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494.00||||494.00|173.39|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|TRUSTMARK [2030]|STARMARK [203000]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494.00||||494.00|36.71|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494.00||||494.00|43.33|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|HEALTHNET [1495]|HEALTHNET [149500]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|GEHA [1415]|GEHA [141500]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494.00||||494.00|247|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|494.00||||494.00|23.39|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494.00||||494.00|296.4|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|AETNA [1015]|AETNA ACO WILCO [101532]|494.00||||494.00|55.46|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494.00||||494.00|34.97|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|CHAMPVA [1240]|CHAMP VA [124000]|494.00||||494.00|370.5|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|494.00||||494.00|247.49|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|494.00||||494.00|210.44|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|494.00||||494.00|43.46|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494.00||||494.00|38.01|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|UMR [2035]|UMR OPTIONS [203501]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494.00||||494.00|43.33|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494.00||||494.00|38.01|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|||494.00||||494.00|148.2|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494.00||||494.00|236.87|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|FMH BENEFIT SERVICES [1390]|FMH [139000]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494.00||||494.00|103.74|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|FIRST HEALTH [1375]|QUALCHOICE [137513]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MULTIPLAN [1680]|IHC HS [168011]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494.00||||494.00|494|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|494.00||||494.00|39.51|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494.00||||494.00|321.1|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494.00||||494.00|444.6|494|23.39 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MULTIPLAN [1680]|HMA [168003]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494.00||||494.00||| 30687541|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP LEGIONELLA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494.00||||494.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|374.00||||374.00|131.27|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|374.00||||374.00|187.37|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|374.00||||374.00|43.33|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|374.00||||374.00|224.4|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|374.00||||374.00|45.16|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|HEALTHNET [1495]|HEALTHNET [149500]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|374.00||||374.00|25.01|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|TRUSTMARK [2030]|STARMARK [203000]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|374.00||||374.00|51.64|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|374.00||||374.00|43.33|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|FIRST HEALTH [1375]|QUALCHOICE [137513]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|||374.00||||374.00|112.2|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|FMH BENEFIT SERVICES [1390]|FMH [139000]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|374.00||||374.00|78.54|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|CORESOURCE [1315]|CORESOURCE [131500]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|374.00||||374.00|43.61|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MULTIPLAN [1680]|IHC HS [168011]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|374.00||||374.00|179.33|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|374.00||||374.00|374|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|374.00||||374.00|243.1|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|374.00||||374.00|46.94|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|CHAMPVA [1240]|CHAMP VA [124000]|374.00||||374.00|280.5|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|374.00||||374.00|45.16|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|GEHA [1415]|GEHA [141500]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|AETNA [1015]|AETNA ACO WILCO [101532]|374.00||||374.00|59.28|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|UMR [2035]|UMR OPTIONS [203501]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|374.00||||374.00|41.53|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|374.00||||374.00|159.32|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|374.00||||374.00|187|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|374.00||||374.00|336.6|374|25.01 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MULTIPLAN [1680]|HMA [168003]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|374.00||||374.00||| 30687556|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIUM TUBERCU DNA PCR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|374.00||||374.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|517.00||||517.00|23.39|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|517.00||||517.00|38.01|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|517.00||||517.00|220.24|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|517.00||||517.00|258.5|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|TRUSTMARK [2030]|STARMARK [203000]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|517.00||||517.00|181.47|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|517.00||||517.00|43.33|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|HEALTHNET [1495]|HEALTHNET [149500]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|517.00||||517.00|36.71|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|517.00||||517.00|310.2|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|517.00||||517.00|247.9|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|||517.00||||517.00|155.1|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|GEHA [1415]|GEHA [141500]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|517.00||||517.00|34.97|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|517.00||||517.00|39.51|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|517.00||||517.00|259.02|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|CHAMPVA [1240]|CHAMP VA [124000]|517.00||||517.00|387.75|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.00||||517.00|336.05|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|517.00||||517.00|517|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|UMR [2035]|UMR OPTIONS [203501]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MULTIPLAN [1680]|IHC HS [168011]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|517.00||||517.00|43.33|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|517.00||||517.00|108.57|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|AETNA [1015]|AETNA ACO WILCO [101532]|517.00||||517.00|55.46|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|CORESOURCE [1315]|CORESOURCE [131500]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|517.00||||517.00|465.3|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|517.00||||517.00|38.01|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|517.00||||517.00|43.46|517|23.39 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|MULTIPLAN [1680]|HMA [168003]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|517.00||||517.00||| 30687561|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC MYCOBACTERIA AMP NA PROBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|517.00||||517.00||| 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|495.00||||495.00|38.6|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|TRUSTMARK [2030]|STARMARK [203000]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|495.00||||495.00|248|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|495.00||||495.00|43.33|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|495.00||||495.00|297|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|495.00||||495.00|38.6|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|495.00||||495.00|247.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|495.00||||495.00|38.01|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|AETNA [1015]|COVENTRY HEALTHCARE [101502]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|495.00||||495.00|173.75|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|495.00||||495.00|50.45|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MULTIPLAN [1680]|IHC HS [168011]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|495.00||||495.00|36.71|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|HEALTHNET [1495]|HEALTHNET [149500]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|495.00||||495.00|43.46|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|FIRST HEALTH [1375]|QUALCHOICE [137513]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|FMH BENEFIT SERVICES [1390]|FMH [139000]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|495.00||||495.00|51.23|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|495.00||||495.00|35.79|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|495.00||||495.00|43.33|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|UMR [2035]|UMR OPTIONS [203501]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|495.00||||495.00|38.01|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|495.00||||495.00|321.75|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|495.00||||495.00|237.35|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|495.00||||495.00|495|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|495.00||||495.00|23.39|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|GEHA [1415]|GEHA [141500]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|495.00||||495.00|50.45|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|495.00||||495.00|35.09|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|495.00||||495.00|39.51|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|AETNA [1015]|AETNA ACO WILCO [101532]|495.00||||495.00|55.46|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|CORESOURCE [1315]|CORESOURCE [131500]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|495.00||||495.00|210.87|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MULTIPLAN [1680]|HMA [168003]|495.00||||495.00|52.64|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|||495.00||||495.00|148.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|495.00||||495.00|103.95|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|495.00||||495.00|36.84|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|CHAMPVA [1240]|CHAMP VA [124000]|495.00||||495.00|371.25|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|495.00||||495.00|34.97|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|495.00||||495.00|445.5|495|23.39 30687581|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP MYCOPLAS P|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|495.00||||495.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|189.00||||189.00|30.28|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|189.00||||189.00|26.88|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|189.00||||189.00|189|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|CHAMPVA [1240]|CHAMP VA [124000]|189.00||||189.00|141.75|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|GEHA [1415]|GEHA [141500]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|CORESOURCE [1315]|CORESOURCE [131500]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|189.00||||189.00|26.8|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|TRUSTMARK [2030]|STARMARK [203000]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|189.00||||189.00|90.63|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|189.00||||189.00|122.85|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|||189.00||||189.00|56.7|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|UMR [2035]|UMR OPTIONS [203501]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MULTIPLAN [1680]|IHC HS [168011]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|189.00||||189.00|39.69|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|189.00||||189.00|33.3|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|189.00||||189.00|29.13|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|FIRST HEALTH [1375]|QUALCHOICE [137513]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|189.00||||189.00|113.4|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|189.00||||189.00|66.34|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|189.00||||189.00|80.51|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|189.00||||189.00|16.13|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|HEALTHNET [1495]|HEALTHNET [149500]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|189.00||||189.00|26.88|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|FMH BENEFIT SERVICES [1390]|FMH [139000]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|189.00||||189.00|94.5|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|189.00||||189.00|94.69|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|189.00||||189.00|29.13|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|189.00||||189.00|28.14|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|189.00||||189.00|170.1|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|AETNA [1015]|AETNA ACO WILCO [101532]|189.00||||189.00|38.24|189|16.13 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MULTIPLAN [1680]|HMA [168003]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|189.00||||189.00||| 30687590|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT GC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|189.00||||189.00||| 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349.00||||349.00|43.33|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349.00||||349.00|38.6|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349.00||||349.00|38.01|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349.00||||349.00|122.5|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MULTIPLAN [1680]|IHC HS [168011]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|349.00||||349.00|50.45|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349.00||||349.00|38.6|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349.00||||349.00|174.5|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|349.00||||349.00|23.39|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|TRUSTMARK [2030]|STARMARK [203000]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MULTIPLAN [1680]|HMA [168003]|349.00||||349.00|52.64|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|FMH BENEFIT SERVICES [1390]|FMH [139000]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|349.00||||349.00|148.67|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|FIRST HEALTH [1375]|QUALCHOICE [137513]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349.00||||349.00|43.33|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|349.00||||349.00|43.46|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|349.00||||349.00|174.85|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349.00||||349.00|73.29|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|HEALTHNET [1495]|HEALTHNET [149500]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349.00||||349.00|35.79|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349.00||||349.00|51.23|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|UMR [2035]|UMR OPTIONS [203501]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349.00||||349.00|34.97|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|CHAMPVA [1240]|CHAMP VA [124000]|349.00||||349.00|261.75|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349.00||||349.00|167.35|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|||349.00||||349.00|104.7|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349.00||||349.00|226.85|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349.00||||349.00|209.4|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349.00||||349.00|36.84|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|GEHA [1415]|GEHA [141500]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|CORESOURCE [1315]|CORESOURCE [131500]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|349.00||||349.00|39.51|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|AETNA [1015]|AETNA ACO WILCO [101532]|349.00||||349.00|55.46|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349.00||||349.00|38.01|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349.00||||349.00|349|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349.00||||349.00|36.71|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349.00||||349.00|314.1|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349.00||||349.00|35.09|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|349.00||||349.00|50.45|349|23.39 30687591|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP GC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|349.00||||349.00||| 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|552.00||||552.00|235.15|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|552.00||||552.00|156.89|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|552.00||||552.00|276|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|552.00||||552.00|158.38|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|552.00||||552.00|276.55|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|552.00||||552.00|193.75|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|CORESOURCE [1315]|CORESOURCE [131500]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|552.00||||552.00|142.14|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|GEHA [1415]|GEHA [141500]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|552.00||||552.00|115.92|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|552.00||||552.00|154.53|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|552.00||||552.00|160.61|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|CHAMPVA [1240]|CHAMP VA [124000]|552.00||||552.00|414|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|552.00||||552.00|552|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|552.00||||552.00|358.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|552.00||||552.00|264.68|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|552.00||||552.00|205.04|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|FIRST HEALTH [1375]|QUALCHOICE [137513]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|UMR [2035]|UMR OPTIONS [203501]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MULTIPLAN [1680]|IHC HS [168011]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|552.00||||552.00|158.38|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|FMH BENEFIT SERVICES [1390]|FMH [139000]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|552.00||||552.00|145.48|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|552.00||||552.00|176.67|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|552.00||||552.00|205.04|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MULTIPLAN [1680]|HMA [168003]|552.00||||552.00|213.95|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|552.00||||552.00|208.24|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|||552.00||||552.00|165.6|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|AETNA [1015]|AETNA ACO WILCO [101532]|552.00||||552.00|202.88|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|552.00||||552.00|85.58|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|TRUSTMARK [2030]|STARMARK [203000]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|552.00||||552.00|142.63|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|HEALTHNET [1495]|HEALTHNET [149500]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|552.00||||552.00|149.25|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|552.00||||552.00|156.89|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|552.00||||552.00|154.53|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|552.00||||552.00|331.2|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|552.00||||552.00|496.8|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|552.00||||552.00|149.76|552|85.58 30687631|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID RESP VIRUS 3-5 TARGETS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|552.00||||552.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|925.00||||925.00|463.43|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|925.00||||925.00|263.49|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|925.00||||925.00|218.06|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|925.00||||925.00|462.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|925.00||||925.00|218.06|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|925.00||||925.00|324.68|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|925.00||||925.00|394.05|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|925.00||||925.00|555|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|925.00||||925.00|236.26|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|925.00||||925.00|218.06|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|925.00||||925.00|142.28|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|925.00||||925.00|573.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|CHAMPVA [1240]|CHAMP VA [124000]|925.00||||925.00|693.75|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|FIRST HEALTH [1375]|QUALCHOICE [137513]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MULTIPLAN [1680]|IHC HS [168011]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MULTIPLAN [1680]|HMA [168003]|925.00||||925.00|327.09|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|925.00||||925.00|270.12|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|||925.00||||925.00|277.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|925.00||||925.00|218.06|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|925.00||||925.00|222.42|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|925.00||||925.00|443.54|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|925.00||||925.00|601.25|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|925.00||||925.00|574.43|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|925.00||||925.00|194.25|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|925.00||||925.00|925|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|HEALTHNET [1495]|HEALTHNET [149500]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|925.00||||925.00|236.26|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|FMH BENEFIT SERVICES [1390]|FMH [139000]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|UMR [2035]|UMR OPTIONS [203501]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|925.00||||925.00|245.56|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|925.00||||925.00|217.32|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|TRUSTMARK [2030]|STARMARK [203000]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|CORESOURCE [1315]|CORESOURCE [131500]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|925.00||||925.00|228.19|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|GEHA [1415]|GEHA [141500]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|925.00||||925.00|313.48|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|925.00||||925.00|218.06|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|925.00||||925.00|228.96|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|925.00||||925.00|832.5|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|925.00||||925.00|218.06|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|925.00||||925.00|263.49|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|AETNA [1015]|AETNA ACO WILCO [101532]|925.00||||925.00|337.31|925|142.28 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|925.00||||925.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|925.00||||925.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|925.00||||925.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|925.00||||925.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|925.00||||925.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|925.00||||925.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|925.00||||925.00||| 30687632|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RESP VIRUS 6-11 TARGETS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|925.00||||925.00||| 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|GEHA [1415]|GEHA [141500]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|CORESOURCE [1315]|CORESOURCE [131500]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|149.00||||149.00|100.92|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|CHAMPVA [1240]|CHAMP VA [124000]|149.00||||149.00|111.75|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149.00||||149.00|31.29|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|||149.00||||149.00|44.7|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149.00||||149.00|71.45|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149.00||||149.00|149|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149.00||||149.00|102.49|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MULTIPLAN [1680]|IHC HS [168011]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149.00||||149.00|71.6|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149.00||||149.00|86.66|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|149.00||||149.00|37.25|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|UMR [2035]|UMR OPTIONS [203501]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|149.00||||149.00|100.92|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MULTIPLAN [1680]|HMA [168003]|149.00||||149.00|105.3|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|HEALTHNET [1495]|HEALTHNET [149500]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149.00||||149.00|86.66|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|AETNA [1015]|AETNA ACO WILCO [101532]|149.00||||149.00|110.94|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|TRUSTMARK [2030]|STARMARK [203000]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|149.00||||149.00|46.79|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149.00||||149.00|89.4|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149.00||||149.00|74.5|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149.00||||149.00|77.22|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149.00||||149.00|70.2|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|149.00||||149.00|63.47|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149.00||||149.00|52.3|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|149.00||||149.00|74.65|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149.00||||149.00|134.1|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149.00||||149.00|73.71|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149.00||||149.00|96.85|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149.00||||149.00|77.22|149|31.29 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|149.00||||149.00||| 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149.00||||149.00||| 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|149.00||||149.00||| 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149.00||||149.00||| 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149.00||||149.00||| 30687634|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC RSV DNA/RNA AMP PROBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149.00||||149.00||| 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|267.00||||267.00|23.39|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267.00||||267.00|160.2|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|267.00||||267.00|113.74|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|267.00||||267.00|43.33|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|267.00||||267.00|38.6|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|267.00||||267.00|133.77|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|267.00||||267.00|93.72|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|267.00||||267.00|38.01|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|267.00||||267.00|38.6|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|267.00||||267.00|56.07|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|267.00||||267.00|36.71|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267.00||||267.00|128.03|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|HEALTHNET [1495]|HEALTHNET [149500]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MULTIPLAN [1680]|IHC HS [168011]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|267.00||||267.00|36.84|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|267.00||||267.00|35.79|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|267.00||||267.00|43.46|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|267.00||||267.00|43.33|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MULTIPLAN [1680]|HMA [168003]|267.00||||267.00|52.64|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|267.00||||267.00|50.45|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|AETNA [1015]|AETNA ACO WILCO [101532]|267.00||||267.00|55.46|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|UMR [2035]|UMR OPTIONS [203501]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|267.00||||267.00|51.23|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|267.00||||267.00|267|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|267.00||||267.00|38.01|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|TRUSTMARK [2030]|STARMARK [203000]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|||267.00||||267.00|80.1|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|267.00||||267.00|173.55|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|267.00||||267.00|133.5|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|267.00||||267.00|34.97|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|CHAMPVA [1240]|CHAMP VA [124000]|267.00||||267.00|200.25|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|267.00||||267.00|39.51|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|GEHA [1415]|GEHA [141500]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|CORESOURCE [1315]|CORESOURCE [131500]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|267.00||||267.00|35.09|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|267.00||||267.00|50.45|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|267.00||||267.00|240.3|267|23.39 30687641|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID MRSA AMP PROBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|267.00||||267.00||| 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|284.00||||284.00|19.99|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|CORESOURCE [1315]|CORESOURCE [131500]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|284.00||||284.00|22.59|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|GEHA [1415]|GEHA [141500]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|CHAMPVA [1240]|CHAMP VA [124000]|284.00||||284.00|213|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|||284.00||||284.00|85.2|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|284.00||||284.00|284|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|284.00||||284.00|184.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|284.00||||284.00|29.27|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MULTIPLAN [1680]|IHC HS [168011]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|284.00||||284.00|24.76|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MULTIPLAN [1680]|HMA [168003]|284.00||||284.00|30.08|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|284.00||||284.00|24.84|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|FMH BENEFIT SERVICES [1390]|FMH [139000]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|FIRST HEALTH [1375]|QUALCHOICE [137513]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|284.00||||284.00|170.4|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|284.00||||284.00|20.45|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|284.00||||284.00|28.82|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|UMR [2035]|UMR OPTIONS [203501]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|AETNA [1015]|COVENTRY HEALTHCARE [101502]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|HEALTHNET [1495]|HEALTHNET [149500]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|AETNA [1015]|AETNA ACO WILCO [101532]|284.00||||284.00|31.7|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|284.00||||284.00|21.73|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|284.00||||284.00|13.37|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|284.00||||284.00|22.06|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|284.00||||284.00|59.64|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|284.00||||284.00|21.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|284.00||||284.00|24.76|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|284.00||||284.00|99.68|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|284.00||||284.00|142.28|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|284.00||||284.00|21.73|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|TRUSTMARK [2030]|STARMARK [203000]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|284.00||||284.00|120.98|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|284.00||||284.00|136.18|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|284.00||||284.00|142|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|284.00||||284.00|22.06|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|284.00||||284.00|28.82|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|284.00||||284.00|255.6|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|284.00||||284.00|20.05|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|284.00||||284.00|20.99|284|13.37 30687650|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE DIRECT STREP A|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|284.00||||284.00||| 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130.00||||130.00|36.71|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|130.00||||130.00|55.38|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130.00||||130.00|43.33|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130.00||||130.00|38.6|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130.00||||130.00|45.63|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|130.00||||130.00|65.13|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130.00||||130.00|65|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130.00||||130.00|36.84|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130.00||||130.00|38.01|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|130.00||||130.00|23.39|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130.00||||130.00|27.3|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|TRUSTMARK [2030]|STARMARK [203000]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MULTIPLAN [1680]|IHC HS [168011]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|FMH BENEFIT SERVICES [1390]|FMH [139000]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|FIRST HEALTH [1375]|QUALCHOICE [137513]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|130.00||||130.00|43.46|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130.00||||130.00|43.33|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130.00||||130.00|35.79|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|130.00||||130.00|50.45|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MULTIPLAN [1680]|HMA [168003]|130.00||||130.00|52.64|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|UMR [2035]|UMR OPTIONS [203501]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130.00||||130.00|51.23|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130.00||||130.00|38.01|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130.00||||130.00|130|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130.00||||130.00|38.6|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130.00||||130.00|62.34|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130.00||||130.00|78|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|HEALTHNET [1495]|HEALTHNET [149500]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|CHAMPVA [1240]|CHAMP VA [124000]|130.00||||130.00|97.5|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|130.00||||130.00|50.45|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|GEHA [1415]|GEHA [141500]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|CORESOURCE [1315]|CORESOURCE [131500]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|130.00||||130.00|39.51|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130.00||||130.00|117|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|130.00||||130.00|35.09|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130.00||||130.00|34.97|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130.00||||130.00|84.5|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|AETNA [1015]|AETNA ACO WILCO [101532]|130.00||||130.00|55.46|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|||130.00||||130.00|39|130|23.39 30687651|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP STREP A|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|130.00||||130.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|GEHA [1415]|GEHA [141500]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|87.00||||87.00|22.59|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|CORESOURCE [1315]|CORESOURCE [131500]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87.00||||87.00|19.99|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|CHAMPVA [1240]|CHAMP VA [124000]|87.00||||87.00|65.25|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87.00||||87.00|21.73|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|||87.00||||87.00|26.1|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87.00||||87.00|56.55|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|TRUSTMARK [2030]|STARMARK [203000]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87.00||||87.00|21.73|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87.00||||87.00|87|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87.00||||87.00|24.76|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|87.00||||87.00|24.84|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|UMR [2035]|UMR OPTIONS [203501]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|AETNA [1015]|AETNA ACO WILCO [101532]|87.00||||87.00|31.7|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|HEALTHNET [1495]|HEALTHNET [149500]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MULTIPLAN [1680]|IHC HS [168011]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|87.00||||87.00|13.37|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87.00||||87.00|20.99|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87.00||||87.00|18.27|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87.00||||87.00|43.5|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|87.00||||87.00|43.59|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87.00||||87.00|30.54|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|87.00||||87.00|37.06|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87.00||||87.00|24.76|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87.00||||87.00|41.72|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87.00||||87.00|78.3|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87.00||||87.00|52.2|87|13.37 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MULTIPLAN [1680]|HMA [168003]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87.00||||87.00||| 30687660|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC T.VAGINALIS DIRECT PROBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87.00||||87.00||| 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151.00||||151.00|72.4|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|HEALTHNET [1495]|HEALTHNET [149500]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|AETNA [1015]|AETNA ACO WILCO [101532]|151.00||||151.00|55.46|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MULTIPLAN [1680]|IHC HS [168011]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151.00||||151.00|35.79|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151.00||||151.00|43.33|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|FMH BENEFIT SERVICES [1390]|FMH [139000]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|151.00||||151.00|50.45|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|UMR [2035]|UMR OPTIONS [203501]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MULTIPLAN [1680]|HMA [168003]|151.00||||151.00|52.64|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|FIRST HEALTH [1375]|QUALCHOICE [137513]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|151.00||||151.00|43.46|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151.00||||151.00|51.23|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151.00||||151.00|31.71|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151.00||||151.00|151|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|||151.00||||151.00|45.3|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151.00||||151.00|98.15|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151.00||||151.00|34.97|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|TRUSTMARK [2030]|STARMARK [203000]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|151.00||||151.00|39.51|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|GEHA [1415]|GEHA [141500]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|CORESOURCE [1315]|CORESOURCE [131500]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151.00||||151.00|36.71|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|151.00||||151.00|50.45|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|CHAMPVA [1240]|CHAMP VA [124000]|151.00||||151.00|113.25|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|151.00||||151.00|23.39|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151.00||||151.00|38.01|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151.00||||151.00|38.6|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151.00||||151.00|43.33|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|151.00||||151.00|75.65|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151.00||||151.00|53|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|151.00||||151.00|64.33|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151.00||||151.00|75.5|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151.00||||151.00|36.84|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151.00||||151.00|90.6|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151.00||||151.00|135.9|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151.00||||151.00|38.01|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151.00||||151.00|38.6|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151.00||||151.00|35.09|151|23.39 30687661|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC TRICHOMONAS VAGINALIS AMP PRB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|151.00||||151.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|GEHA [1415]|GEHA [141500]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|CORESOURCE [1315]|CORESOURCE [131500]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|CHAMPVA [1240]|CHAMP VA [124000]|144.00||||144.00|108|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|||144.00||||144.00|43.2|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144.00||||144.00|69.05|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144.00||||144.00|93.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144.00||||144.00|30.24|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|UMR [2035]|UMR OPTIONS [203501]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|144.00||||144.00|36|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|FIRST HEALTH [1375]|QUALCHOICE [137513]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|FMH BENEFIT SERVICES [1390]|FMH [139000]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144.00||||144.00|63.35|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MULTIPLAN [1680]|IHC HS [168011]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|HEALTHNET [1495]|HEALTHNET [149500]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144.00||||144.00|144|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|AETNA [1015]|AETNA ACO WILCO [101532]|144.00||||144.00|81.11|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|TRUSTMARK [2030]|STARMARK [203000]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|144.00||||144.00|34.21|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|144.00||||144.00|72.14|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144.00||||144.00|72|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144.00||||144.00|86.4|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144.00||||144.00|50.54|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|144.00||||144.00|61.34|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144.00||||144.00|63.35|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144.00||||144.00|129.6|144|30.24 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MULTIPLAN [1680]|HMA [168003]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144.00||||144.00||| 30687662|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC ZIKA VIRUS AMPLIFIED PROBE TECHNIQUE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144.00||||144.00||| 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390.00||||390.00|35.79|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|390.00||||390.00|136.89|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|390.00||||390.00|38.6|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|390.00||||390.00|43.33|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|390.00||||390.00|195.39|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|390.00||||390.00|166.14|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|390.00||||390.00|195|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|390.00||||390.00|234|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|390.00||||390.00|38.01|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|390.00||||390.00|36.71|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|390.00||||390.00|23.39|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|TRUSTMARK [2030]|STARMARK [203000]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|HEALTHNET [1495]|HEALTHNET [149500]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MULTIPLAN [1680]|IHC HS [168011]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|390.00||||390.00|50.45|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MULTIPLAN [1680]|HMA [168003]|390.00||||390.00|52.64|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|AETNA [1015]|AETNA ACO WILCO [101532]|390.00||||390.00|55.46|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|390.00||||390.00|43.46|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390.00||||390.00|43.33|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|UMR [2035]|UMR OPTIONS [203501]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|390.00||||390.00|51.23|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|390.00||||390.00|38.6|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|390.00||||390.00|81.9|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|390.00||||390.00|390|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390.00||||390.00|187.01|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|390.00||||390.00|253.5|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390.00||||390.00|36.84|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|390.00||||390.00|34.97|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|390.00||||390.00|39.51|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|GEHA [1415]|GEHA [141500]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|390.00||||390.00|50.45|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|CHAMPVA [1240]|CHAMP VA [124000]|390.00||||390.00|292.5|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|CORESOURCE [1315]|CORESOURCE [131500]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|390.00||||390.00|351|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|390.00||||390.00|35.09|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|390.00||||390.00|38.01|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|||390.00||||390.00|117|390|23.39 30687798|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NUC ACID PROBE AMP INFECTIOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|390.00||||390.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|CORESOURCE [1315]|CORESOURCE [131500]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|591.00||||591.00|42.7|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|||591.00||||591.00|177.3|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|591.00||||591.00|124.11|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|591.00||||591.00|367.01|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|591.00||||591.00|53.07|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MULTIPLAN [1680]|IHC HS [168011]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|591.00||||591.00|61.59|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|AETNA [1015]|AETNA ACO WILCO [101532]|591.00||||591.00|67.7|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|591.00||||591.00|42.84|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|591.00||||591.00|44.83|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|591.00||||591.00|42.84|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|591.00||||591.00|46.42|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|591.00||||591.00|354.6|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|591.00||||591.00|44.98|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|591.00||||591.00|28.56|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|591.00||||591.00|42.84|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|591.00||||591.00|295.5|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|591.00||||591.00|52.88|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|TRUSTMARK [2030]|STARMARK [203000]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|591.00||||591.00|296.09|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|591.00||||591.00|207.44|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|591.00||||591.00|251.77|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|591.00||||591.00|42.84|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|HEALTHNET [1495]|HEALTHNET [149500]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MULTIPLAN [1680]|HMA [168003]|591.00||||591.00|64.26|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|591.00||||591.00|42.84|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|591.00||||591.00|52.88|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|591.00||||591.00|43.7|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|UMR [2035]|UMR OPTIONS [203501]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|591.00||||591.00|591|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|591.00||||591.00|46.42|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|591.00||||591.00|42.84|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|591.00||||591.00|366.42|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|591.00||||591.00|48.25|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|GEHA [1415]|GEHA [141500]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|591.00||||591.00|531.9|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|CHAMPVA [1240]|CHAMP VA [124000]|591.00||||591.00|443.25|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|591.00||||591.00|384.15|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|591.00||||591.00|283.38|591|28.56 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|591.00||||591.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|591.00||||591.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|591.00||||591.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|591.00||||591.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|591.00||||591.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|591.00||||591.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|591.00||||591.00||| 30687799|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC NA QUANT NOS AGENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|591.00||||591.00||| 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|970.00||||970.00|86.66|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|970.00||||970.00|77.22|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|970.00||||970.00|485.97|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|970.00||||970.00|340.47|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|970.00||||970.00|413.22|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|970.00||||970.00|485|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|970.00||||970.00|73.71|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|970.00||||970.00|582|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|970.00||||970.00|76.06|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|970.00||||970.00|77.22|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|970.00||||970.00|46.79|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|HEALTHNET [1495]|HEALTHNET [149500]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|AETNA [1015]|AETNA ACO WILCO [101532]|970.00||||970.00|110.94|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MULTIPLAN [1680]|IHC HS [168011]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MULTIPLAN [1680]|HMA [168003]|970.00||||970.00|105.3|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|FMH BENEFIT SERVICES [1390]|FMH [139000]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|FIRST HEALTH [1375]|QUALCHOICE [137513]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|970.00||||970.00|86.96|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|970.00||||970.00|100.92|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|970.00||||970.00|86.66|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|970.00||||970.00|71.6|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|UMR [2035]|UMR OPTIONS [203501]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|970.00||||970.00|102.49|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|970.00||||970.00|73.46|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|970.00||||970.00|203.7|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|TRUSTMARK [2030]|STARMARK [203000]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|970.00||||970.00|970|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|970.00||||970.00|465.12|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|970.00||||970.00|630.5|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|970.00||||970.00|70.2|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|970.00||||970.00|100.92|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|GEHA [1415]|GEHA [141500]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|970.00||||970.00|79.05|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|970.00||||970.00|69.96|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|CHAMPVA [1240]|CHAMP VA [124000]|970.00||||970.00|727.5|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|970.00||||970.00|76.06|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|||970.00||||970.00|291|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|CORESOURCE [1315]|CORESOURCE [131500]|970.00||||970.00|873|970|46.79 30687801|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IA NUC ACID AMP PROBE MULT ORG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|970.00||||970.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|GEHA [1415]|GEHA [141500]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|CORESOURCE [1315]|CORESOURCE [131500]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|CHAMPVA [1240]|CHAMP VA [124000]|49.00||||49.00|36.75|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.00||||49.00|17.93|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|||49.00||||49.00|14.7|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.00||||49.00|31.85|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.00||||49.00|23.5|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.00||||49.00|49|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.00||||49.00|10.29|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|UMR [2035]|UMR OPTIONS [203501]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.00||||49.00|16.55|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.00||||49.00|20.5|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MULTIPLAN [1680]|IHC HS [168011]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|AETNA [1015]|AETNA ACO WILCO [101532]|49.00||||49.00|23.54|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|HEALTHNET [1495]|HEALTHNET [149500]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|TRUSTMARK [2030]|STARMARK [203000]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.00||||49.00|16.55|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.00||||49.00|24.55|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.00||||49.00|16.5|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.00||||49.00|20.87|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.00||||49.00|18.64|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.00||||49.00|24.5|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.00||||49.00|17.2|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.00||||49.00|44.1|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.00||||49.00|29.4|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.00||||49.00|17.93|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.00||||49.00|17.32|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.00||||49.00|9.93|49|9.93 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MULTIPLAN [1680]|HMA [168003]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.00||||49.00||| 30687804|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGNT BY IA INFLUENZA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.00||||49.00||| 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|175.00||||175.00|61.43|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|175.00||||175.00|18.18|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|175.00||||175.00|87.68|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|175.00||||175.00|74.55|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|175.00||||175.00|87.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|175.00||||175.00|105|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|175.00||||175.00|17.91|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|175.00||||175.00|18.18|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|175.00||||175.00|17.3|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|175.00||||175.00|9.92|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|TRUSTMARK [2030]|STARMARK [203000]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|HEALTHNET [1495]|HEALTHNET [149500]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|AETNA [1015]|COVENTRY HEALTHCARE [101502]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MULTIPLAN [1680]|IHC HS [168011]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|175.00||||175.00|23.76|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MULTIPLAN [1680]|HMA [168003]|175.00||||175.00|24.8|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|FMH BENEFIT SERVICES [1390]|FMH [139000]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|FIRST HEALTH [1375]|QUALCHOICE [137513]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|175.00||||175.00|20.48|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|175.00||||175.00|16.86|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|AETNA [1015]|AETNA ACO WILCO [101532]|175.00||||175.00|23.51|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|UMR [2035]|UMR OPTIONS [203501]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|175.00||||175.00|24.13|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|175.00||||175.00|36.75|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|175.00||||175.00|175|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|175.00||||175.00|17.36|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|175.00||||175.00|83.91|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|175.00||||175.00|113.75|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|175.00||||175.00|16.47|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|CORESOURCE [1315]|CORESOURCE [131500]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|175.00||||175.00|18.62|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|GEHA [1415]|GEHA [141500]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|175.00||||175.00|23.76|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|CHAMPVA [1240]|CHAMP VA [124000]|175.00||||175.00|131.25|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|175.00||||175.00|16.53|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|175.00||||175.00|157.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|175.00||||175.00|17.91|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|||175.00||||175.00|52.5|175|9.92 30687880|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC IMMUNO OPTICAL STREP SCREEN A|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|175.00||||175.00||| 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.00||||119.00|23.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|GEHA [1415]|GEHA [141500]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.00||||119.00|18.11|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|CORESOURCE [1315]|CORESOURCE [131500]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|CHAMPVA [1240]|CHAMP VA [124000]|119.00||||119.00|89.25|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.00||||119.00|16.02|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.00||||119.00|17.42|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|||119.00||||119.00|35.7|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.00||||119.00|77.35|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.00||||119.00|16.39|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.00||||119.00|23.46|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.00||||119.00|19.91|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.00||||119.00|57.06|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|UMR [2035]|UMR OPTIONS [203501]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MULTIPLAN [1680]|IHC HS [168011]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.00||||119.00|23.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MULTIPLAN [1680]|HMA [168003]|119.00||||119.00|24.11|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.00||||119.00|24.99|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.00||||119.00|119|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|AETNA [1015]|AETNA ACO WILCO [101532]|119.00||||119.00|22.86|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|HEALTHNET [1495]|HEALTHNET [149500]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|TRUSTMARK [2030]|STARMARK [203000]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.00||||119.00|9.64|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.00||||119.00|16.82|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.00||||119.00|59.5|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.00||||119.00|50.69|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.00||||119.00|107.1|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.00||||119.00|41.77|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.00||||119.00|59.62|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.00||||119.00|17.68|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.00||||119.00|16.87|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.00||||119.00|71.4|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.00||||119.00|17.68|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.00||||119.00|17.42|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.00||||119.00|16.07|119|9.64 30687899|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC INF AGENT AG DETECT IA/OPTC SCREEN NOC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.00||||119.00||| 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|742.00||||742.00|371|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|742.00||||742.00|143.39|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|742.00||||742.00|160.92|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|742.00||||742.00|371.74|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|742.00||||742.00|260.44|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|742.00||||742.00|316.09|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|742.00||||742.00|136.87|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|742.00||||742.00|445.2|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|742.00||||742.00|141.23|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|742.00||||742.00|143.39|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|742.00||||742.00|136.4|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|TRUSTMARK [2030]|STARMARK [203000]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|HEALTHNET [1495]|HEALTHNET [149500]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MULTIPLAN [1680]|IHC HS [168011]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|FIRST HEALTH [1375]|QUALCHOICE [137513]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|FMH BENEFIT SERVICES [1390]|FMH [139000]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|742.00||||742.00|161.47|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|742.00||||742.00|160.92|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|742.00||||742.00|132.96|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|AETNA [1015]|AETNA ACO WILCO [101532]|742.00||||742.00|206|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|UMR [2035]|UMR OPTIONS [203501]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|742.00||||742.00|190.31|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|742.00||||742.00|86.9|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|742.00||||742.00|155.82|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|742.00||||742.00|742|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|742.00||||742.00|355.79|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|742.00||||742.00|482.3|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|742.00||||742.00|141.23|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|742.00||||742.00|187.39|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|742.00||||742.00|146.79|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|GEHA [1415]|GEHA [141500]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|CORESOURCE [1315]|CORESOURCE [131500]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|742.00||||742.00|129.9|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|CHAMPVA [1240]|CHAMP VA [124000]|742.00||||742.00|556.5|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|742.00||||742.00|667.8|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MULTIPLAN [1680]|HMA [168003]|742.00||||742.00|195.53|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|742.00||||742.00|130.35|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|||742.00||||742.00|222.6|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|742.00||||742.00|187.39|742|86.9 30687900|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE INFECT AGENT DRUG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|742.00||||742.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2727.00||||2727.00|289.91|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|GEHA [1415]|GEHA [141500]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|CORESOURCE [1315]|CORESOURCE [131500]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|CHAMPVA [1240]|CHAMP VA [124000]|2727.00||||2727.00|2045.25|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2727.00||||2727.00|256.57|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2727.00||||2727.00|278.93|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|||2727.00||||2727.00|818.1|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2727.00||||2727.00|1772.55|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2727.00||||2727.00|1307.6|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2727.00||||2727.00|572.67|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2727.00||||2727.00|2727|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|UMR [2035]|UMR OPTIONS [203501]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2727.00||||2727.00|317.84|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2727.00||||2727.00|318.9|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MULTIPLAN [1680]|IHC HS [168011]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|AETNA [1015]|AETNA ACO WILCO [101532]|2727.00||||2727.00|406.87|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|HEALTHNET [1495]|HEALTHNET [149500]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|TRUSTMARK [2030]|STARMARK [203000]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2727.00||||2727.00|1636.2|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2727.00||||2727.00|317.84|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2727.00||||2727.00|1161.7|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2727.00||||2727.00|1366.23|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2727.00||||2727.00|957.18|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2727.00||||2727.00|1363.5|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2727.00||||2727.00|278.93|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2727.00||||2727.00|269.4|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2727.00||||2727.00|171.63|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2727.00||||2727.00|2454.3|2727|171.63 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MULTIPLAN [1680]|HMA [168003]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2727.00||||2727.00||| 30687901|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE DNA/RNA HIV-1 REV TRNSCR&PROTEAS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2727.00||||2727.00||| 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2548.00||||2548.00|894.35|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2548.00||||2548.00|317.84|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2548.00||||2548.00|1276.55|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2548.00||||2548.00|1085.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2548.00||||2548.00|1274|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2548.00||||2548.00|270.32|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2548.00||||2548.00|1528.8|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2548.00||||2548.00|278.93|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2548.00||||2548.00|269.4|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2548.00||||2548.00|171.63|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|TRUSTMARK [2030]|STARMARK [203000]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2548.00||||2548.00|370.11|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MULTIPLAN [1680]|HMA [168003]|2548.00||||2548.00|386.18|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|FMH BENEFIT SERVICES [1390]|FMH [139000]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|FIRST HEALTH [1375]|QUALCHOICE [137513]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2548.00||||2548.00|318.9|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2548.00||||2548.00|317.84|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2548.00||||2548.00|262.6|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|AETNA [1015]|AETNA ACO WILCO [101532]|2548.00||||2548.00|406.87|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|UMR [2035]|UMR OPTIONS [203501]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|HEALTHNET [1495]|HEALTHNET [149500]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MULTIPLAN [1680]|IHC HS [168011]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2548.00||||2548.00|375.88|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2548.00||||2548.00|535.08|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2548.00||||2548.00|2548|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2548.00||||2548.00|283.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2548.00||||2548.00|1221.77|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2548.00||||2548.00|1656.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2548.00||||2548.00|256.57|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2548.00||||2548.00|289.91|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|GEHA [1415]|GEHA [141500]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2548.00||||2548.00|283.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2548.00||||2548.00|370.11|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|CHAMPVA [1240]|CHAMP VA [124000]|2548.00||||2548.00|1911|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|CORESOURCE [1315]|CORESOURCE [131500]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2548.00||||2548.00|278.93|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|||2548.00||||2548.00|764.4|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2548.00||||2548.00|257.45|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2548.00||||2548.00|2293.2|2548|171.63 30687902|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC GENOTYPE HEPATITIS C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2548.00||||2548.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|GEHA [1415]|GEHA [141500]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3524.00||||3524.00|550.29|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|CORESOURCE [1315]|CORESOURCE [131500]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|CHAMPVA [1240]|CHAMP VA [124000]|3524.00||||3524.00|2643|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3524.00||||3524.00|486.99|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3524.00||||3524.00|529.44|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|||3524.00||||3524.00|1057.2|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3524.00||||3524.00|2290.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3524.00||||3524.00|1689.76|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3524.00||||3524.00|3524|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|UMR [2035]|UMR OPTIONS [203501]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3524.00||||3524.00|603.28|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3524.00||||3524.00|605.31|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|FIRST HEALTH [1375]|QUALCHOICE [137513]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|FMH BENEFIT SERVICES [1390]|FMH [139000]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MULTIPLAN [1680]|IHC HS [168011]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3524.00||||3524.00|740.04|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|AETNA [1015]|AETNA ACO WILCO [101532]|3524.00||||3524.00|772.3|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|HEALTHNET [1495]|HEALTHNET [149500]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|TRUSTMARK [2030]|STARMARK [203000]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3524.00||||3524.00|511.35|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3524.00||||3524.00|1762|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3524.00||||3524.00|1236.92|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3524.00||||3524.00|1501.22|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3524.00||||3524.00|1765.52|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3524.00||||3524.00|3171.6|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3524.00||||3524.00|2114.4|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3524.00||||3524.00|603.28|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3524.00||||3524.00|529.44|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3524.00||||3524.00|325.77|3524|325.77 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MULTIPLAN [1680]|HMA [168003]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3524.00||||3524.00||| 30687903|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC PHENOTYPE DNA HIV W/CULT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3524.00||||3524.00||| 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1107.00||||1107.00|553.5|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1107.00||||1107.00|317.84|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1107.00||||1107.00|283.2|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1107.00||||1107.00|554.61|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1107.00||||1107.00|388.56|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1107.00||||1107.00|471.58|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1107.00||||1107.00|270.32|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1107.00||||1107.00|664.2|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1107.00||||1107.00|278.93|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1107.00||||1107.00|283.2|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1107.00||||1107.00|269.4|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1107.00||||1107.00|171.63|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|HEALTHNET [1495]|HEALTHNET [149500]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MULTIPLAN [1680]|IHC HS [168011]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MULTIPLAN [1680]|HMA [168003]|1107.00||||1107.00|386.18|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1107.00||||1107.00|318.9|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1107.00||||1107.00|317.84|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1107.00||||1107.00|262.6|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1107.00||||1107.00|370.11|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|AETNA [1015]|AETNA ACO WILCO [101532]|1107.00||||1107.00|406.87|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|UMR [2035]|UMR OPTIONS [203501]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1107.00||||1107.00|375.88|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|TRUSTMARK [2030]|STARMARK [203000]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1107.00||||1107.00|232.47|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1107.00||||1107.00|1107|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1107.00||||1107.00|530.81|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1107.00||||1107.00|719.55|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1107.00||||1107.00|370.11|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|GEHA [1415]|GEHA [141500]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1107.00||||1107.00|289.91|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|CORESOURCE [1315]|CORESOURCE [131500]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1107.00||||1107.00|256.57|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|CHAMPVA [1240]|CHAMP VA [124000]|1107.00||||1107.00|830.25|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1107.00||||1107.00|257.45|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1107.00||||1107.00|996.3|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1107.00||||1107.00|278.93|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|||1107.00||||1107.00|332.1|1107|171.63 30687912|EAP|0306 - LABORATORY-BACTERIOLOGY AND MICROBIOLOGY|HC HEP B VIRUS GENOTYPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1107.00||||1107.00||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|14.37||||14.37|10.78|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.37||||14.37|6.89|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.37||||14.37|9.34|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.37||||14.37|3.02|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.37||||14.37|6.18|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|||14.37||||14.37|4.31|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.37||||14.37|7.2|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.37||||14.37|12.93|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.37||||14.37|8.62|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.37||||14.37|6.12|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.37||||14.37|5.04|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.37||||14.37|6.18|12.93|3.02 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.37||||14.37||| 3071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.37||||14.37||| 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|140.00||||140.00|3.49|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|140.00||||140.00|3.92|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|140.00||||140.00|70.14|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|140.00||||140.00|49.14|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|140.00||||140.00|59.64|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|140.00||||140.00|70|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|140.00||||140.00|3.33|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|140.00||||140.00|3.43|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|140.00||||140.00|3.32|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|140.00||||140.00|2.11|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|TRUSTMARK [2030]|STARMARK [203000]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|HEALTHNET [1495]|HEALTHNET [149500]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|140.00||||140.00|4.56|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MULTIPLAN [1680]|HMA [168003]|140.00||||140.00|4.76|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|FMH BENEFIT SERVICES [1390]|FMH [139000]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|FIRST HEALTH [1375]|QUALCHOICE [137513]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|140.00||||140.00|3.92|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|140.00||||140.00|3.92|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MULTIPLAN [1680]|IHC HS [168011]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|140.00||||140.00|3.23|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|AETNA [1015]|AETNA ACO WILCO [101532]|140.00||||140.00|5.01|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|UMR [2035]|UMR OPTIONS [203501]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|140.00||||140.00|4.63|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|140.00||||140.00|29.4|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|140.00||||140.00|3.49|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|140.00||||140.00|140|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|140.00||||140.00|84|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|140.00||||140.00|67.13|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|140.00||||140.00|91|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|140.00||||140.00|3.57|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|GEHA [1415]|GEHA [141500]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|CORESOURCE [1315]|CORESOURCE [131500]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|140.00||||140.00|4.56|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|CHAMPVA [1240]|CHAMP VA [124000]|140.00||||140.00|105|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|140.00||||140.00|3.17|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|140.00||||140.00|126|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|140.00||||140.00|3.43|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|||140.00||||140.00|42|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|140.00||||140.00|3.16|140|2.11 30781001|EAP|0307 - LABORATORY-UROLOGY|HC URINALYSIS AUTO W/ MICRO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|140.00||||140.00||| 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|GEHA [1415]|GEHA [141500]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30.00||||30.00|3.92|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|CORESOURCE [1315]|CORESOURCE [131500]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|CHAMPVA [1240]|CHAMP VA [124000]|30.00||||30.00|22.5|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30.00||||30.00|3.47|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30.00||||30.00|3.77|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|||30.00||||30.00|9|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30.00||||30.00|14.39|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30.00||||30.00|6.3|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30.00||||30.00|5.08|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|UMR [2035]|UMR OPTIONS [203501]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30.00||||30.00|4.31|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|FIRST HEALTH [1375]|QUALCHOICE [137513]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30.00||||30.00|3.55|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MULTIPLAN [1680]|IHC HS [168011]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|FMH BENEFIT SERVICES [1390]|FMH [139000]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30.00||||30.00|5|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MULTIPLAN [1680]|HMA [168003]|30.00||||30.00|5.22|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|AETNA [1015]|AETNA ACO WILCO [101532]|30.00||||30.00|4.95|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30.00||||30.00|30|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30.00||||30.00|19.5|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|HEALTHNET [1495]|HEALTHNET [149500]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|TRUSTMARK [2030]|STARMARK [203000]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30.00||||30.00|2.09|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30.00||||30.00|3.65|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30.00||||30.00|18|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30.00||||30.00|15|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30.00||||30.00|5|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30.00||||30.00|12.78|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30.00||||30.00|27|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30.00||||30.00|10.53|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30.00||||30.00|3.83|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30.00||||30.00|15.03|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30.00||||30.00|3.83|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30.00||||30.00|3.77|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30.00||||30.00|3.48|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30.00||||30.00|3.65|30|2.09 30781002|EAP|0307 - LABORATORY-UROLOGY|HC UA NONAUTO W/O MICRO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30.00||||30.00||| 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|CORESOURCE [1315]|CORESOURCE [131500]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.00||||58.00|2.54|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|GEHA [1415]|GEHA [141500]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.00||||58.00|2.48|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.00||||58.00|29.06|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.00||||58.00|20.36|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.00||||58.00|24.71|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.00||||58.00|34.8|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.00||||58.00|2.36|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.00||||58.00|2.44|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.00||||58.00|2.48|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.00||||58.00|1.49|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|TRUSTMARK [2030]|STARMARK [203000]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|HEALTHNET [1495]|HEALTHNET [149500]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|AETNA [1015]|AETNA ACO WILCO [101532]|58.00||||58.00|3.54|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MULTIPLAN [1680]|IHC HS [168011]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.00||||58.00|3.23|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MULTIPLAN [1680]|HMA [168003]|58.00||||58.00|3.38|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.00||||58.00|2.79|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.00||||58.00|2.77|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.00||||58.00|2.3|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.00||||58.00|2.36|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|UMR [2035]|UMR OPTIONS [203501]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.00||||58.00|3.29|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.00||||58.00|12.18|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.00||||58.00|58|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.00||||58.00|29|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.00||||58.00|2.77|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.00||||58.00|27.81|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.00||||58.00|37.7|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|||58.00||||58.00|17.4|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.00||||58.00|2.44|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.00||||58.00|2.25|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.00||||58.00|52.2|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|CHAMPVA [1240]|CHAMP VA [124000]|58.00||||58.00|43.5|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.00||||58.00|3.23|58|1.49 30781003|EAP|0307 - LABORATORY-UROLOGY|HC UA AUTO W/O MICRO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.00||||58.00||| 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00|4.38|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00|3.31|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|||39.00||||39.00|11.7|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00|39|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00|4.45|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00|3.11|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|3.76|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00|3.78|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00|4.58|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00|4.38|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00|4.83|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00|2.03|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00|3.2|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00|3.36|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00|3.44|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00|3.31|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00|3.2|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00|19.5|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|3.76|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00|3.05|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00|3.36|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|39|2.03 30781015|EAP|0307 - LABORATORY-UROLOGY|HC UA MICRO ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00|4|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|3.71|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00|14.5|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00|3.82|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00|3.94|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00|3.81|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00|2.18|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00|5.23|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|5.46|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00|4.5|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|3.71|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00|5.17|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00|3.71|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|5.31|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00|4|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00|29|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|||29.00||||29.00|8.7|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00|3.94|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00|3.64|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00|3.63|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00|5.23|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00|4.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|29|2.18 30781050|EAP|0307 - LABORATORY-UROLOGY|HC URINE VOLUME MEASURE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|||10.00||||10.00|3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|880.00||||880.00|440|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|880.00||||880.00|528|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|880.00||||880.00|202.42|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|880.00||||880.00|308.88|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|880.00||||880.00|374.88|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|880.00||||880.00|177.64|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|880.00||||880.00|171.57|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|880.00||||880.00|109.31|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|HEALTHNET [1495]|HEALTHNET [149500]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MULTIPLAN [1680]|IHC HS [168011]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|FMH BENEFIT SERVICES [1390]|FMH [139000]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|FIRST HEALTH [1375]|QUALCHOICE [137513]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|880.00||||880.00|202.42|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|AETNA [1015]|AETNA ACO WILCO [101532]|880.00||||880.00|259.13|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|880.00||||880.00|203.09|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|TRUSTMARK [2030]|STARMARK [203000]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|UMR [2035]|UMR OPTIONS [203501]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|880.00||||880.00|184.8|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|880.00||||880.00|880|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|880.00||||880.00|572|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|880.00||||880.00|421.96|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|||880.00||||880.00|264|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|880.00||||880.00|440.88|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|880.00||||880.00|177.64|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|880.00||||880.00|163.39|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|CHAMPVA [1240]|CHAMP VA [124000]|880.00||||880.00|660|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|CORESOURCE [1315]|CORESOURCE [131500]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|GEHA [1415]|GEHA [141500]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|880.00||||880.00|792|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|880.00||||880.00|184.63|880|109.31 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MULTIPLAN [1680]|HMA [168003]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|880.00||||880.00||| 31081206|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BCR/ABL1 GENE MAJOR BP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|880.00||||880.00||| 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|GEHA [1415]|GEHA [141500]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|CORESOURCE [1315]|CORESOURCE [131500]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|226.00||||226.00|197.52|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|226.00||||226.00|252.16|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|CHAMPVA [1240]|CHAMP VA [124000]|226.00||||226.00|169.5|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226.00||||226.00|190.04|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226.00||||226.00|146.9|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226.00||||226.00|108.37|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226.00||||226.00|226|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226.00||||226.00|47.46|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|UMR [2035]|UMR OPTIONS [203501]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226.00||||226.00|178.91|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|226.00||||226.00|217.27|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|FIRST HEALTH [1375]|QUALCHOICE [137513]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|FMH BENEFIT SERVICES [1390]|FMH [139000]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MULTIPLAN [1680]|IHC HS [168011]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226.00||||226.00|256.08|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|226.00||||226.00|252.16|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MULTIPLAN [1680]|HMA [168003]|226.00||||226.00|263.1|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|||226.00||||226.00|67.8|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|AETNA [1015]|AETNA ACO WILCO [101532]|226.00||||226.00|226|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|HEALTHNET [1495]|HEALTHNET [149500]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|TRUSTMARK [2030]|STARMARK [203000]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226.00||||226.00|174.81|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|226.00||||226.00|105.24|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226.00||||226.00|183.55|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226.00||||226.00|192.94|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226.00||||226.00|190.04|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226.00||||226.00|184.17|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226.00||||226.00|135.6|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|226.00||||226.00|113.23|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226.00||||226.00|79.33|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|226.00||||226.00|96.28|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226.00||||226.00|113|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226.00||||226.00|175.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226.00||||226.00|203.4|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226.00||||226.00|192.94|263.1|47.46 31081210|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC BRAF GENE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|226.00||||226.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1812.00||||1812.00|906|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1812.00||||1812.00|499|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1812.00||||1812.00|907.81|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1812.00||||1812.00|636.01|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1812.00||||1812.00|771.91|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1812.00||||1812.00|1087.2|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|TRUSTMARK [2030]|STARMARK [203000]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|HEALTHNET [1495]|HEALTHNET [149500]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|AETNA [1015]|AETNA ACO WILCO [101532]|1812.00||||1812.00|709.78|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|FMH BENEFIT SERVICES [1390]|FMH [139000]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MULTIPLAN [1680]|IHC HS [168011]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|FIRST HEALTH [1375]|QUALCHOICE [137513]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1812.00||||1812.00|499|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|UMR [2035]|UMR OPTIONS [203501]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1812.00||||1812.00|299.4|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1812.00||||1812.00|380.52|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1812.00||||1812.00|1812|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1812.00||||1812.00|868.85|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1812.00||||1812.00|1177.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|||1812.00||||1812.00|543.6|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|CHAMPVA [1240]|CHAMP VA [124000]|1812.00||||1812.00|1359|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|CORESOURCE [1315]|CORESOURCE [131500]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|GEHA [1415]|GEHA [141500]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1812.00||||1812.00|1630.8|1812|299.4 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MULTIPLAN [1680]|HMA [168003]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1812.00||||1812.00||| 31081223|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE ANALYSIS FULL SEQ|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|CORESOURCE [1315]|CORESOURCE [131500]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|||1812.00||||1812.00|543.6|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1812.00||||1812.00|1177.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1812.00||||1812.00|1812|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1812.00||||1812.00|380.52|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|UMR [2035]|UMR OPTIONS [203501]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1812.00||||1812.00|168.75|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|FIRST HEALTH [1375]|QUALCHOICE [137513]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|FMH BENEFIT SERVICES [1390]|FMH [139000]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MULTIPLAN [1680]|IHC HS [168011]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|AETNA [1015]|AETNA ACO WILCO [101532]|1812.00||||1812.00|240.03|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1812.00||||1812.00|868.85|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|HEALTHNET [1495]|HEALTHNET [149500]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|TRUSTMARK [2030]|STARMARK [203000]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1812.00||||1812.00|101.25|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|CHAMPVA [1240]|CHAMP VA [124000]|1812.00||||1812.00|1359|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|GEHA [1415]|GEHA [141500]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1812.00||||1812.00|1087.2|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1812.00||||1812.00|168.75|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1812.00||||1812.00|907.81|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1812.00||||1812.00|636.01|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1812.00||||1812.00|771.91|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1812.00||||1812.00|906|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1812.00||||1812.00|1630.8|1812|101.25 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MULTIPLAN [1680]|HMA [168003]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1812.00||||1812.00||| 31081224|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CFTR GENE INTRON 8 POLY-T|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1812.00||||1812.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2325.00||||2325.00|1162.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2325.00||||2325.00|291.36|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2325.00||||2325.00|1164.83|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2325.00||||2325.00|816.08|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2325.00||||2325.00|1395|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2325.00||||2325.00|315.67|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2325.00||||2325.00|304.89|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2325.00||||2325.00|174.82|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|HEALTHNET [1495]|HEALTHNET [149500]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|AETNA [1015]|AETNA ACO WILCO [101532]|2325.00||||2325.00|414.43|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MULTIPLAN [1680]|IHC HS [168011]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|FMH BENEFIT SERVICES [1390]|FMH [139000]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|FIRST HEALTH [1375]|QUALCHOICE [137513]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2325.00||||2325.00|291.36|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2325.00||||2325.00|360.91|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|TRUSTMARK [2030]|STARMARK [203000]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|UMR [2035]|UMR OPTIONS [203501]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2325.00||||2325.00|488.25|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2325.00||||2325.00|2325|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2325.00||||2325.00|1114.84|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2325.00||||2325.00|990.45|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2325.00||||2325.00|1511.25|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|||2325.00||||2325.00|697.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2325.00||||2325.00|315.67|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2325.00||||2325.00|290.37|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|CHAMPVA [1240]|CHAMP VA [124000]|2325.00||||2325.00|1743.75|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2325.00||||2325.00|328.1|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|CORESOURCE [1315]|CORESOURCE [131500]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|GEHA [1415]|GEHA [141500]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2325.00||||2325.00|2092.5|2325|174.82 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MULTIPLAN [1680]|HMA [168003]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2325.00||||2325.00||| 31081225|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC CYP2C19 GENOTYPING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2325.00||||2325.00||| 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|GEHA [1415]|GEHA [141500]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|CORESOURCE [1315]|CORESOURCE [131500]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3600.00||||3600.00|1667.62|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|CHAMPVA [1240]|CHAMP VA [124000]|3600.00||||3600.00|2700|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|||3600.00||||3600.00|1080|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3600.00||||3600.00|2340|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3600.00||||3600.00|1726.2|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3600.00||||3600.00|756|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|UMR [2035]|UMR OPTIONS [203501]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3600.00||||3600.00|1183.2|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|FIRST HEALTH [1375]|QUALCHOICE [137513]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|FMH BENEFIT SERVICES [1390]|FMH [139000]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3600.00||||3600.00|1693.6|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MULTIPLAN [1680]|IHC HS [168011]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3600.00||||3600.00|3600|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3600.00||||3600.00|1667.62|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MULTIPLAN [1680]|HMA [168003]|3600.00||||3600.00|1740|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|AETNA [1015]|AETNA ACO WILCO [101532]|3600.00||||3600.00|1649.98|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|HEALTHNET [1495]|HEALTHNET [149500]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|TRUSTMARK [2030]|STARMARK [203000]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3600.00||||3600.00|696|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3600.00||||3600.00|1276|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3600.00||||3600.00|1218|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3600.00||||3600.00|2160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3600.00||||3600.00|1803.6|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3600.00||||3600.00|1263.6|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3600.00||||3600.00|1533.6|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3600.00||||3600.00|1800|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3600.00||||3600.00|1160|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3600.00||||3600.00|3240|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3600.00||||3600.00|1276|3600|696 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3600.00||||3600.00||| 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3600.00||||3600.00||| 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3600.00||||3600.00||| 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3600.00||||3600.00||| 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3600.00||||3600.00||| 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3600.00||||3600.00||| 31081229|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SNP MICROARRAY CHROMO ABNORM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3600.00||||3600.00||| 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3856.00||||3856.00|357.04|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3856.00||||3856.00|1928|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3856.00||||3856.00|1353.46|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3856.00||||3856.00|1642.66|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3856.00||||3856.00|2313.6|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3856.00||||3856.00|351.67|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3856.00||||3856.00|357.04|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3856.00||||3856.00|339.65|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3856.00||||3856.00|194.75|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|TRUSTMARK [2030]|STARMARK [203000]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|HEALTHNET [1495]|HEALTHNET [149500]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|AETNA [1015]|AETNA ACO WILCO [101532]|3856.00||||3856.00|461.69|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3856.00||||3856.00|466.62|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MULTIPLAN [1680]|HMA [168003]|3856.00||||3856.00|486.87|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|FMH BENEFIT SERVICES [1390]|FMH [139000]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|FIRST HEALTH [1375]|QUALCHOICE [137513]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3856.00||||3856.00|402.07|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3856.00||||3856.00|331.07|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MULTIPLAN [1680]|IHC HS [168011]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|UMR [2035]|UMR OPTIONS [203501]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3856.00||||3856.00|473.89|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3856.00||||3856.00|809.76|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3856.00||||3856.00|340.81|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3856.00||||3856.00|3856|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3856.00||||3856.00|1848.95|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3856.00||||3856.00|1931.86|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3856.00||||3856.00|2506.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|||3856.00||||3856.00|1156.8|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3856.00||||3856.00|351.67|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3856.00||||3856.00|324.58|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3856.00||||3856.00|323.47|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|CHAMPVA [1240]|CHAMP VA [124000]|3856.00||||3856.00|2892|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3856.00||||3856.00|466.62|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3856.00||||3856.00|365.52|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|CORESOURCE [1315]|CORESOURCE [131500]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|GEHA [1415]|GEHA [141500]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3856.00||||3856.00|3470.4|3856|194.75 31081235|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC EGFR GENE COM VARIANTS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3856.00||||3856.00||| 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|CORESOURCE [1315]|CORESOURCE [131500]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|564.00||||564.00|73.97|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|564.00||||564.00|94.44|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|CHAMPVA [1240]|CHAMP VA [124000]|564.00||||564.00|423|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|564.00||||564.00|65.47|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|||564.00||||564.00|169.2|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|564.00||||564.00|366.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|564.00||||564.00|564|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|564.00||||564.00|118.44|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|564.00||||564.00|95.91|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|564.00||||564.00|81.37|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.00||||564.00|67|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|UMR [2035]|UMR OPTIONS [203501]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MULTIPLAN [1680]|IHC HS [168011]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|564.00||||564.00|94.44|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MULTIPLAN [1680]|HMA [168003]|564.00||||564.00|98.54|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|564.00||||564.00|270.44|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|AETNA [1015]|AETNA ACO WILCO [101532]|564.00||||564.00|93.44|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|564.00||||564.00|71.17|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|HEALTHNET [1495]|HEALTHNET [149500]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|TRUSTMARK [2030]|STARMARK [203000]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|564.00||||564.00|39.41|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|564.00||||564.00|68.75|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|564.00||||564.00|72.26|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|564.00||||564.00|71.17|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|564.00||||564.00|68.97|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|GEHA [1415]|GEHA [141500]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.00||||564.00|338.4|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|564.00||||564.00|282.56|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|564.00||||564.00|197.96|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|564.00||||564.00|240.26|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|564.00||||564.00|282|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|564.00||||564.00|65.69|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|564.00||||564.00|507.6|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|564.00||||564.00|72.26|564|39.41 31081240|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F2 ANALYSIS 20210G>A VARIANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|564.00||||564.00||| 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|564.00||||564.00|282|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|564.00||||564.00|75.44|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|564.00||||564.00|240.26|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|564.00||||564.00|282.56|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|564.00||||564.00|197.96|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.00||||564.00|338.4|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|564.00||||564.00|77.04|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|564.00||||564.00|79.49|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|564.00||||564.00|80.71|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|564.00||||564.00|76.78|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|564.00||||564.00|44.02|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|HEALTHNET [1495]|HEALTHNET [149500]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|AETNA [1015]|AETNA ACO WILCO [101532]|564.00||||564.00|104.36|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MULTIPLAN [1680]|IHC HS [168011]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|564.00||||564.00|105.48|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MULTIPLAN [1680]|HMA [168003]|564.00||||564.00|110.06|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.00||||564.00|75.44|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|564.00||||564.00|90.88|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.00||||564.00|74.84|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|UMR [2035]|UMR OPTIONS [203501]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|564.00||||564.00|107.12|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|TRUSTMARK [2030]|STARMARK [203000]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|564.00||||564.00|118.44|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|564.00||||564.00|564|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|564.00||||564.00|270.44|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|564.00||||564.00|366.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|||564.00||||564.00|169.2|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|564.00||||564.00|79.49|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|564.00||||564.00|80.71|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|564.00||||564.00|73.37|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|564.00||||564.00|73.12|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|CHAMPVA [1240]|CHAMP VA [124000]|564.00||||564.00|423|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|564.00||||564.00|105.48|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|564.00||||564.00|82.62|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|CORESOURCE [1315]|CORESOURCE [131500]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|GEHA [1415]|GEHA [141500]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|564.00||||564.00|507.6|564|44.02 31081241|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC F5 GENE ANALYSIS LEIDEN VARIANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|564.00||||564.00||| 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|GEHA [1415]|GEHA [141500]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|CORESOURCE [1315]|CORESOURCE [131500]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|498.00||||498.00|237.94|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|CHAMPVA [1240]|CHAMP VA [124000]|498.00||||498.00|373.5|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|498.00||||498.00|179.32|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|498.00||||498.00|323.7|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|498.00||||498.00|238.79|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|498.00||||498.00|104.58|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|UMR [2035]|UMR OPTIONS [203501]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|498.00||||498.00|168.82|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|498.00||||498.00|205.02|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|FIRST HEALTH [1375]|QUALCHOICE [137513]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|FMH BENEFIT SERVICES [1390]|FMH [139000]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MULTIPLAN [1680]|IHC HS [168011]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|498.00||||498.00|241.64|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|498.00||||498.00|498|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|498.00||||498.00|237.94|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MULTIPLAN [1680]|HMA [168003]|498.00||||498.00|248.27|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|AETNA [1015]|AETNA ACO WILCO [101532]|498.00||||498.00|235.42|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|HEALTHNET [1495]|HEALTHNET [149500]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|TRUSTMARK [2030]|STARMARK [203000]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|||498.00||||498.00|149.4|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|498.00||||498.00|99.31|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|498.00||||498.00|164.94|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|498.00||||498.00|173.19|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|498.00||||498.00|182.06|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|498.00||||498.00|186.38|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|498.00||||498.00|179.32|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|498.00||||498.00|173.79|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|498.00||||498.00|298.8|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|498.00||||498.00|249.5|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|498.00||||498.00|174.8|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|498.00||||498.00|212.15|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|498.00||||498.00|249|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|498.00||||498.00|165.51|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|498.00||||498.00|448.2|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|498.00||||498.00|182.06|498|99.31 31081245|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANALYSIS ITD VARIANTS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|498.00||||498.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|423.00||||423.00|211.5|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|423.00||||423.00|83|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|423.00||||423.00|211.92|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|423.00||||423.00|148.47|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|423.00||||423.00|253.8|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|TRUSTMARK [2030]|STARMARK [203000]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|HEALTHNET [1495]|HEALTHNET [149500]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|AETNA [1015]|AETNA ACO WILCO [101532]|423.00||||423.00|118.06|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|FMH BENEFIT SERVICES [1390]|FMH [139000]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MULTIPLAN [1680]|IHC HS [168011]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|FIRST HEALTH [1375]|QUALCHOICE [137513]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|423.00||||423.00|83|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|UMR [2035]|UMR OPTIONS [203501]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|423.00||||423.00|49.8|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|423.00||||423.00|88.83|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|423.00||||423.00|423|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|423.00||||423.00|202.83|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|423.00||||423.00|180.2|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|423.00||||423.00|274.95|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|||423.00||||423.00|126.9|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|CHAMPVA [1240]|CHAMP VA [124000]|423.00||||423.00|317.25|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|CORESOURCE [1315]|CORESOURCE [131500]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|GEHA [1415]|GEHA [141500]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|423.00||||423.00|380.7|423|49.8 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MULTIPLAN [1680]|HMA [168003]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|423.00||||423.00||| 31081246|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FLT3 GENE ANAL TKD VARIANTS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|423.00||||423.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|GEHA [1415]|GEHA [141500]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|CORESOURCE [1315]|CORESOURCE [131500]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|||1249.00||||1249.00|374.7|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1249.00||||1249.00|811.85|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1249.00||||1249.00|598.9|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1249.00||||1249.00|1249|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1249.00||||1249.00|262.29|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1249.00||||1249.00|51.45|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|UMR [2035]|UMR OPTIONS [203501]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MULTIPLAN [1680]|IHC HS [168011]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|AETNA [1015]|AETNA ACO WILCO [101532]|1249.00||||1249.00|73.18|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|HEALTHNET [1495]|HEALTHNET [149500]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|TRUSTMARK [2030]|STARMARK [203000]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1249.00||||1249.00|30.87|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|CHAMPVA [1240]|CHAMP VA [124000]|1249.00||||1249.00|936.75|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1249.00||||1249.00|749.4|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1249.00||||1249.00|51.45|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1249.00||||1249.00|625.75|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1249.00||||1249.00|438.4|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1249.00||||1249.00|532.07|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1249.00||||1249.00|624.5|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1249.00||||1249.00|1124.1|1249|30.87 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MULTIPLAN [1680]|HMA [168003]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1249.00||||1249.00||| 31081255|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC TAYSACHS MUTATION ANALYSIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1249.00||||1249.00||| 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1065.00||||1065.00|532.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1065.00||||1065.00|80.69|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1065.00||||1065.00|453.69|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1065.00||||1065.00|533.57|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1065.00||||1065.00|639|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1065.00||||1065.00|68.63|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1065.00||||1065.00|70.82|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1065.00||||1065.00|71.9|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1065.00||||1065.00|68.4|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1065.00||||1065.00|43.57|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|TRUSTMARK [2030]|STARMARK [203000]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|HEALTHNET [1495]|HEALTHNET [149500]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|AETNA [1015]|AETNA ACO WILCO [101532]|1065.00||||1065.00|103.3|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MULTIPLAN [1680]|IHC HS [168011]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1065.00||||1065.00|93.96|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MULTIPLAN [1680]|HMA [168003]|1065.00||||1065.00|98.04|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1065.00||||1065.00|80.69|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1065.00||||1065.00|80.97|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1065.00||||1065.00|66.67|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|UMR [2035]|UMR OPTIONS [203501]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1065.00||||1065.00|95.43|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1065.00||||1065.00|223.65|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1065.00||||1065.00|1065|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1065.00||||1065.00|510.67|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1065.00||||1065.00|692.25|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|||1065.00||||1065.00|319.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1065.00||||1065.00|70.82|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1065.00||||1065.00|373.82|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1065.00||||1065.00|71.9|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1065.00||||1065.00|65.36|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1065.00||||1065.00|65.14|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|CHAMPVA [1240]|CHAMP VA [124000]|1065.00||||1065.00|798.75|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1065.00||||1065.00|93.96|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1065.00||||1065.00|73.61|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|CORESOURCE [1315]|CORESOURCE [131500]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|GEHA [1415]|GEHA [141500]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1065.00||||1065.00|958.5|1065|43.57 31081256|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HFE GENE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1065.00||||1065.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|GEHA [1415]|GEHA [141500]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|CORESOURCE [1315]|CORESOURCE [131500]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|CHAMPVA [1240]|CHAMP VA [124000]|368.00||||368.00|276|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|368.00||||368.00|239.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|368.00||||368.00|176.46|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|368.00||||368.00|77.28|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|UMR [2035]|UMR OPTIONS [203501]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|368.00||||368.00|39.31|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MULTIPLAN [1680]|IHC HS [168011]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|368.00||||368.00|368|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|||368.00||||368.00|110.4|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|AETNA [1015]|AETNA ACO WILCO [101532]|368.00||||368.00|55.91|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|HEALTHNET [1495]|HEALTHNET [149500]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|TRUSTMARK [2030]|STARMARK [203000]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|368.00||||368.00|23.59|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|368.00||||368.00|220.8|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|368.00||||368.00|184.37|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|368.00||||368.00|129.17|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|368.00||||368.00|156.77|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|368.00||||368.00|39.31|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|368.00||||368.00|184|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|368.00||||368.00|331.2|368|23.59 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MULTIPLAN [1680]|HMA [168003]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|368.00||||368.00||| 31081260|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC FAMILIAL MUTATION ANALYSIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|368.00||||368.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3010.00||||3010.00|1505|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3010.00||||3010.00|363.6|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3010.00||||3010.00|1508.01|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3010.00||||3010.00|1056.51|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3010.00||||3010.00|1806|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3010.00||||3010.00|319.1|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3010.00||||3010.00|308.2|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|TRUSTMARK [2030]|STARMARK [203000]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|HEALTHNET [1495]|HEALTHNET [149500]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|AETNA [1015]|AETNA ACO WILCO [101532]|3010.00||||3010.00|465.46|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MULTIPLAN [1680]|IHC HS [168011]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3010.00||||3010.00|363.6|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3010.00||||3010.00|364.83|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|UMR [2035]|UMR OPTIONS [203501]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3010.00||||3010.00|196.34|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3010.00||||3010.00|632.1|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3010.00||||3010.00|3010|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3010.00||||3010.00|1443.3|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3010.00||||3010.00|1282.26|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3010.00||||3010.00|1956.5|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|||3010.00||||3010.00|903|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3010.00||||3010.00|319.1|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3010.00||||3010.00|293.52|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|CHAMPVA [1240]|CHAMP VA [124000]|3010.00||||3010.00|2257.5|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3010.00||||3010.00|331.66|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|CORESOURCE [1315]|CORESOURCE [131500]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|GEHA [1415]|GEHA [141500]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3010.00||||3010.00|2709|3010|196.34 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|MULTIPLAN [1680]|HMA [168003]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3010.00||||3010.00||| 31081263|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC IGH VAR REG SOMATIC MUTATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3010.00||||3010.00||| 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|CORESOURCE [1315]|CORESOURCE [131500]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1509.00||||1509.00|103.22|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1509.00||||1509.00|131.77|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1509.00||||1509.00|91.34|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1509.00||||1509.00|99.31|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|||1509.00||||1509.00|452.7|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1509.00||||1509.00|980.85|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1509.00||||1509.00|1509|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1509.00||||1509.00|316.89|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1509.00||||1509.00|133.82|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1509.00||||1509.00|93.49|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1509.00||||1509.00|113.54|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1509.00||||1509.00|113.17|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|UMR [2035]|UMR OPTIONS [203501]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MULTIPLAN [1680]|IHC HS [168011]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MULTIPLAN [1680]|HMA [168003]|1509.00||||1509.00|137.49|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1509.00||||1509.00|131.77|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1509.00||||1509.00|723.57|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|AETNA [1015]|AETNA ACO WILCO [101532]|1509.00||||1509.00|144.87|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|HEALTHNET [1495]|HEALTHNET [149500]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|TRUSTMARK [2030]|STARMARK [203000]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1509.00||||1509.00|61.11|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1509.00||||1509.00|95.91|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|CHAMPVA [1240]|CHAMP VA [124000]|1509.00||||1509.00|1131.75|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1509.00||||1509.00|100.83|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1509.00||||1509.00|99.31|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1509.00||||1509.00|96.24|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|GEHA [1415]|GEHA [141500]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1509.00||||1509.00|905.4|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1509.00||||1509.00|113.17|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1509.00||||1509.00|756.01|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1509.00||||1509.00|529.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1509.00||||1509.00|642.83|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1509.00||||1509.00|754.5|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1509.00||||1509.00|91.66|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1509.00||||1509.00|1358.1|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1509.00||||1509.00|100.83|1509|61.11 31081270|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC JAK2 GENE ANAL P VAL617PHE VARIAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1509.00||||1509.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|946.00||||946.00|473|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|946.00||||946.00|193.25|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|946.00||||946.00|473.95|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|946.00||||946.00|332.05|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|946.00||||946.00|567.6|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|946.00||||946.00|209.38|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|946.00||||946.00|202.23|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|946.00||||946.00|115.95|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|HEALTHNET [1495]|HEALTHNET [149500]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|AETNA [1015]|AETNA ACO WILCO [101532]|946.00||||946.00|274.88|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MULTIPLAN [1680]|IHC HS [168011]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|946.00||||946.00|193.25|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|946.00||||946.00|239.39|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|TRUSTMARK [2030]|STARMARK [203000]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|UMR [2035]|UMR OPTIONS [203501]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|946.00||||946.00|198.66|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|946.00||||946.00|946|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|946.00||||946.00|453.61|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|946.00||||946.00|614.9|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|||946.00||||946.00|283.8|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|946.00||||946.00|403|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|946.00||||946.00|209.38|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|946.00||||946.00|192.59|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|CHAMPVA [1240]|CHAMP VA [124000]|946.00||||946.00|709.5|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|946.00||||946.00|217.62|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|CORESOURCE [1315]|CORESOURCE [131500]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|GEHA [1415]|GEHA [141500]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|946.00||||946.00|851.4|946|115.95 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MULTIPLAN [1680]|HMA [168003]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|946.00||||946.00||| 31081275|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC KRAS MUTATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|946.00||||946.00||| 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|GEHA [1415]|GEHA [141500]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|CORESOURCE [1315]|CORESOURCE [131500]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1465.00||||1465.00|392.52|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1465.00||||1465.00|501.09|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|CHAMPVA [1240]|CHAMP VA [124000]|1465.00||||1465.00|1098.75|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1465.00||||1465.00|377.65|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1465.00||||1465.00|952.25|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1465.00||||1465.00|702.47|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1465.00||||1465.00|1465|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1465.00||||1465.00|307.65|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|UMR [2035]|UMR OPTIONS [203501]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1465.00||||1465.00|355.53|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1465.00||||1465.00|431.78|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1465.00||||1465.00|357.48|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MULTIPLAN [1680]|IHC HS [168011]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1465.00||||1465.00|508.9|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1465.00||||1465.00|501.09|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MULTIPLAN [1680]|HMA [168003]|1465.00||||1465.00|522.84|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|||1465.00||||1465.00|439.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|AETNA [1015]|AETNA ACO WILCO [101532]|1465.00||||1465.00|495.79|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|HEALTHNET [1495]|HEALTHNET [149500]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|TRUSTMARK [2030]|STARMARK [203000]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1465.00||||1465.00|347.37|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1465.00||||1465.00|209.14|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1465.00||||1465.00|364.75|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1465.00||||1465.00|383.42|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1465.00||||1465.00|377.65|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1465.00||||1465.00|365.99|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1465.00||||1465.00|879|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1465.00||||1465.00|733.97|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1465.00||||1465.00|514.22|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1465.00||||1465.00|624.09|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1465.00||||1465.00|357.48|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1465.00||||1465.00|732.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1465.00||||1465.00|348.56|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1465.00||||1465.00|1318.5|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1465.00||||1465.00|383.42|1465|209.14 31081301|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MICROSATELLITE INSTABILITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1465.00||||1465.00||| 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|742.00||||742.00|271.17|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|742.00||||742.00|371|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|742.00||||742.00|371.74|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|742.00||||742.00|260.44|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|742.00||||742.00|316.09|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|742.00||||742.00|445.2|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|742.00||||742.00|267.09|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|742.00||||742.00|271.17|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|742.00||||742.00|257.96|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|TRUSTMARK [2030]|STARMARK [203000]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|HEALTHNET [1495]|HEALTHNET [149500]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|AETNA [1015]|AETNA ACO WILCO [101532]|742.00||||742.00|350.65|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|742.00||||742.00|354.4|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MULTIPLAN [1680]|HMA [168003]|742.00||||742.00|369.78|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MULTIPLAN [1680]|IHC HS [168011]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|742.00||||742.00|305.37|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|742.00||||742.00|251.45|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|UMR [2035]|UMR OPTIONS [203501]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|742.00||||742.00|147.91|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|742.00||||742.00|359.92|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|742.00||||742.00|155.82|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|742.00||||742.00|258.85|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|742.00||||742.00|742|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|742.00||||742.00|355.79|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|742.00||||742.00|482.3|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|||742.00||||742.00|222.6|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|742.00||||742.00|267.09|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|742.00||||742.00|246.52|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|742.00||||742.00|245.67|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|CHAMPVA [1240]|CHAMP VA [124000]|742.00||||742.00|556.5|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|742.00||||742.00|354.4|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|742.00||||742.00|277.61|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|CORESOURCE [1315]|CORESOURCE [131500]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|GEHA [1415]|GEHA [141500]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|742.00||||742.00|667.8|742|147.91 31081310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC NPM1 GENE ANALYSIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|742.00||||742.00||| 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|CORESOURCE [1315]|CORESOURCE [131500]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|179.00||||179.00|49.15|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|179.00||||179.00|62.75|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|CHAMPVA [1240]|CHAMP VA [124000]|179.00||||179.00|134.25|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179.00||||179.00|43.5|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|||179.00||||179.00|53.7|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179.00||||179.00|116.35|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179.00||||179.00|179|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179.00||||179.00|37.59|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179.00||||179.00|63.73|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|UMR [2035]|UMR OPTIONS [203501]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|179.00||||179.00|54.07|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179.00||||179.00|44.52|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179.00||||179.00|53.89|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|FIRST HEALTH [1375]|QUALCHOICE [137513]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|FMH BENEFIT SERVICES [1390]|FMH [139000]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MULTIPLAN [1680]|IHC HS [168011]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|179.00||||179.00|62.75|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MULTIPLAN [1680]|HMA [168003]|179.00||||179.00|65.48|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|AETNA [1015]|AETNA ACO WILCO [101532]|179.00||||179.00|68.99|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179.00||||179.00|85.83|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179.00||||179.00|47.29|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|HEALTHNET [1495]|HEALTHNET [149500]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|TRUSTMARK [2030]|STARMARK [203000]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|179.00||||179.00|29.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179.00||||179.00|45.68|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179.00||||179.00|48.02|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|GEHA [1415]|GEHA [141500]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179.00||||179.00|47.29|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179.00||||179.00|45.83|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179.00||||179.00|107.4|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|179.00||||179.00|89.68|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179.00||||179.00|53.89|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179.00||||179.00|62.83|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|179.00||||179.00|76.25|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179.00||||179.00|89.5|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179.00||||179.00|43.65|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179.00||||179.00|161.1|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179.00||||179.00|48.02|179|29.1 31081332|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SERPINA1 GENE ANALYSIS COMMON VARIANTS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|179.00||||179.00||| 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|553.00||||553.00|276.5|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|553.00||||553.00|277.05|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|553.00||||553.00|194.1|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|553.00||||553.00|235.58|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|553.00||||553.00|331.8|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|553.00||||553.00|423.77|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|553.00||||553.00|437.26|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|553.00||||553.00|443.95|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|553.00||||553.00|422.33|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|553.00||||553.00|242.15|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|HEALTHNET [1495]|HEALTHNET [149500]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|AETNA [1015]|AETNA ACO WILCO [101532]|553.00||||553.00|553|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MULTIPLAN [1680]|IHC HS [168011]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|553.00||||553.00|580.2|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MULTIPLAN [1680]|HMA [168003]|553.00||||553.00|605.39|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|FMH BENEFIT SERVICES [1390]|FMH [139000]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|FIRST HEALTH [1375]|QUALCHOICE [137513]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|553.00||||553.00|499.93|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|553.00||||553.00|411.66|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|TRUSTMARK [2030]|STARMARK [203000]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|UMR [2035]|UMR OPTIONS [203501]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|553.00||||553.00|589.24|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|553.00||||553.00|116.13|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|553.00||||553.00|553|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|553.00||||553.00|265.16|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|553.00||||553.00|359.45|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|||553.00||||553.00|165.9|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|553.00||||553.00|437.26|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|553.00||||553.00|443.95|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|553.00||||553.00|403.59|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|553.00||||553.00|402.21|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|CHAMPVA [1240]|CHAMP VA [124000]|553.00||||553.00|414.75|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|553.00||||553.00|580.2|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|553.00||||553.00|454.48|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|CORESOURCE [1315]|CORESOURCE [131500]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|GEHA [1415]|GEHA [141500]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|553.00||||553.00|497.7|605.39|116.13 31081372|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A B C DNA TYPING LOW RES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|553.00||||553.00||| 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|GEHA [1415]|GEHA [141500]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|CORESOURCE [1315]|CORESOURCE [131500]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|438.00||||438.00|183.19|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|CHAMPVA [1240]|CHAMP VA [124000]|438.00||||438.00|328.5|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|438.00||||438.00|138.06|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|||438.00||||438.00|131.4|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|438.00||||438.00|284.7|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|438.00||||438.00|210.02|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|438.00||||438.00|91.98|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|UMR [2035]|UMR OPTIONS [203501]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|438.00||||438.00|129.98|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|438.00||||438.00|157.85|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|438.00||||438.00|137.48|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|FIRST HEALTH [1375]|QUALCHOICE [137513]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|FMH BENEFIT SERVICES [1390]|FMH [139000]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|438.00||||438.00|186.05|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MULTIPLAN [1680]|IHC HS [168011]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|438.00||||438.00|438|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|438.00||||438.00|183.19|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MULTIPLAN [1680]|HMA [168003]|438.00||||438.00|191.15|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|AETNA [1015]|AETNA ACO WILCO [101532]|438.00||||438.00|181.26|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|HEALTHNET [1495]|HEALTHNET [149500]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|TRUSTMARK [2030]|STARMARK [203000]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|438.00||||438.00|76.46|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|438.00||||438.00|126.99|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|438.00||||438.00|133.35|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|438.00||||438.00|143.5|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|438.00||||438.00|140.17|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|438.00||||438.00|138.06|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|438.00||||438.00|133.8|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|438.00||||438.00|262.8|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|438.00||||438.00|219.44|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|438.00||||438.00|153.74|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|438.00||||438.00|186.59|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|438.00||||438.00|137.48|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|438.00||||438.00|219|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|438.00||||438.00|127.43|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|438.00||||438.00|394.2|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|438.00||||438.00|140.17|438|76.46 31081373|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA-A DNA TYPING LOW RESOLTN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|438.00||||438.00||| 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237.00||||237.00|127.9|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|237.00||||237.00|81.48|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|TRUSTMARK [2030]|STARMARK [203000]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|HEALTHNET [1495]|HEALTHNET [149500]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|AETNA [1015]|AETNA ACO WILCO [101532]|237.00||||237.00|193.17|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|237.00||||237.00|175.7|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MULTIPLAN [1680]|HMA [168003]|237.00||||237.00|183.33|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237.00||||237.00|150.89|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|237.00||||237.00|151.4|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237.00||||237.00|124.66|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|UMR [2035]|UMR OPTIONS [203501]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237.00||||237.00|178.44|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237.00||||237.00|49.77|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MULTIPLAN [1680]|IHC HS [168011]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237.00||||237.00|237|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237.00||||237.00|113.64|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237.00||||237.00|154.05|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|||237.00||||237.00|71.1|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237.00||||237.00|132.42|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237.00||||237.00|121.81|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|CHAMPVA [1240]|CHAMP VA [124000]|237.00||||237.00|177.75|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|237.00||||237.00|175.7|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|237.00||||237.00|137.63|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|CORESOURCE [1315]|CORESOURCE [131500]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|GEHA [1415]|GEHA [141500]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237.00||||237.00|128.33|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|237.00||||237.00|100.96|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237.00||||237.00|118.5|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237.00||||237.00|122.22|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237.00||||237.00|134.44|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|237.00||||237.00|118.74|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237.00||||237.00|150.89|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237.00||||237.00|132.42|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237.00||||237.00|213.3|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237.00||||237.00|142.2|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237.00||||237.00|83.19|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237.00||||237.00|134.44|237|49.77 31081376|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II TYPING 1 LOCUS EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|237.00||||237.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.00||||57.00|34.2|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.00||||57.00|27.33|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.00||||57.00|20.01|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.00||||57.00|28.56|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.00||||57.00|106.69|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|CORESOURCE [1315]|CORESOURCE [131500]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|||57.00||||57.00|17.1|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.00||||57.00|11.97|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|HEALTHNET [1495]|HEALTHNET [149500]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.00||||57.00|24.28|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.00||||57.00|28.5|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|AETNA [1015]|AETNA ACO WILCO [101532]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.00||||57.00|102.65|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MULTIPLAN [1680]|IHC HS [168011]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|CHAMPVA [1240]|CHAMP VA [124000]|57.00||||57.00|42.75|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.00||||57.00|102.65|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|GEHA [1415]|GEHA [141500]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.00||||57.00|37.05|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|UMR [2035]|UMR OPTIONS [203501]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|TRUSTMARK [2030]|STARMARK [203000]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.00||||57.00|51.3|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.00||||57.00|57|106.69|11.97 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MULTIPLAN [1680]|HMA [168003]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.00||||57.00||| 31081377|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA CLASS II LOW ONE ANTIGEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.00||||57.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1305.00||||1305.00|274.05|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1305.00||||1305.00|280.12|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1305.00||||1305.00|219.58|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1305.00||||1305.00|1305|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1305.00||||1305.00|625.75|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1305.00||||1305.00|218.83|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1305.00||||1305.00|978.75|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1305.00||||1305.00|199.61|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1305.00||||1305.00|176.65|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|GEHA [1415]|GEHA [141500]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1305.00||||1305.00|652.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1305.00||||1305.00|653.81|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1305.00||||1305.00|192.05|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1305.00||||1305.00|458.06|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|UMR [2035]|UMR OPTIONS [203501]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|||1305.00||||1305.00|391.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1305.00||||1305.00|848.25|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1305.00||||1305.00|218.83|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1305.00||||1305.00|185.48|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1305.00||||1305.00|783|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1305.00||||1305.00|118.16|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1305.00||||1305.00|555.93|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1305.00||||1305.00|192.05|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1305.00||||1305.00|1174.5|1305|118.16 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MULTIPLAN [1680]|HMA [168003]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1305.00||||1305.00||| 31081380|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA LOCUS EACH HIGH RESOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1305.00||||1305.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2025.00||||2025.00|123.26|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|CORESOURCE [1315]|CORESOURCE [131500]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2025.00||||2025.00|139.28|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|GEHA [1415]|GEHA [141500]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|||2025.00||||2025.00|607.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2025.00||||2025.00|2025|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2025.00||||2025.00|134|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|CHAMPVA [1240]|CHAMP VA [124000]|2025.00||||2025.00|1518.75|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2025.00||||2025.00|153.2|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2025.00||||2025.00|970.99|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2025.00||||2025.00|425.25|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2025.00||||2025.00|152.69|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MULTIPLAN [1680]|IHC HS [168011]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|TRUSTMARK [2030]|STARMARK [203000]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2025.00||||2025.00|82.45|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2025.00||||2025.00|1014.53|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2025.00||||2025.00|1215|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2025.00||||2025.00|152.69|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2025.00||||2025.00|1012.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2025.00||||2025.00|129.43|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2025.00||||2025.00|862.65|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2025.00||||2025.00|134|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2025.00||||2025.00|710.78|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|AETNA [1015]|AETNA ACO WILCO [101532]|2025.00||||2025.00|195.46|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2025.00||||2025.00|1316.25|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|UMR [2035]|UMR OPTIONS [203501]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|HEALTHNET [1495]|HEALTHNET [149500]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2025.00||||2025.00|1822.5|2025|82.45 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MULTIPLAN [1680]|HMA [168003]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2025.00||||2025.00||| 31081382|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC PROMETHEUS CELIAC GENETICS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2025.00||||2025.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.00||||57.00|11.97|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|GEHA [1415]|GEHA [141500]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.00||||57.00|118.23|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.00||||57.00|122.89|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MULTIPLAN [1680]|IHC HS [168011]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|CORESOURCE [1315]|CORESOURCE [131500]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|CHAMPVA [1240]|CHAMP VA [124000]|57.00||||57.00|42.75|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|UMR [2035]|UMR OPTIONS [203501]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.00||||57.00|27.33|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.00||||57.00|37.05|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.00||||57.00|20.01|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|||57.00||||57.00|17.1|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.00||||57.00|28.5|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.00||||57.00|34.2|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.00||||57.00|118.23|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|AETNA [1015]|AETNA ACO WILCO [101532]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.00||||57.00|28.56|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.00||||57.00|24.28|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|TRUSTMARK [2030]|STARMARK [203000]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.00||||57.00|57|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|HEALTHNET [1495]|HEALTHNET [149500]|57.00||||57.00|51.3|122.89|11.97 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MULTIPLAN [1680]|HMA [168003]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.00||||57.00||| 31081383|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC HLA II HIGH RES 1 ALLELE/ALLELE GROUP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.00||||57.00||| 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|630.00||||630.00|196.95|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|CORESOURCE [1315]|CORESOURCE [131500]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|630.00||||630.00|157.5|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|GEHA [1415]|GEHA [141500]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|CHAMPVA [1240]|CHAMP VA [124000]|630.00||||630.00|472.5|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|630.00||||630.00|196.95|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|FMH BENEFIT SERVICES [1390]|FMH [139000]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|||630.00||||630.00|189|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|UMR [2035]|UMR OPTIONS [203501]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|630.00||||630.00|302.09|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|630.00||||630.00|139.74|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|AETNA [1015]|COVENTRY HEALTHCARE [101502]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|630.00||||630.00|630|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MULTIPLAN [1680]|HMA [168003]|630.00||||630.00|205.5|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|FIRST HEALTH [1375]|QUALCHOICE [137513]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|630.00||||630.00|409.5|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|630.00||||630.00|200.02|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|HEALTHNET [1495]|HEALTHNET [149500]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MULTIPLAN [1680]|IHC HS [168011]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|630.00||||630.00|378|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|630.00||||630.00|268.38|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|630.00||||630.00|82.2|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|TRUSTMARK [2030]|STARMARK [203000]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|630.00||||630.00|143.85|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|630.00||||630.00|221.13|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|630.00||||630.00|315.63|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|630.00||||630.00|150.7|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|630.00||||630.00|132.3|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|630.00||||630.00|164.09|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|630.00||||630.00|150.7|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|630.00||||630.00|315|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|630.00||||630.00|169.89|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|630.00||||630.00|176.58|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|630.00||||630.00|137|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|630.00||||630.00|194.24|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|AETNA [1015]|AETNA ACO WILCO [101532]|630.00||||630.00|194.87|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|630.00||||630.00|169.89|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|630.00||||630.00|567|630|82.2 31081401|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 2|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|630.00||||630.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1545.00||||1545.00|542.3|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1545.00||||1545.00|927|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1545.00||||1545.00|229.67|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|TRUSTMARK [2030]|STARMARK [203000]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|HEALTHNET [1495]|HEALTHNET [149500]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1545.00||||1545.00|111.12|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1545.00||||1545.00|221.83|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1545.00||||1545.00|185.2|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1545.00||||1545.00|262.59|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1545.00||||1545.00|772.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|FMH BENEFIT SERVICES [1390]|FMH [139000]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|AETNA [1015]|AETNA ACO WILCO [101532]|1545.00||||1545.00|263.42|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1545.00||||1545.00|185.2|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1545.00||||1545.00|211.26|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1545.00||||1545.00|229.67|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|FIRST HEALTH [1375]|QUALCHOICE [137513]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|CHAMPVA [1240]|CHAMP VA [124000]|1545.00||||1545.00|1158.75|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1545.00||||1545.00|740.83|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1545.00||||1545.00|1545|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1545.00||||1545.00|1004.25|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MULTIPLAN [1680]|IHC HS [168011]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|CORESOURCE [1315]|CORESOURCE [131500]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|||1545.00||||1545.00|463.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|GEHA [1415]|GEHA [141500]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1545.00||||1545.00|238.71|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1545.00||||1545.00|774.05|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|UMR [2035]|UMR OPTIONS [203501]|1545.00||||1545.00|1390.5|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1545.00||||1545.00|324.45|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1545.00||||1545.00|658.17|1545|111.12 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MULTIPLAN [1680]|HMA [168003]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1545.00||||1545.00||| 31081403|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 4|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1545.00||||1545.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5625.00||||5625.00|313.49|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|CORESOURCE [1315]|CORESOURCE [131500]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|GEHA [1415]|GEHA [141500]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5625.00||||5625.00|354.24|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5625.00||||5625.00|340.82|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5625.00||||5625.00|2697.19|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5625.00||||5625.00|2818.13|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|AETNA [1015]|AETNA ACO WILCO [101532]|5625.00||||5625.00|390.91|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|FIRST HEALTH [1375]|QUALCHOICE [137513]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5625.00||||5625.00|5625|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|HEALTHNET [1495]|HEALTHNET [149500]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5625.00||||5625.00|1181.25|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|CHAMPVA [1240]|CHAMP VA [124000]|5625.00||||5625.00|4218.75|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MULTIPLAN [1680]|IHC HS [168011]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5625.00||||5625.00|329.18|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5625.00||||5625.00|164.9|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5625.00||||5625.00|340.82|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5625.00||||5625.00|3375|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|FMH BENEFIT SERVICES [1390]|FMH [139000]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5625.00||||5625.00|389.66|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5625.00||||5625.00|1974.38|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5625.00||||5625.00|274.83|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|UMR [2035]|UMR OPTIONS [203501]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|||5625.00||||5625.00|1687.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5625.00||||5625.00|2396.25|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5625.00||||5625.00|3656.25|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5625.00||||5625.00|274.83|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|TRUSTMARK [2030]|STARMARK [203000]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5625.00||||5625.00|2812.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5625.00||||5625.00|5062.5|5625|164.9 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MULTIPLAN [1680]|HMA [168003]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5625.00||||5625.00||| 31081404|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 5|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5625.00||||5625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8625.00||||8625.00|5606.25|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8625.00||||8625.00|4135.69|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|CHAMPVA [1240]|CHAMP VA [124000]|8625.00||||8625.00|6468.75|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8625.00||||8625.00|350.81|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8625.00||||8625.00|322.68|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|||8625.00||||8625.00|2587.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8625.00||||8625.00|8625|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|UMR [2035]|UMR OPTIONS [203501]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8625.00||||8625.00|1811.25|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|CORESOURCE [1315]|CORESOURCE [131500]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|8625.00||||8625.00|364.62|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|GEHA [1415]|GEHA [141500]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8625.00||||8625.00|282.88|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8625.00||||8625.00|3027.38|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|8625.00||||8625.00|4321.13|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8625.00||||8625.00|5175|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|8625.00||||8625.00|3674.25|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8625.00||||8625.00|4312.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|HEALTHNET [1495]|HEALTHNET [149500]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8625.00||||8625.00|350.81|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8625.00||||8625.00|169.73|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|TRUSTMARK [2030]|STARMARK [203000]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MULTIPLAN [1680]|IHC HS [168011]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|8625.00||||8625.00|401.08|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8625.00||||8625.00|282.88|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|FMH BENEFIT SERVICES [1390]|FMH [139000]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|AETNA [1015]|AETNA ACO WILCO [101532]|8625.00||||8625.00|402.37|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|FIRST HEALTH [1375]|QUALCHOICE [137513]|8625.00||||8625.00|7762.5|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8625.00||||8625.00|338.83|8625|169.73 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|MULTIPLAN [1680]|HMA [168003]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8625.00||||8625.00||| 31081406|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC MOLECULAR PATH PROC LEVEL 7|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8625.00||||8625.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|171.00||||171.00|8.58|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|GEHA [1415]|GEHA [141500]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|CORESOURCE [1315]|CORESOURCE [131500]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|171.00||||171.00|9.69|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|CHAMPVA [1240]|CHAMP VA [124000]|171.00||||171.00|128.25|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|171.00||||171.00|35.91|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|171.00||||171.00|81.99|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|171.00||||171.00|111.15|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|171.00||||171.00|9.32|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|171.00||||171.00|171|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|UMR [2035]|UMR OPTIONS [203501]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|171.00||||171.00|10.63|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MULTIPLAN [1680]|IHC HS [168011]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|171.00||||171.00|10.65|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|||171.00||||171.00|51.3|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|171.00||||171.00|10.63|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|HEALTHNET [1495]|HEALTHNET [149500]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|171.00||||171.00|9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|171.00||||171.00|102.6|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|171.00||||171.00|85.67|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|171.00||||171.00|72.85|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|TRUSTMARK [2030]|STARMARK [203000]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|171.00||||171.00|9.32|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|171.00||||171.00|85.5|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|171.00||||171.00|5.74|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|171.00||||171.00|153.9|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|AETNA [1015]|AETNA ACO WILCO [101532]|171.00||||171.00|13.61|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|171.00||||171.00|60.02|171|5.74 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MULTIPLAN [1680]|HMA [168003]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|171.00||||171.00||| 31089310|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC SEMEN ANALYSIS MOTILITY/CNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|171.00||||171.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|239.00||||239.00|83.89|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|239.00||||239.00|14.88|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|239.00||||239.00|12.31|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|239.00||||239.00|12.31|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|239.00||||239.00|101.81|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|239.00||||239.00|12.93|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|239.00||||239.00|19.05|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|239.00||||239.00|12.88|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|239.00||||239.00|8.03|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|239.00||||239.00|12.31|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|239.00||||239.00|13.34|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|239.00||||239.00|17.7|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MULTIPLAN [1680]|HMA [168003]|239.00||||239.00|18.47|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|239.00||||239.00|12.31|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|UMR [2035]|UMR OPTIONS [203501]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|239.00||||239.00|12.56|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|239.00||||239.00|15.25|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|239.00||||239.00|119.74|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|239.00||||239.00|12.31|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|239.00||||239.00|143.4|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|239.00||||239.00|148.42|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|239.00||||239.00|14.88|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|239.00||||239.00|50.19|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|239.00||||239.00|155.35|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|239.00||||239.00|13.34|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|239.00||||239.00|12.26|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|||239.00||||239.00|71.7|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|239.00||||239.00|119.5|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|239.00||||239.00|148.18|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|239.00||||239.00|114.6|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|239.00||||239.00|13.87|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|239.00||||239.00|12.31|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|239.00||||239.00|239|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|GEHA [1415]|GEHA [141500]|239.00||||239.00|215.1|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|239.00||||239.00|179.25|239|8.03 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|239.00||||239.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|239.00||||239.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|239.00||||239.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|239.00||||239.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|239.00||||239.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|239.00||||239.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|239.00||||239.00||| 31089320|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC LAB SEMEN ANALYSIS COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|239.00||||239.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|10.63|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|12.02|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|13.18|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|||150.00||||150.00|45|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|11.56|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00|16.87|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|11.17|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|11.56|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|7.12|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|13.18|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|13.22|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|7.12 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 31089325|EAP|0310 - LABORATORY PATHOLOGY-GENERAL|HC AB SPERM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|||10.00||||10.00|3|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 311|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALLOPURINOL 300 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|401.12||||401.12|300.84|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|401.12||||401.12|300.84|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|GEHA [1415]|GEHA [141500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|401.12||||401.12|84.24|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|||401.12||||401.12|120.34|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|401.12||||401.12|260.73|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|401.12||||401.12|172.48|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|401.12||||401.12|172.48|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|401.12||||401.12|84.24|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|401.12||||401.12|260.73|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|401.12||||401.12|172.48|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|401.12||||401.12|192.34|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|401.12||||401.12|192.34|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|||401.12||||401.12|120.34|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|401.12||||401.12|140.79|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|401.12||||401.12|170.88|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|401.12||||401.12|140.79|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|401.12||||401.12|172.48|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|401.12||||401.12|240.67|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|GEHA [1415]|GEHA [141500]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|401.12||||401.12|170.88|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|401.12||||401.12|240.67|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|401.12||||401.12|361.01|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|401.12||||401.12|200.96|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|401.12||||401.12|200.96|361.01|84.24 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|401.12||||401.12||| 31158|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BRIMONIDINE 0.15 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|401.12||||401.12||| 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.00||||464.00|12.73|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.00||||464.00|232|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.00||||464.00|13.19|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.00||||464.00|232.46|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.00||||464.00|162.86|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.00||||464.00|197.66|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|AETNA [1015]|AETNA ACO WILCO [101532]|464.00||||464.00|16.88|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.00||||464.00|12.54|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.00||||464.00|12.11|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|TRUSTMARK [2030]|STARMARK [203000]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.00||||464.00|12.73|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MULTIPLAN [1680]|IHC HS [168011]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.00||||464.00|16.63|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MULTIPLAN [1680]|HMA [168003]|464.00||||464.00|17.36|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|UMR [2035]|UMR OPTIONS [203501]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|464.00||||464.00|7.12|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|HEALTHNET [1495]|HEALTHNET [149500]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.00||||464.00|14.33|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.00||||464.00|12.15|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.00||||464.00|11.8|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.00||||464.00|278.4|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.00||||464.00|13.19|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.00||||464.00|16.89|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.00||||464.00|301.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.00||||464.00|11.54|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.00||||464.00|11.57|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|||464.00||||464.00|139.2|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|CHAMPVA [1240]|CHAMP VA [124000]|464.00||||464.00|348|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|CORESOURCE [1315]|CORESOURCE [131500]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.00||||464.00|12.54|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.00||||464.00|13.03|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|GEHA [1415]|GEHA [141500]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.00||||464.00|222.49|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.00||||464.00|97.44|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.00||||464.00|16.63|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.00||||464.00|417.6|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.00||||464.00|464|464|7.12 31183605|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC LATATE/LACTIC ACID I-STAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.00||||464.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371.00||||371.00|76.78|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|GEHA [1415]|GEHA [141500]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|CORESOURCE [1315]|CORESOURCE [131500]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|CHAMPVA [1240]|CHAMP VA [124000]|371.00||||371.00|278.25|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371.00||||371.00|177.89|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371.00||||371.00|77.91|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|UMR [2035]|UMR OPTIONS [203501]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371.00||||371.00|371|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|371.00||||371.00|45.6|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371.00||||371.00|159.53|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371.00||||371.00|39.88|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|FIRST HEALTH [1375]|QUALCHOICE [137513]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371.00||||371.00|241.15|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|FMH BENEFIT SERVICES [1390]|FMH [139000]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371.00||||371.00|36.68|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MULTIPLAN [1680]|IHC HS [168011]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|HEALTHNET [1495]|HEALTHNET [149500]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|TRUSTMARK [2030]|STARMARK [203000]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|371.00||||371.00|19.27|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371.00||||371.00|38.52|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371.00||||371.00|333.9|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|371.00||||371.00|41.45|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371.00||||371.00|39.88|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|AETNA [1015]|AETNA ACO WILCO [101532]|371.00||||371.00|54.94|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371.00||||371.00|222.6|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|||371.00||||371.00|111.3|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371.00||||371.00|159.53|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371.00||||371.00|130.22|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|371.00||||371.00|158.05|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|371.00||||371.00|185.87|371|19.27 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MULTIPLAN [1680]|HMA [168003]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371.00||||371.00||| 31188104|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH BODY FLUIDS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371.00||||371.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|552.00||||552.00|41.04|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|552.00||||552.00|235.15|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|552.00||||552.00|237.36|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|552.00||||552.00|193.75|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|552.00||||552.00|331.2|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|552.00||||552.00|276.55|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|552.00||||552.00|10.3|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|HEALTHNET [1495]|HEALTHNET [149500]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|AETNA [1015]|AETNA ACO WILCO [101532]|552.00||||552.00|59.18|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|TRUSTMARK [2030]|STARMARK [203000]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|552.00||||552.00|43.66|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|FMH BENEFIT SERVICES [1390]|FMH [139000]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MULTIPLAN [1680]|IHC HS [168011]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|FIRST HEALTH [1375]|QUALCHOICE [137513]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|552.00||||552.00|237.36|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|552.00||||552.00|51.68|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|UMR [2035]|UMR OPTIONS [203501]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|552.00||||552.00|115.92|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|552.00||||552.00|264.68|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|||552.00||||552.00|165.6|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|552.00||||552.00|45.2|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|552.00||||552.00|41.58|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|CHAMPVA [1240]|CHAMP VA [124000]|552.00||||552.00|414|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|552.00||||552.00|358.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|552.00||||552.00|46.98|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|CORESOURCE [1315]|CORESOURCE [131500]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|GEHA [1415]|GEHA [141500]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|552.00||||552.00|496.8|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|552.00||||552.00|552|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|552.00||||552.00|45.2|552|10.3 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MULTIPLAN [1680]|HMA [168003]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|552.00||||552.00||| 31188106|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH FLUID FILTER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|552.00||||552.00||| 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|GEHA [1415]|GEHA [141500]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|CORESOURCE [1315]|CORESOURCE [131500]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|428.00||||428.00|40.71|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|428.00||||428.00|45.75|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|||428.00||||428.00|128.4|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|428.00||||428.00|278.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|428.00||||428.00|428|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|428.00||||428.00|89.88|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|428.00||||428.00|46.46|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|428.00||||428.00|44.79|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|428.00||||428.00|39.17|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|FIRST HEALTH [1375]|QUALCHOICE [137513]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|428.00||||428.00|184.04|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|FMH BENEFIT SERVICES [1390]|FMH [139000]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|428.00||||428.00|205.23|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|428.00||||428.00|32.46|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|UMR [2035]|UMR OPTIONS [203501]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MULTIPLAN [1680]|HMA [168003]|428.00||||428.00|47.74|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|428.00||||428.00|36.03|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MULTIPLAN [1680]|IHC HS [168011]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|428.00||||428.00|45.75|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|428.00||||428.00|37.83|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|428.00||||428.00|39.17|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|428.00||||428.00|33.41|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|428.00||||428.00|256.8|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|428.00||||428.00|214.43|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|428.00||||428.00|35.01|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|428.00||||428.00|182.33|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|428.00||||428.00|150.23|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|CHAMPVA [1240]|CHAMP VA [124000]|428.00||||428.00|321|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|428.00||||428.00|184.04|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|428.00||||428.00|76.78|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|428.00||||428.00|19.27|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|TRUSTMARK [2030]|STARMARK [203000]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|428.00||||428.00|35.01|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|428.00||||428.00|31.82|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|AETNA [1015]|AETNA ACO WILCO [101532]|428.00||||428.00|50.21|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|HEALTHNET [1495]|HEALTHNET [149500]|428.00||||428.00|385.2|428|19.27 31188108|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH CONCENTRATION SMEARS & INTERP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|428.00||||428.00||| 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|850.00||||850.00|51.8|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|850.00||||850.00|121.87|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|850.00||||850.00|365.5|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|850.00||||850.00|425.85|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|850.00||||850.00|298.35|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|850.00||||850.00|510|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|850.00||||850.00|39.17|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|850.00||||850.00|37.83|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|AETNA [1015]|AETNA ACO WILCO [101532]|850.00||||850.00|51.63|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|TRUSTMARK [2030]|STARMARK [203000]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|850.00||||850.00|67.7|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|FMH BENEFIT SERVICES [1390]|FMH [139000]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|850.00||||850.00|30.59|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MULTIPLAN [1680]|HMA [168003]|850.00||||850.00|70.63|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|FIRST HEALTH [1375]|QUALCHOICE [137513]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MULTIPLAN [1680]|IHC HS [168011]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|850.00||||850.00|51.8|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|850.00||||850.00|49.44|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|850.00||||850.00|365.5|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|850.00||||850.00|44.79|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|850.00||||850.00|48.03|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|HEALTHNET [1495]|HEALTHNET [149500]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|850.00||||850.00|362.1|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|850.00||||850.00|68.75|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|850.00||||850.00|850|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|850.00||||850.00|407.58|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|||850.00||||850.00|255|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|850.00||||850.00|47.09|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|850.00||||850.00|36.03|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|CHAMPVA [1240]|CHAMP VA [124000]|850.00||||850.00|637.5|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|850.00||||850.00|67.7|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|850.00||||850.00|39.17|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|850.00||||850.00|552.5|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|850.00||||850.00|40.71|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|CORESOURCE [1315]|CORESOURCE [131500]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|GEHA [1415]|GEHA [141500]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|850.00||||850.00|178.5|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|UMR [2035]|UMR OPTIONS [203501]|850.00||||850.00|765|850|30.59 31188112|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTO SELCT CELL ENHNCE W/INTP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|850.00||||850.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00|25.01|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|25.1|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|25.01|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|||150.00||||150.00|45|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|20.19|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|21.95|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|25.01|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|22.81|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|21.19|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|21.95|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|13.51|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00|32.02|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|13.51 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 31188142|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|365.00||||365.00|24.07|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|365.00||||365.00|41.04|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|365.00||||365.00|155.49|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|365.00||||365.00|128.12|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|365.00||||365.00|182.87|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|365.00||||365.00|219|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|365.00||||365.00|44.86|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|365.00||||365.00|24.07|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|365.00||||365.00|10.3|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|HEALTHNET [1495]|HEALTHNET [149500]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|AETNA [1015]|AETNA ACO WILCO [101532]|365.00||||365.00|59.65|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|365.00||||365.00|31.45|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MULTIPLAN [1680]|HMA [168003]|365.00||||365.00|32.82|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|FMH BENEFIT SERVICES [1390]|FMH [139000]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|FIRST HEALTH [1375]|QUALCHOICE [137513]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|365.00||||365.00|156.95|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|365.00||||365.00|156.95|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MULTIPLAN [1680]|IHC HS [168011]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|365.00||||365.00|43.33|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|365.00||||365.00|22.97|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|365.00||||365.00|51.29|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|365.00||||365.00|22.32|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|TRUSTMARK [2030]|STARMARK [203000]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|UMR [2035]|UMR OPTIONS [203501]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|365.00||||365.00|76.65|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|365.00||||365.00|237.25|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|365.00||||365.00|175.02|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|365.00||||365.00|44.86|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|365.00||||365.00|41.26|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|||365.00||||365.00|109.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|CHAMPVA [1240]|CHAMP VA [124000]|365.00||||365.00|273.75|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|365.00||||365.00|21.88|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|365.00||||365.00|31.45|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|365.00||||365.00|46.63|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|CORESOURCE [1315]|CORESOURCE [131500]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|365.00||||365.00|365|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|GEHA [1415]|GEHA [141500]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|365.00||||365.00|31.94|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|365.00||||365.00|328.5|365|10.3 31188160|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|365.00||||365.00||| 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|CORESOURCE [1315]|CORESOURCE [131500]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|351.00||||351.00|44.4|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|351.00||||351.00|31.45|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|351.00||||351.00|39.29|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|||351.00||||351.00|105.3|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|351.00||||351.00|228.15|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|351.00||||351.00|168.3|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|351.00||||351.00|31.94|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|351.00||||351.00|48.84|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|351.00||||351.00|73.71|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|351.00||||351.00|150.93|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|FIRST HEALTH [1375]|QUALCHOICE [137513]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|351.00||||351.00|22.32|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|FMH BENEFIT SERVICES [1390]|FMH [139000]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|351.00||||351.00|351|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|UMR [2035]|UMR OPTIONS [203501]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MULTIPLAN [1680]|IHC HS [168011]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|351.00||||351.00|31.45|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MULTIPLAN [1680]|HMA [168003]|351.00||||351.00|32.82|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|TRUSTMARK [2030]|STARMARK [203000]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|351.00||||351.00|41.25|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|351.00||||351.00|24.07|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|351.00||||351.00|22.97|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|351.00||||351.00|210.6|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|351.00||||351.00|150.93|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|351.00||||351.00|175.85|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|CHAMPVA [1240]|CHAMP VA [124000]|351.00||||351.00|263.25|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|351.00||||351.00|42.72|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|351.00||||351.00|149.53|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|GEHA [1415]|GEHA [141500]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|351.00||||351.00|123.2|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|351.00||||351.00|76.78|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|351.00||||351.00|19.27|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|HEALTHNET [1495]|HEALTHNET [149500]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|351.00||||351.00|24.07|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|351.00||||351.00|42.72|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|AETNA [1015]|AETNA ACO WILCO [101532]|351.00||||351.00|53.98|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|351.00||||351.00|21.88|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|351.00||||351.00|315.9|351|19.27 31188161|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR W/PREP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|351.00||||351.00||| 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|526.00||||526.00|51.8|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|526.00||||526.00|121.87|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|526.00||||526.00|226.18|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|526.00||||526.00|263.53|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|526.00||||526.00|224.08|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|526.00||||526.00|60.23|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|526.00||||526.00|51.8|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|526.00||||526.00|58.18|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|526.00||||526.00|30.59|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|TRUSTMARK [2030]|STARMARK [203000]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|AETNA [1015]|AETNA ACO WILCO [101532]|526.00||||526.00|75.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MULTIPLAN [1680]|IHC HS [168011]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|526.00||||526.00|67.7|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|FMH BENEFIT SERVICES [1390]|FMH [139000]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|526.00||||526.00|49.44|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|FIRST HEALTH [1375]|QUALCHOICE [137513]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|526.00||||526.00|226.18|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MULTIPLAN [1680]|HMA [168003]|526.00||||526.00|70.63|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|HEALTHNET [1495]|HEALTHNET [149500]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|526.00||||526.00|68.86|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|526.00||||526.00|48.03|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|526.00||||526.00|184.63|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|526.00||||526.00|68.75|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|526.00||||526.00|526|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|526.00||||526.00|341.9|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|||526.00||||526.00|157.8|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|526.00||||526.00|55.41|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|526.00||||526.00|47.09|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|526.00||||526.00|315.6|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|CHAMPVA [1240]|CHAMP VA [124000]|526.00||||526.00|394.5|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|526.00||||526.00|252.22|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|526.00||||526.00|67.7|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|526.00||||526.00|62.6|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|CORESOURCE [1315]|CORESOURCE [131500]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|GEHA [1415]|GEHA [141500]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|526.00||||526.00|60.23|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|UMR [2035]|UMR OPTIONS [203501]|526.00||||526.00|473.4|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|526.00||||526.00|110.46|526|30.59 31188162|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOPATH OTHER SMEAR EXTENDED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|526.00||||526.00||| 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|GEHA [1415]|GEHA [141500]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|CORESOURCE [1315]|CORESOURCE [131500]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|370.00||||370.00|20.04|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|370.00||||370.00|196.36|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|CHAMPVA [1240]|CHAMP VA [124000]|370.00||||370.00|277.5|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|||370.00||||370.00|111|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|370.00||||370.00|56.69|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|370.00||||370.00|77.7|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|370.00||||370.00|139.32|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|370.00||||370.00|22.05|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|370.00||||370.00|159.1|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MULTIPLAN [1680]|IHC HS [168011]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|370.00||||370.00|196.36|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|AETNA [1015]|AETNA ACO WILCO [101532]|370.00||||370.00|26.13|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MULTIPLAN [1680]|HMA [168003]|370.00||||370.00|204.89|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|HEALTHNET [1495]|HEALTHNET [149500]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|TRUSTMARK [2030]|STARMARK [203000]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|UMR [2035]|UMR OPTIONS [203501]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|370.00||||370.00|86.84|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|370.00||||370.00|18.62|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|370.00||||370.00|150.25|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|370.00||||370.00|19.28|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|370.00||||370.00|199.42|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|370.00||||370.00|143.42|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|370.00||||370.00|222|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|370.00||||370.00|159.1|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|370.00||||370.00|185.37|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|370.00||||370.00|157.62|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|370.00||||370.00|177.42|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|370.00||||370.00|129.87|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|370.00||||370.00|345.93|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|370.00||||370.00|19.28|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|370.00||||370.00|150.25|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|370.00||||370.00|240.5|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|370.00||||370.00|136.59|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|370.00||||370.00|333|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|370.00||||370.00|370|370|17.73 31188172|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE EVAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|370.00||||370.00|17.73|370|17.73 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|858.00||||858.00|51.8|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|858.00||||858.00|121.87|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|858.00||||858.00|365.51|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|858.00||||858.00|368.94|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|858.00||||858.00|429.86|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|858.00||||858.00|514.8|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|858.00||||858.00|82.25|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|858.00||||858.00|301.16|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|858.00||||858.00|51.8|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|TRUSTMARK [2030]|STARMARK [203000]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|858.00||||858.00|30.59|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|HEALTHNET [1495]|HEALTHNET [149500]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|AETNA [1015]|AETNA ACO WILCO [101532]|858.00||||858.00|107.51|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|858.00||||858.00|67.7|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MULTIPLAN [1680]|HMA [168003]|858.00||||858.00|70.63|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|858.00||||858.00|79.44|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|FMH BENEFIT SERVICES [1390]|FMH [139000]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MULTIPLAN [1680]|IHC HS [168011]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|FIRST HEALTH [1375]|QUALCHOICE [137513]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|858.00||||858.00|368.94|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|858.00||||858.00|49.44|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|858.00||||858.00|94.04|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|858.00||||858.00|48.03|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|UMR [2035]|UMR OPTIONS [203501]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|858.00||||858.00|180.18|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|858.00||||858.00|557.7|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|858.00||||858.00|411.41|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|||858.00||||858.00|257.4|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|858.00||||858.00|82.25|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|858.00||||858.00|75.66|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|858.00||||858.00|150.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|CHAMPVA [1240]|CHAMP VA [124000]|858.00||||858.00|643.5|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|858.00||||858.00|67.7|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|858.00||||858.00|85.49|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|858.00||||858.00|858|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|CORESOURCE [1315]|CORESOURCE [131500]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|GEHA [1415]|GEHA [141500]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|858.00||||858.00|68.75|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|858.00||||858.00|47.09|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|858.00||||858.00|772.2|858|30.59 31188173|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FINE NEEDLE ASPIRATE INTERPRE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|858.00||||858.00|47.09|858|30.59 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|CORESOURCE [1315]|CORESOURCE [131500]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|248.00||||248.00|29.97|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|248.00||||248.00|38.25|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|CHAMPVA [1240]|CHAMP VA [124000]|248.00||||248.00|186|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|||248.00||||248.00|74.4|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248.00||||248.00|161.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248.00||||248.00|52.08|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248.00||||248.00|38.85|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|UMR [2035]|UMR OPTIONS [203501]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|248.00||||248.00|32.96|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248.00||||248.00|28.83|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|FIRST HEALTH [1375]|QUALCHOICE [137513]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|FMH BENEFIT SERVICES [1390]|FMH [139000]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248.00||||248.00|32.71|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248.00||||248.00|27.14|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248.00||||248.00|118.92|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248.00||||248.00|248|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MULTIPLAN [1680]|HMA [168003]|248.00||||248.00|39.92|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248.00||||248.00|26.52|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MULTIPLAN [1680]|IHC HS [168011]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|248.00||||248.00|38.25|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|AETNA [1015]|AETNA ACO WILCO [101532]|248.00||||248.00|41.88|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|HEALTHNET [1495]|HEALTHNET [149500]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|248.00||||248.00|32.71|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248.00||||248.00|27.94|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248.00||||248.00|148.8|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248.00||||248.00|32.71|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|248.00||||248.00|124.25|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248.00||||248.00|28.83|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248.00||||248.00|87.05|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|248.00||||248.00|105.65|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|GEHA [1415]|GEHA [141500]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248.00||||248.00|27.84|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248.00||||248.00|124|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|248.00||||248.00|17.66|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|TRUSTMARK [2030]|STARMARK [203000]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248.00||||248.00|29.27|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248.00||||248.00|26.61|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248.00||||248.00|223.2|248|17.66 31188175|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTP C/V AUTO THIN SCR MNL RESCR PHYS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248.00||||248.00|29.27|248|17.66 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86.00||||86.00|43|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86.00||||86.00|36.98|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86.00||||86.00|43.09|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86.00||||86.00|30.19|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86.00||||86.00|51.6|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86.00||||86.00|7.1|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86.00||||86.00|6.85|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|HEALTHNET [1495]|HEALTHNET [149500]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|AETNA [1015]|AETNA ACO WILCO [101532]|86.00||||86.00|9.44|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|TRUSTMARK [2030]|STARMARK [203000]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.00||||86.00|4.33|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.00||||86.00|36.98|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MULTIPLAN [1680]|IHC HS [168011]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86.00||||86.00|8.12|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86.00||||86.00|36.64|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86.00||||86.00|86|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|||86.00||||86.00|25.8|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86.00||||86.00|6.53|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|CHAMPVA [1240]|CHAMP VA [124000]|86.00||||86.00|64.5|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86.00||||86.00|7.1|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86.00||||86.00|7.38|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|CORESOURCE [1315]|CORESOURCE [131500]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|GEHA [1415]|GEHA [141500]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86.00||||86.00|18.06|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|UMR [2035]|UMR OPTIONS [203501]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86.00||||86.00|77.4|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.00||||86.00|41.24|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86.00||||86.00|55.9|86|4.33 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MULTIPLAN [1680]|HMA [168003]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.00||||86.00||| 31188177|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FNA SPEC ADEQUACY EA ADD EVAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86.00||||86.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|GEHA [1415]|GEHA [141500]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|CORESOURCE [1315]|CORESOURCE [131500]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|CHAMPVA [1240]|CHAMP VA [124000]|710.00||||710.00|532.5|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|710.00||||710.00|149.1|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|UMR [2035]|UMR OPTIONS [203501]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|710.00||||710.00|112.83|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|710.00||||710.00|98.69|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|FIRST HEALTH [1375]|QUALCHOICE [137513]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|710.00||||710.00|340.45|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|710.00||||710.00|710|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|FMH BENEFIT SERVICES [1390]|FMH [139000]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|710.00||||710.00|305.3|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|||710.00||||710.00|213|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|710.00||||710.00|461.5|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|710.00||||710.00|90.77|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MULTIPLAN [1680]|IHC HS [168011]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|TRUSTMARK [2030]|STARMARK [203000]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|710.00||||710.00|30.59|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|710.00||||710.00|426|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|710.00||||710.00|249.21|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|710.00||||710.00|305.3|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|710.00||||710.00|302.46|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|710.00||||710.00|355.71|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|710.00||||710.00|95.31|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|710.00||||710.00|102.58|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|710.00||||710.00|121.87|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|710.00||||710.00|98.69|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|AETNA [1015]|AETNA ACO WILCO [101532]|710.00||||710.00|126.56|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|HEALTHNET [1495]|HEALTHNET [149500]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|710.00||||710.00|639|710|30.59 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MULTIPLAN [1680]|HMA [168003]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|710.00||||710.00||| 31188182|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY CELL CYCLE/DNA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|710.00||||710.00||| 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|317.00||||317.00|296.75|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|317.00||||317.00|317|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|317.00||||317.00|135.04|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|317.00||||317.00|158.82|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|317.00||||317.00|190.2|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|317.00||||317.00|67.33|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|317.00||||317.00|296.75|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|TRUSTMARK [2030]|STARMARK [203000]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|HEALTHNET [1495]|HEALTHNET [149500]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|AETNA [1015]|AETNA ACO WILCO [101532]|317.00||||317.00|89.1|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MULTIPLAN [1680]|HMA [168003]|317.00||||317.00|404.65|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|317.00||||317.00|317|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|317.00||||317.00|65.04|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|FMH BENEFIT SERVICES [1390]|FMH [139000]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|FIRST HEALTH [1375]|QUALCHOICE [137513]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|317.00||||317.00|283.26|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|317.00||||317.00|136.31|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|317.00||||317.00|76.98|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|317.00||||317.00|275.16|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|317.00||||317.00|164.53|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MULTIPLAN [1680]|IHC HS [168011]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|UMR [2035]|UMR OPTIONS [203501]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|317.00||||317.00|206.05|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|317.00||||317.00|152|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|317.00||||317.00|67.33|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|317.00||||317.00|269.77|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|317.00||||317.00|111.27|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|317.00||||317.00|61.94|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|CHAMPVA [1240]|CHAMP VA [124000]|317.00||||317.00|237.75|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|317.00||||317.00|317|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|317.00||||317.00|69.98|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|CORESOURCE [1315]|CORESOURCE [131500]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|317.00||||317.00|317|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|GEHA [1415]|GEHA [141500]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|||317.00||||317.00|95.1|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|317.00||||317.00|66.57|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|317.00||||317.00|317|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|317.00||||317.00|136.31|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|317.00||||317.00|285.3|404.65|61.94 31188184|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY FIRST MARKER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|317.00||||317.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00|22.88|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00|20.25|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|||150.00||||150.00|45|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00|25.16|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00|22.01|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|64.5|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00|21.26|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00|22.01|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|64.5|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00|75|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00|14.92|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00|32.58|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|14.92 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 31188185|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC FLOW CYTOMETRY EA ADD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1364.00||||1364.00|1364|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1364.00||||1364.00|654.04|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1364.00||||1364.00|886.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|||1364.00||||1364.00|409.2|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1364.00||||1364.00|126.21|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1364.00||||1364.00|116.09|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1364.00||||1364.00|286.44|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|CHAMPVA [1240]|CHAMP VA [124000]|1364.00||||1364.00|1023|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1364.00||||1364.00|167.47|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1364.00||||1364.00|131.18|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|CORESOURCE [1315]|CORESOURCE [131500]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|GEHA [1415]|GEHA [141500]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1364.00||||1364.00|682|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1364.00||||1364.00|478.76|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1364.00||||1364.00|683.36|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1364.00||||1364.00|143.82|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1364.00||||1364.00|581.06|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1364.00||||1364.00|818.4|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1364.00||||1364.00|122.31|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1364.00||||1364.00|126.21|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1364.00||||1364.00|128.14|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1364.00||||1364.00|121.9|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1364.00||||1364.00|77.66|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|TRUSTMARK [2030]|STARMARK [203000]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|HEALTHNET [1495]|HEALTHNET [149500]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|AETNA [1015]|AETNA ACO WILCO [101532]|1364.00||||1364.00|184.12|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MULTIPLAN [1680]|IHC HS [168011]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1364.00||||1364.00|167.47|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MULTIPLAN [1680]|HMA [168003]|1364.00||||1364.00|174.74|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1364.00||||1364.00|128.14|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1364.00||||1364.00|143.82|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1364.00||||1364.00|144.3|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1364.00||||1364.00|118.82|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1364.00||||1364.00|116.49|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|UMR [2035]|UMR OPTIONS [203501]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1364.00||||1364.00|1227.6|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1364.00||||1364.00|170.08|1364|77.66 31188230|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ANALYSIS LYMPHOCYTE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1364.00||||1364.00||| 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|GEHA [1415]|GEHA [141500]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|CORESOURCE [1315]|CORESOURCE [131500]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1647.00||||1647.00|202.31|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|CHAMPVA [1240]|CHAMP VA [124000]|1647.00||||1647.00|1235.25|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1647.00||||1647.00|152.48|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1647.00||||1647.00|1070.55|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1647.00||||1647.00|789.74|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1647.00||||1647.00|345.87|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|UMR [2035]|UMR OPTIONS [203501]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1647.00||||1647.00|143.54|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1647.00||||1647.00|174.33|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1647.00||||1647.00|173.74|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MULTIPLAN [1680]|IHC HS [168011]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1647.00||||1647.00|205.47|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1647.00||||1647.00|1647|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1647.00||||1647.00|202.31|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MULTIPLAN [1680]|HMA [168003]|1647.00||||1647.00|211.1|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|AETNA [1015]|AETNA ACO WILCO [101532]|1647.00||||1647.00|222.41|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|HEALTHNET [1495]|HEALTHNET [149500]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|TRUSTMARK [2030]|STARMARK [203000]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|||1647.00||||1647.00|494.1|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1647.00||||1647.00|93.82|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1647.00||||1647.00|140.26|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1647.00||||1647.00|147.27|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1647.00||||1647.00|154.8|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1647.00||||1647.00|158.48|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1647.00||||1647.00|152.48|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1647.00||||1647.00|147.77|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1647.00||||1647.00|988.2|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1647.00||||1647.00|825.15|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1647.00||||1647.00|578.1|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1647.00||||1647.00|701.62|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1647.00||||1647.00|173.74|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1647.00||||1647.00|823.5|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1647.00||||1647.00|140.73|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1647.00||||1647.00|1482.3|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1647.00||||1647.00|154.8|1647|93.82 31188233|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE SKIN/SOLID TISSUE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1647.00||||1647.00||| 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1383.00||||1383.00|158.13|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1383.00||||1383.00|691.5|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1383.00||||1383.00|589.16|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1383.00||||1383.00|155.93|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1383.00||||1383.00|692.88|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1383.00||||1383.00|829.8|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1383.00||||1383.00|155.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1383.00||||1383.00|158.13|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1383.00||||1383.00|150.43|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|TRUSTMARK [2030]|STARMARK [203000]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|HEALTHNET [1495]|HEALTHNET [149500]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|AETNA [1015]|AETNA ACO WILCO [101532]|1383.00||||1383.00|204.47|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1383.00||||1383.00|206.66|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MULTIPLAN [1680]|HMA [168003]|1383.00||||1383.00|215.63|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|FMH BENEFIT SERVICES [1390]|FMH [139000]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MULTIPLAN [1680]|IHC HS [168011]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|FIRST HEALTH [1375]|QUALCHOICE [137513]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1383.00||||1383.00|155.93|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1383.00||||1383.00|178.08|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1383.00||||1383.00|146.63|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|UMR [2035]|UMR OPTIONS [203501]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1383.00||||1383.00|86.25|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1383.00||||1383.00|209.88|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1383.00||||1383.00|290.43|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1383.00||||1383.00|1383|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1383.00||||1383.00|663.15|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1383.00||||1383.00|150.94|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1383.00||||1383.00|485.43|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1383.00||||1383.00|898.95|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|||1383.00||||1383.00|414.9|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1383.00||||1383.00|155.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1383.00||||1383.00|143.75|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1383.00||||1383.00|143.26|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|CHAMPVA [1240]|CHAMP VA [124000]|1383.00||||1383.00|1037.25|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1383.00||||1383.00|206.66|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1383.00||||1383.00|161.88|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|CORESOURCE [1315]|CORESOURCE [131500]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|GEHA [1415]|GEHA [141500]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1383.00||||1383.00|1244.7|1383|86.25 31188237|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC HIST CHROMO ANALS BONE MARROW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1383.00||||1383.00||| 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|GEHA [1415]|GEHA [141500]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|CORESOURCE [1315]|CORESOURCE [131500]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|443.00||||443.00|166.12|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|443.00||||443.00|212.07|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|443.00||||443.00|147.01|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|||443.00||||443.00|132.9|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|443.00||||443.00|287.95|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|443.00||||443.00|212.42|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|443.00||||443.00|443|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|443.00||||443.00|93.03|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|443.00||||443.00|215.38|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|443.00||||443.00|182.73|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|443.00||||443.00|182.12|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|FIRST HEALTH [1375]|QUALCHOICE [137513]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|443.00||||443.00|150.47|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|FMH BENEFIT SERVICES [1390]|FMH [139000]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|UMR [2035]|UMR OPTIONS [203501]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MULTIPLAN [1680]|IHC HS [168011]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|443.00||||443.00|212.07|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MULTIPLAN [1680]|HMA [168003]|443.00||||443.00|221.28|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|AETNA [1015]|AETNA ACO WILCO [101532]|443.00||||443.00|233.15|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|443.00||||443.00|159.83|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|HEALTHNET [1495]|HEALTHNET [149500]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|TRUSTMARK [2030]|STARMARK [203000]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|443.00||||443.00|98.35|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|443.00||||443.00|154.37|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|CHAMPVA [1240]|CHAMP VA [124000]|443.00||||443.00|332.25|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|443.00||||443.00|162.27|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|443.00||||443.00|159.83|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|443.00||||443.00|154.9|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|443.00||||443.00|265.8|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|443.00||||443.00|221.94|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|443.00||||443.00|188.72|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|443.00||||443.00|155.49|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|443.00||||443.00|182.12|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|443.00||||443.00|221.5|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|443.00||||443.00|147.52|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|443.00||||443.00|398.7|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|443.00||||443.00|162.27|443|93.03 31188239|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC TISSUE CULTURE OTHER TISSUE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|443.00||||443.00||| 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2567.00||||2567.00|1283.5|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2567.00||||2567.00|1286.07|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2567.00||||2567.00|1093.54|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2567.00||||2567.00|1540.2|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2567.00||||2567.00|277.56|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2567.00||||2567.00|286.4|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2567.00||||2567.00|290.77|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2567.00||||2567.00|276.62|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2567.00||||2567.00|158.6|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|TRUSTMARK [2030]|STARMARK [203000]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|HEALTHNET [1495]|HEALTHNET [149500]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|AETNA [1015]|AETNA ACO WILCO [101532]|2567.00||||2567.00|376|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MULTIPLAN [1680]|IHC HS [168011]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2567.00||||2567.00|380.02|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MULTIPLAN [1680]|HMA [168003]|2567.00||||2567.00|396.51|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2567.00||||2567.00|327.44|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2567.00||||2567.00|269.63|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|UMR [2035]|UMR OPTIONS [203501]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2567.00||||2567.00|385.94|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2567.00||||2567.00|539.07|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2567.00||||2567.00|2567|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2567.00||||2567.00|1230.88|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2567.00||||2567.00|1668.55|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|||2567.00||||2567.00|770.1|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2567.00||||2567.00|286.4|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2567.00||||2567.00|901.02|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2567.00||||2567.00|290.77|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2567.00||||2567.00|264.34|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2567.00||||2567.00|263.44|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|CHAMPVA [1240]|CHAMP VA [124000]|2567.00||||2567.00|1925.25|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2567.00||||2567.00|380.02|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2567.00||||2567.00|297.68|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|CORESOURCE [1315]|CORESOURCE [131500]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|GEHA [1415]|GEHA [141500]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2567.00||||2567.00|2310.3|2567|158.6 31188261|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT 5/1|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2567.00||||2567.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|GEHA [1415]|GEHA [141500]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|CORESOURCE [1315]|CORESOURCE [131500]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1460.00||||1460.00|905.2|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|CHAMPVA [1240]|CHAMP VA [124000]|1460.00||||1460.00|1095|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1460.00||||1460.00|125.06|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1460.00||||1460.00|125.49|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1460.00||||1460.00|135.96|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1460.00||||1460.00|949|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1460.00||||1460.00|700.07|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1460.00||||1460.00|306.6|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1460.00||||1460.00|906.66|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|UMR [2035]|UMR OPTIONS [203501]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1460.00||||1460.00|128|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1460.00||||1460.00|155.45|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1460.00||||1460.00|153.88|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|FIRST HEALTH [1375]|QUALCHOICE [137513]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1460.00||||1460.00|125.49|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|FMH BENEFIT SERVICES [1390]|FMH [139000]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MULTIPLAN [1680]|IHC HS [168011]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1460.00||||1460.00|180.4|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MULTIPLAN [1680]|HMA [168003]|1460.00||||1460.00|188.24|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1460.00||||1460.00|125.49|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1460.00||||1460.00|1460|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|||1460.00||||1460.00|438|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|AETNA [1015]|AETNA ACO WILCO [101532]|1460.00||||1460.00|196.99|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|HEALTHNET [1495]|HEALTHNET [149500]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|TRUSTMARK [2030]|STARMARK [203000]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1460.00||||1460.00|83.09|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1460.00||||1460.00|131.32|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1460.00||||1460.00|125.49|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1460.00||||1460.00|141.31|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1460.00||||1460.00|135.96|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1460.00||||1460.00|131.76|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1460.00||||1460.00|876|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1460.00||||1460.00|731.46|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1460.00||||1460.00|512.46|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1460.00||||1460.00|621.96|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1460.00||||1460.00|153.88|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1460.00||||1460.00|125.49|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1460.00||||1460.00|730|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1460.00||||1460.00|125.49|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1460.00||||1460.00|1314|1460|83.09 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1460.00||||1460.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1460.00||||1460.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1460.00||||1460.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1460.00||||1460.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1460.00||||1460.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1460.00||||1460.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1460.00||||1460.00||| 31188262|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO COUNT 15-20/2|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1460.00||||1460.00||| 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|935.00||||935.00|159.07|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|935.00||||935.00|467.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|935.00||||935.00|468.44|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|935.00||||935.00|153.88|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|935.00||||935.00|328.19|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|935.00||||935.00|561|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|935.00||||935.00|151.84|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|935.00||||935.00|156.67|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|935.00||||935.00|159.07|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|935.00||||935.00|151.32|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|TRUSTMARK [2030]|STARMARK [203000]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|HEALTHNET [1495]|HEALTHNET [149500]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|AETNA [1015]|AETNA ACO WILCO [101532]|935.00||||935.00|205.69|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MULTIPLAN [1680]|IHC HS [168011]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MULTIPLAN [1680]|HMA [168003]|935.00||||935.00|216.92|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|935.00||||935.00|207.89|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|FMH BENEFIT SERVICES [1390]|FMH [139000]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|FIRST HEALTH [1375]|QUALCHOICE [137513]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|935.00||||935.00|153.88|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|935.00||||935.00|179.13|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|935.00||||935.00|147.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|UMR [2035]|UMR OPTIONS [203501]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|935.00||||935.00|86.77|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|935.00||||935.00|211.13|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|935.00||||935.00|196.35|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|935.00||||935.00|935|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|935.00||||935.00|448.33|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|935.00||||935.00|398.31|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|935.00||||935.00|607.75|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|||935.00||||935.00|280.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|935.00||||935.00|156.67|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|935.00||||935.00|144.61|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|935.00||||935.00|144.11|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|CHAMPVA [1240]|CHAMP VA [124000]|935.00||||935.00|701.25|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|935.00||||935.00|207.89|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|935.00||||935.00|162.84|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|CORESOURCE [1315]|CORESOURCE [131500]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|GEHA [1415]|GEHA [141500]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|935.00||||935.00|841.5|935|86.77 31188264|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROM ANALY 20-25 CELLS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|935.00||||935.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|CORESOURCE [1315]|CORESOURCE [131500]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2105.00||||2105.00|212.35|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2105.00||||2105.00|187.93|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2105.00||||2105.00|204.31|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|||2105.00||||2105.00|631.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2105.00||||2105.00|1368.25|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2105.00||||2105.00|2105|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2105.00||||2105.00|442.05|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2105.00||||2105.00|233.59|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2105.00||||2105.00|221.95|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|FIRST HEALTH [1375]|QUALCHOICE [137513]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|FMH BENEFIT SERVICES [1390]|FMH [139000]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|UMR [2035]|UMR OPTIONS [203501]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MULTIPLAN [1680]|IHC HS [168011]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2105.00||||2105.00|1009.35|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|AETNA [1015]|AETNA ACO WILCO [101532]|2105.00||||2105.00|284.12|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|HEALTHNET [1495]|HEALTHNET [149500]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|TRUSTMARK [2030]|STARMARK [203000]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2105.00||||2105.00|119.85|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2105.00||||2105.00|197.34|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|CHAMPVA [1240]|CHAMP VA [124000]|2105.00||||2105.00|1578.75|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2105.00||||2105.00|204.31|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|GEHA [1415]|GEHA [141500]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2105.00||||2105.00|1263|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2105.00||||2105.00|221.95|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2105.00||||2105.00|1054.61|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2105.00||||2105.00|896.73|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2105.00||||2105.00|738.86|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2105.00||||2105.00|1052.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2105.00||||2105.00|1894.5|2105|119.85 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MULTIPLAN [1680]|HMA [168003]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2105.00||||2105.00||| 31188267|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO CNT AMNIOTIC 15/1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2105.00||||2105.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235.00||||235.00|117.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235.00||||235.00|26.44|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|235.00||||235.00|117.74|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|235.00||||235.00|100.11|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235.00||||235.00|141|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235.00||||235.00|23.2|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235.00||||235.00|22.41|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|235.00||||235.00|14.28|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|HEALTHNET [1495]|HEALTHNET [149500]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|AETNA [1015]|AETNA ACO WILCO [101532]|235.00||||235.00|33.86|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MULTIPLAN [1680]|IHC HS [168011]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|FMH BENEFIT SERVICES [1390]|FMH [139000]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|FIRST HEALTH [1375]|QUALCHOICE [137513]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235.00||||235.00|26.44|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|235.00||||235.00|26.52|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|TRUSTMARK [2030]|STARMARK [203000]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|UMR [2035]|UMR OPTIONS [203501]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235.00||||235.00|49.35|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235.00||||235.00|235|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235.00||||235.00|112.68|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235.00||||235.00|152.75|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|||235.00||||235.00|70.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235.00||||235.00|82.49|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235.00||||235.00|23.2|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235.00||||235.00|21.34|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|CHAMPVA [1240]|CHAMP VA [124000]|235.00||||235.00|176.25|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|235.00||||235.00|24.11|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|CORESOURCE [1315]|CORESOURCE [131500]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|GEHA [1415]|GEHA [141500]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235.00||||235.00|211.5|235|14.28 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MULTIPLAN [1680]|HMA [168003]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235.00||||235.00||| 31188271|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTOGEN DNA PROBE FISH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|235.00||||235.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|GEHA [1415]|GEHA [141500]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|CORESOURCE [1315]|CORESOURCE [131500]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|418.00||||418.00|45.84|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|CHAMPVA [1240]|CHAMP VA [124000]|418.00||||418.00|313.5|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|418.00||||418.00|44.1|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|418.00||||418.00|271.7|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|418.00||||418.00|200.43|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|418.00||||418.00|418|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|418.00||||418.00|87.78|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|UMR [2035]|UMR OPTIONS [203501]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|418.00||||418.00|50.42|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|418.00||||418.00|40.7|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|FIRST HEALTH [1375]|QUALCHOICE [137513]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|FMH BENEFIT SERVICES [1390]|FMH [139000]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MULTIPLAN [1680]|IHC HS [168011]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|||418.00||||418.00|125.4|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|AETNA [1015]|AETNA ACO WILCO [101532]|418.00||||418.00|57.89|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|HEALTHNET [1495]|HEALTHNET [149500]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|TRUSTMARK [2030]|STARMARK [203000]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|418.00||||418.00|40.57|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|418.00||||418.00|24.42|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|418.00||||418.00|42.6|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|418.00||||418.00|44.1|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|418.00||||418.00|250.8|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|418.00||||418.00|209.42|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|418.00||||418.00|178.07|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|418.00||||418.00|146.72|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|418.00||||418.00|40.7|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|418.00||||418.00|209|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|418.00||||418.00|376.2|418|24.42 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MULTIPLAN [1680]|HMA [168003]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|418.00||||418.00||| 31188272|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG SITU HYBRID 3-5 CELLS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|418.00||||418.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|501.00||||501.00|250.5|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|501.00||||501.00|213.43|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|501.00||||501.00|39.66|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|501.00||||501.00|251|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|501.00||||501.00|175.85|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|501.00||||501.00|300.6|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|501.00||||501.00|37.71|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|501.00||||501.00|36.42|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|TRUSTMARK [2030]|STARMARK [203000]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|HEALTHNET [1495]|HEALTHNET [149500]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|AETNA [1015]|COVENTRY HEALTHCARE [101502]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|AETNA [1015]|AETNA ACO WILCO [101532]|501.00||||501.00|50.78|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|FMH BENEFIT SERVICES [1390]|FMH [139000]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MULTIPLAN [1680]|IHC HS [168011]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|FIRST HEALTH [1375]|QUALCHOICE [137513]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|501.00||||501.00|39.66|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|501.00||||501.00|43.11|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|UMR [2035]|UMR OPTIONS [203501]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|501.00||||501.00|21.42|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|501.00||||501.00|105.21|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|501.00||||501.00|501|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|501.00||||501.00|240.23|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|501.00||||501.00|325.65|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|||501.00||||501.00|150.3|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|501.00||||501.00|37.71|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|501.00||||501.00|34.68|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|CHAMPVA [1240]|CHAMP VA [124000]|501.00||||501.00|375.75|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|501.00||||501.00|39.19|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|CORESOURCE [1315]|CORESOURCE [131500]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|GEHA [1415]|GEHA [141500]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|501.00||||501.00|450.9|501|21.42 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MULTIPLAN [1680]|HMA [168003]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|501.00||||501.00||| 31188273|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MOLEC CYTO CHROM IN SIT 10-30|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|501.00||||501.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|CORESOURCE [1315]|CORESOURCE [131500]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|542.00||||542.00|47.73|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|CHAMPVA [1240]|CHAMP VA [124000]|542.00||||542.00|406.5|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|542.00||||542.00|42.24|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|||542.00||||542.00|162.6|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|542.00||||542.00|352.3|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|542.00||||542.00|542|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|542.00||||542.00|113.82|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|UMR [2035]|UMR OPTIONS [203501]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|542.00||||542.00|52.5|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|542.00||||542.00|42.98|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|FIRST HEALTH [1375]|QUALCHOICE [137513]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|FMH BENEFIT SERVICES [1390]|FMH [139000]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MULTIPLAN [1680]|IHC HS [168011]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|AETNA [1015]|AETNA ACO WILCO [101532]|542.00||||542.00|60.28|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|542.00||||542.00|259.89|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|542.00||||542.00|45.92|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|HEALTHNET [1495]|HEALTHNET [149500]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|TRUSTMARK [2030]|STARMARK [203000]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|542.00||||542.00|25.43|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|542.00||||542.00|44.35|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|GEHA [1415]|GEHA [141500]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|542.00||||542.00|45.92|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|542.00||||542.00|325.2|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|542.00||||542.00|271.54|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|542.00||||542.00|230.89|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|542.00||||542.00|42.98|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|542.00||||542.00|190.24|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|542.00||||542.00|271|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|542.00||||542.00|487.8|542|25.43 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MULTIPLAN [1680]|HMA [168003]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|542.00||||542.00||| 31188274|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC MCG IP SITU 25-99 CELLS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|542.00||||542.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|441.00||||441.00|220.5|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|441.00||||441.00|51.19|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|441.00||||441.00|220.94|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|441.00||||441.00|187.87|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|441.00||||441.00|264.6|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|441.00||||441.00|55.46|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|441.00||||441.00|53.57|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|441.00||||441.00|30.71|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|HEALTHNET [1495]|HEALTHNET [149500]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|AETNA [1015]|COVENTRY HEALTHCARE [101502]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|AETNA [1015]|AETNA ACO WILCO [101532]|441.00||||441.00|72.81|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MULTIPLAN [1680]|IHC HS [168011]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|FMH BENEFIT SERVICES [1390]|FMH [139000]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|FIRST HEALTH [1375]|QUALCHOICE [137513]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|441.00||||441.00|51.19|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|441.00||||441.00|63.41|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|TRUSTMARK [2030]|STARMARK [203000]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|UMR [2035]|UMR OPTIONS [203501]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|441.00||||441.00|92.61|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|441.00||||441.00|441|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|441.00||||441.00|211.46|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|441.00||||441.00|154.79|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|441.00||||441.00|286.65|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|||441.00||||441.00|132.3|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|441.00||||441.00|55.46|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|441.00||||441.00|51.01|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|CHAMPVA [1240]|CHAMP VA [124000]|441.00||||441.00|330.75|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|441.00||||441.00|57.64|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|CORESOURCE [1315]|CORESOURCE [131500]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|GEHA [1415]|GEHA [141500]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|441.00||||441.00|396.9|441|30.71 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MULTIPLAN [1680]|HMA [168003]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|441.00||||441.00||| 31188275|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CYTOGEN INTERPHASE 100-300|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|441.00||||441.00||| 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|GEHA [1415]|GEHA [141500]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|CORESOURCE [1315]|CORESOURCE [131500]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|275.00||||275.00|48.12|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|CHAMPVA [1240]|CHAMP VA [124000]|275.00||||275.00|206.25|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|275.00||||275.00|36.26|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|||275.00||||275.00|82.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|275.00||||275.00|178.75|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|275.00||||275.00|131.86|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|275.00||||275.00|57.75|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|UMR [2035]|UMR OPTIONS [203501]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|275.00||||275.00|34.14|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|275.00||||275.00|41.46|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|FIRST HEALTH [1375]|QUALCHOICE [137513]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|FMH BENEFIT SERVICES [1390]|FMH [139000]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|275.00||||275.00|48.87|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MULTIPLAN [1680]|IHC HS [168011]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|275.00||||275.00|275|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|275.00||||275.00|48.12|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MULTIPLAN [1680]|HMA [168003]|275.00||||275.00|50.21|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|AETNA [1015]|AETNA ACO WILCO [101532]|275.00||||275.00|47.61|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|HEALTHNET [1495]|HEALTHNET [149500]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|TRUSTMARK [2030]|STARMARK [203000]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|275.00||||275.00|20.08|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|275.00||||275.00|33.35|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|275.00||||275.00|35.02|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|275.00||||275.00|37.69|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|275.00||||275.00|36.82|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|275.00||||275.00|36.26|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|275.00||||275.00|35.14|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|275.00||||275.00|165|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|275.00||||275.00|117.15|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|275.00||||275.00|96.53|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|275.00||||275.00|137.78|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|275.00||||275.00|137.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|275.00||||275.00|33.47|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|275.00||||275.00|247.5|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|275.00||||275.00|36.82|275|20.08 31188280|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL KARYO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|275.00||||275.00||| 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|984.00||||984.00|75.46|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|984.00||||984.00|492|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|984.00||||984.00|419.18|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|984.00||||984.00|492.98|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|984.00||||984.00|345.38|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|984.00||||984.00|590.4|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|984.00||||984.00|74.32|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|984.00||||984.00|75.46|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|984.00||||984.00|71.78|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|984.00||||984.00|45.73|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|TRUSTMARK [2030]|STARMARK [203000]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|HEALTHNET [1495]|HEALTHNET [149500]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|AETNA [1015]|AETNA ACO WILCO [101532]|984.00||||984.00|108.42|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MULTIPLAN [1680]|HMA [168003]|984.00||||984.00|102.9|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|984.00||||984.00|98.62|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|FMH BENEFIT SERVICES [1390]|FMH [139000]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MULTIPLAN [1680]|IHC HS [168011]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|FIRST HEALTH [1375]|QUALCHOICE [137513]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|984.00||||984.00|84.69|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|984.00||||984.00|84.97|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|984.00||||984.00|69.97|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|UMR [2035]|UMR OPTIONS [203501]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|984.00||||984.00|100.16|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|984.00||||984.00|206.64|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|984.00||||984.00|72.03|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|984.00||||984.00|984|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|984.00||||984.00|471.83|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|984.00||||984.00|639.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|||984.00||||984.00|295.2|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|984.00||||984.00|74.32|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|984.00||||984.00|84.69|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|984.00||||984.00|68.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|984.00||||984.00|68.36|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|CHAMPVA [1240]|CHAMP VA [124000]|984.00||||984.00|738|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|984.00||||984.00|98.62|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|984.00||||984.00|77.25|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|CORESOURCE [1315]|CORESOURCE [131500]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|GEHA [1415]|GEHA [141500]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|984.00||||984.00|885.6|984|45.73 31188283|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMOSOME BANDING STUDY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|984.00||||984.00||| 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|CORESOURCE [1315]|CORESOURCE [131500]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|295.00||||295.00|30.31|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|295.00||||295.00|38.69|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|CHAMPVA [1240]|CHAMP VA [124000]|295.00||||295.00|221.25|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|295.00||||295.00|26.83|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|||295.00||||295.00|88.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|295.00||||295.00|191.75|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|295.00||||295.00|141.45|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|295.00||||295.00|295|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|295.00||||295.00|61.95|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|295.00||||295.00|39.29|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|295.00||||295.00|33.34|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|295.00||||295.00|27.45|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|UMR [2035]|UMR OPTIONS [203501]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MULTIPLAN [1680]|IHC HS [168011]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|295.00||||295.00|38.69|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MULTIPLAN [1680]|HMA [168003]|295.00||||295.00|40.37|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|AETNA [1015]|AETNA ACO WILCO [101532]|295.00||||295.00|38.28|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|295.00||||295.00|29.16|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|HEALTHNET [1495]|HEALTHNET [149500]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|TRUSTMARK [2030]|STARMARK [203000]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|295.00||||295.00|16.15|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|295.00||||295.00|28.17|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|295.00||||295.00|29.6|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|295.00||||295.00|29.16|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|295.00||||295.00|28.26|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|GEHA [1415]|GEHA [141500]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|295.00||||295.00|177|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|295.00||||295.00|125.67|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|295.00||||295.00|103.55|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|295.00||||295.00|147.8|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|295.00||||295.00|147.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|295.00||||295.00|26.91|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|295.00||||295.00|265.5|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|295.00||||295.00|29.6|295|16.15 31188285|EAP|0311 - LABORATORY PATHOLOGY-CYTOLOGY|HC CHROMO ADDL CELL CNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|295.00||||295.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|||10.00||||10.00|3|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|||10.00||||10.00|3|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 31209|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALSARTAN 80 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|GEHA [1415]|GEHA [141500]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|989.00||||989.00|473.7|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|CHAMPVA [1240]|CHAMP VA [124000]|989.00||||989.00|741.75|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|||989.00||||989.00|296.7|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|989.00||||989.00|642.85|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|989.00||||989.00|474.23|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|989.00||||989.00|989|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|989.00||||989.00|207.69|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|989.00||||989.00|481.08|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|UMR [2035]|UMR OPTIONS [203501]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|989.00||||989.00|336.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MULTIPLAN [1680]|IHC HS [168011]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|989.00||||989.00|473.7|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MULTIPLAN [1680]|HMA [168003]|989.00||||989.00|494.27|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|AETNA [1015]|AETNA ACO WILCO [101532]|989.00||||989.00|468.7|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|HEALTHNET [1495]|HEALTHNET [149500]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|TRUSTMARK [2030]|STARMARK [203000]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|989.00||||989.00|197.71|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|989.00||||989.00|362.46|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|CORESOURCE [1315]|CORESOURCE [131500]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|989.00||||989.00|593.4|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|989.00||||989.00|345.99|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|989.00||||989.00|495.49|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|989.00||||989.00|421.31|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|989.00||||989.00|347.14|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|989.00||||989.00|494.5|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|989.00||||989.00|329.51|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|989.00||||989.00|890.1|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|989.00||||989.00|362.46|989|197.71 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|989.00||||989.00||| 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|989.00||||989.00||| 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|989.00||||989.00||| 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|989.00||||989.00||| 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|989.00||||989.00||| 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|989.00||||989.00||| 31281272|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KIT GENE ANAL TARGET SEQUENCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|989.00||||989.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|592.00||||592.00|296|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|592.00||||592.00|252.19|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|592.00||||592.00|207.79|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|592.00||||592.00|296.59|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|592.00||||592.00|355.2|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|592.00||||592.00|115.95|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|TRUSTMARK [2030]|STARMARK [203000]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MULTIPLAN [1680]|IHC HS [168011]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|FMH BENEFIT SERVICES [1390]|FMH [139000]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|FIRST HEALTH [1375]|QUALCHOICE [137513]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|592.00||||592.00|193.25|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|AETNA [1015]|AETNA ACO WILCO [101532]|592.00||||592.00|274.88|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|HEALTHNET [1495]|HEALTHNET [149500]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|UMR [2035]|UMR OPTIONS [203501]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|592.00||||592.00|124.32|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|592.00||||592.00|592|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|592.00||||592.00|283.86|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|592.00||||592.00|384.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|||592.00||||592.00|177.6|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|592.00||||592.00|193.25|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|CHAMPVA [1240]|CHAMP VA [124000]|592.00||||592.00|444|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|CORESOURCE [1315]|CORESOURCE [131500]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|GEHA [1415]|GEHA [141500]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|592.00||||592.00|532.8|592|115.95 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MULTIPLAN [1680]|HMA [168003]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|592.00||||592.00||| 31281276|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC KRAS GENE ANAL ADDL VARIANT(S)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|592.00||||592.00||| 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|GEHA [1415]|GEHA [141500]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|CORESOURCE [1315]|CORESOURCE [131500]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1040.00||||1040.00|425.23|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|CHAMPVA [1240]|CHAMP VA [124000]|1040.00||||1040.00|780|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|||1040.00||||1040.00|312|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1040.00||||1040.00|498.68|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1040.00||||1040.00|1040|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1040.00||||1040.00|218.4|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1040.00||||1040.00|431.85|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|UMR [2035]|UMR OPTIONS [203501]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1040.00||||1040.00|301.71|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|FIRST HEALTH [1375]|QUALCHOICE [137513]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|FMH BENEFIT SERVICES [1390]|FMH [139000]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MULTIPLAN [1680]|IHC HS [168011]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1040.00||||1040.00|425.23|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MULTIPLAN [1680]|HMA [168003]|1040.00||||1040.00|443.69|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|AETNA [1015]|AETNA ACO WILCO [101532]|1040.00||||1040.00|420.73|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1040.00||||1040.00|676|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|HEALTHNET [1495]|HEALTHNET [149500]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|TRUSTMARK [2030]|STARMARK [203000]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1040.00||||1040.00|177.47|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1040.00||||1040.00|325.37|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1040.00||||1040.00|624|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1040.00||||1040.00|310.58|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1040.00||||1040.00|443.04|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1040.00||||1040.00|521.04|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1040.00||||1040.00|365.04|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1040.00||||1040.00|520|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1040.00||||1040.00|295.79|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1040.00||||1040.00|936|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1040.00||||1040.00|325.37|1040|177.47 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1040.00||||1040.00||| 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1040.00||||1040.00||| 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1040.00||||1040.00||| 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1040.00||||1040.00||| 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1040.00||||1040.00||| 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1040.00||||1040.00||| 31281311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC NRAS GENE ANAL EXON 2 AND 3|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1040.00||||1040.00||| 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|870.00||||870.00|221.65|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|870.00||||870.00|248.76|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|870.00||||870.00|435.87|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|870.00||||870.00|370.62|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|870.00||||870.00|305.37|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|870.00||||870.00|211.58|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|870.00||||870.00|522|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|870.00||||870.00|221.65|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|870.00||||870.00|134.33|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|TRUSTMARK [2030]|STARMARK [203000]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|HEALTHNET [1495]|HEALTHNET [149500]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|AETNA [1015]|AETNA ACO WILCO [101532]|870.00||||870.00|318.45|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MULTIPLAN [1680]|IHC HS [168011]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MULTIPLAN [1680]|HMA [168003]|870.00||||870.00|302.25|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|870.00||||870.00|289.68|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|870.00||||870.00|248.76|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|870.00||||870.00|249.6|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|870.00||||870.00|205.53|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|UMR [2035]|UMR OPTIONS [203501]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|870.00||||870.00|210.86|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|870.00||||870.00|294.19|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|870.00||||870.00|182.7|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|870.00||||870.00|218.31|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|870.00||||870.00|870|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|870.00||||870.00|417.17|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|870.00||||870.00|565.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|||870.00||||870.00|261|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|870.00||||870.00|435|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|870.00||||870.00|218.31|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|870.00||||870.00|201.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|870.00||||870.00|200.81|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|CHAMPVA [1240]|CHAMP VA [124000]|870.00||||870.00|652.5|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|870.00||||870.00|289.68|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|870.00||||870.00|226.91|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|CORESOURCE [1315]|CORESOURCE [131500]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|GEHA [1415]|GEHA [141500]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|870.00||||870.00|783|870|134.33 31281342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TRG GENE REARRANGEMENT ANAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|870.00||||870.00||| 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|GEHA [1415]|GEHA [141500]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.00||||128.00|11.56|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.00||||128.00|31.45|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|CHAMPVA [1240]|CHAMP VA [124000]|128.00||||128.00|96|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.00||||128.00|11.12|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|||128.00||||128.00|38.4|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.00||||128.00|83.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.00||||128.00|61.38|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.00||||128.00|128|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.00||||128.00|26.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.00||||128.00|31.94|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|UMR [2035]|UMR OPTIONS [203501]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.00||||128.00|22.32|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.00||||128.00|12.71|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.00||||128.00|55.04|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MULTIPLAN [1680]|IHC HS [168011]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.00||||128.00|31.45|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MULTIPLAN [1680]|HMA [168003]|128.00||||128.00|32.82|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|AETNA [1015]|AETNA ACO WILCO [101532]|128.00||||128.00|15.28|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|HEALTHNET [1495]|HEALTHNET [149500]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|TRUSTMARK [2030]|STARMARK [203000]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.00||||128.00|10.3|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.00||||128.00|10.23|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.00||||128.00|10.74|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.00||||128.00|24.07|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|CORESOURCE [1315]|CORESOURCE [131500]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.00||||128.00|11.12|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.00||||128.00|76.8|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.00||||128.00|22.97|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.00||||128.00|55.04|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.00||||128.00|64.13|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.00||||128.00|54.53|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.00||||128.00|44.93|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.00||||128.00|41.04|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.00||||128.00|21.88|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.00||||128.00|115.2|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.00||||128.00|24.07|128|10.23 31288300|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS ONLY LEVEL I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.00||||128.00||| 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|274.00||||274.00|24.07|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|274.00||||274.00|76.78|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|274.00||||274.00|96.17|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|274.00||||274.00|116.72|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|274.00||||274.00|137.27|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|274.00||||274.00|164.4|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|274.00||||274.00|23.9|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|274.00||||274.00|24.07|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|274.00||||274.00|23.08|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|274.00||||274.00|19.27|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|TRUSTMARK [2030]|STARMARK [203000]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|AETNA [1015]|COVENTRY HEALTHCARE [101502]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MULTIPLAN [1680]|IHC HS [168011]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|274.00||||274.00|31.45|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MULTIPLAN [1680]|HMA [168003]|274.00||||274.00|32.82|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|FMH BENEFIT SERVICES [1390]|FMH [139000]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|FIRST HEALTH [1375]|QUALCHOICE [137513]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|274.00||||274.00|117.82|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|274.00||||274.00|27.33|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|AETNA [1015]|AETNA ACO WILCO [101532]|274.00||||274.00|31.8|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|274.00||||274.00|22.32|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|HEALTHNET [1495]|HEALTHNET [149500]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|UMR [2035]|UMR OPTIONS [203501]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|274.00||||274.00|31.94|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|274.00||||274.00|57.54|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|274.00||||274.00|274|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|274.00||||274.00|22.97|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|274.00||||274.00|131.38|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|274.00||||274.00|178.1|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|||274.00||||274.00|82.2|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|274.00||||274.00|117.82|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|274.00||||274.00|23.9|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|274.00||||274.00|21.88|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|274.00||||274.00|21.98|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|CHAMPVA [1240]|CHAMP VA [124000]|274.00||||274.00|205.5|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|274.00||||274.00|31.45|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|274.00||||274.00|24.84|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|CORESOURCE [1315]|CORESOURCE [131500]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|GEHA [1415]|GEHA [141500]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|274.00||||274.00|246.6|274|19.27 31288302|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL II|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|274.00||||274.00||| 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|GEHA [1415]|GEHA [141500]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|CORESOURCE [1315]|CORESOURCE [131500]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|437.00||||437.00|30.76|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|CHAMPVA [1240]|CHAMP VA [124000]|437.00||||437.00|327.75|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|437.00||||437.00|27.21|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|437.00||||437.00|29.59|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|||437.00||||437.00|131.1|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|437.00||||437.00|284.05|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|437.00||||437.00|209.54|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|437.00||||437.00|437|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|437.00||||437.00|91.77|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|437.00||||437.00|68.75|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|UMR [2035]|UMR OPTIONS [203501]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|437.00||||437.00|48.03|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|437.00||||437.00|33.83|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|437.00||||437.00|187.91|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|FIRST HEALTH [1375]|QUALCHOICE [137513]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|FMH BENEFIT SERVICES [1390]|FMH [139000]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MULTIPLAN [1680]|IHC HS [168011]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|437.00||||437.00|67.7|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MULTIPLAN [1680]|HMA [168003]|437.00||||437.00|70.63|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|AETNA [1015]|COVENTRY HEALTHCARE [101502]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|AETNA [1015]|AETNA ACO WILCO [101532]|437.00||||437.00|38.4|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|HEALTHNET [1495]|HEALTHNET [149500]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|TRUSTMARK [2030]|STARMARK [203000]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|437.00||||437.00|30.59|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|437.00||||437.00|28.57|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|437.00||||437.00|67.7|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|437.00||||437.00|51.8|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|437.00||||437.00|29.59|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|437.00||||437.00|262.2|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|437.00||||437.00|49.44|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|437.00||||437.00|186.16|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|437.00||||437.00|187.91|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|437.00||||437.00|218.94|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|437.00||||437.00|153.39|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|437.00||||437.00|121.87|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|437.00||||437.00|47.09|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|437.00||||437.00|393.3|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|437.00||||437.00|51.8|437|27.21 31288304|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL III|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|437.00||||437.00||| 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|734.00||||734.00|51.8|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|734.00||||734.00|121.87|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|734.00||||734.00|315.62|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|734.00||||734.00|367.73|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|734.00||||734.00|312.68|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|734.00||||734.00|49.44|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|734.00||||734.00|440.4|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|734.00||||734.00|51.8|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|734.00||||734.00|30.59|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|TRUSTMARK [2030]|STARMARK [203000]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|HEALTHNET [1495]|HEALTHNET [149500]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|AETNA [1015]|AETNA ACO WILCO [101532]|734.00||||734.00|40.3|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MULTIPLAN [1680]|IHC HS [168011]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MULTIPLAN [1680]|HMA [168003]|734.00||||734.00|70.63|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|FMH BENEFIT SERVICES [1390]|FMH [139000]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|734.00||||734.00|67.7|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|FIRST HEALTH [1375]|QUALCHOICE [137513]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|734.00||||734.00|315.62|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|734.00||||734.00|36.25|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|734.00||||734.00|48.03|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|UMR [2035]|UMR OPTIONS [203501]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|734.00||||734.00|30.62|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|734.00||||734.00|68.75|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|734.00||||734.00|154.14|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|734.00||||734.00|31.71|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|734.00||||734.00|734|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|734.00||||734.00|351.95|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|734.00||||734.00|477.1|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|||734.00||||734.00|220.2|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|734.00||||734.00|67.14|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|734.00||||734.00|31.71|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|734.00||||734.00|257.63|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|734.00||||734.00|47.09|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|734.00||||734.00|29.17|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|CHAMPVA [1240]|CHAMP VA [124000]|734.00||||734.00|550.5|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|734.00||||734.00|67.7|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|734.00||||734.00|32.96|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|CORESOURCE [1315]|CORESOURCE [131500]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|GEHA [1415]|GEHA [141500]|734.00||||734.00|660.6|734|29.17 31288305|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL IV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|734.00||||734.00|660.6|734|29.17 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|GEHA [1415]|GEHA [141500]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1506.00||||1506.00|199.63|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1506.00||||1506.00|387.82|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|CHAMPVA [1240]|CHAMP VA [124000]|1506.00||||1506.00|1129.5|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1506.00||||1506.00|176.67|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1506.00||||1506.00|192.07|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|||1506.00||||1506.00|451.8|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1506.00||||1506.00|978.9|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1506.00||||1506.00|722.13|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1506.00||||1506.00|1506|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1506.00||||1506.00|316.26|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1506.00||||1506.00|393.86|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|UMR [2035]|UMR OPTIONS [203501]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1506.00||||1506.00|275.16|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1506.00||||1506.00|219.6|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1506.00||||1506.00|647.58|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|FIRST HEALTH [1375]|QUALCHOICE [137513]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|FMH BENEFIT SERVICES [1390]|FMH [139000]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MULTIPLAN [1680]|IHC HS [168011]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1506.00||||1506.00|387.82|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MULTIPLAN [1680]|HMA [168003]|1506.00||||1506.00|404.65|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|AETNA [1015]|AETNA ACO WILCO [101532]|1506.00||||1506.00|244.9|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1506.00||||1506.00|253.89|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|HEALTHNET [1495]|HEALTHNET [149500]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|TRUSTMARK [2030]|STARMARK [203000]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1506.00||||1506.00|164.53|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1506.00||||1506.00|185.51|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1506.00||||1506.00|296.75|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1506.00||||1506.00|192.07|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1506.00||||1506.00|903.6|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1506.00||||1506.00|283.26|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|CORESOURCE [1315]|CORESOURCE [131500]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1506.00||||1506.00|647.58|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1506.00||||1506.00|754.51|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1506.00||||1506.00|528.61|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1506.00||||1506.00|641.56|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1506.00||||1506.00|655.46|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1506.00||||1506.00|269.77|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1506.00||||1506.00|1355.4|1506|164.53 31288307|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL V|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1506.00||||1506.00|296.75|1506|164.53 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1614.00||||1614.00|657.77|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1614.00||||1614.00|1334.03|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1614.00||||1614.00|808.61|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1614.00||||1614.00|687.56|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1614.00||||1614.00|694.02|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1614.00||||1614.00|627.87|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1614.00||||1614.00|968.4|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1614.00||||1614.00|270.9|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1614.00||||1614.00|261.64|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1614.00||||1614.00|334.87|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|TRUSTMARK [2030]|STARMARK [203000]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|AETNA [1015]|AETNA ACO WILCO [101532]|1614.00||||1614.00|343.74|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MULTIPLAN [1680]|IHC HS [168011]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1614.00||||1614.00|859.64|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MULTIPLAN [1680]|HMA [168003]|1614.00||||1614.00|896.95|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|FMH BENEFIT SERVICES [1390]|FMH [139000]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|FIRST HEALTH [1375]|QUALCHOICE [137513]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1614.00||||1614.00|694.02|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1614.00||||1614.00|309.72|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1614.00||||1614.00|609.93|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|HEALTHNET [1495]|HEALTHNET [149500]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|UMR [2035]|UMR OPTIONS [203501]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1614.00||||1614.00|873.03|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1614.00||||1614.00|657.77|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1614.00||||1614.00|338.94|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1614.00||||1614.00|1614|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1614.00||||1614.00|773.91|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1614.00||||1614.00|1049.1|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|||1614.00||||1614.00|484.2|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1614.00||||1614.00|566.51|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1614.00||||1614.00|270.9|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1614.00||||1614.00|597.97|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1614.00||||1614.00|249.18|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|CHAMPVA [1240]|CHAMP VA [124000]|1614.00||||1614.00|1210.5|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1614.00||||1614.00|859.64|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1614.00||||1614.00|281.57|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|CORESOURCE [1315]|CORESOURCE [131500]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|GEHA [1415]|GEHA [141500]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1614.00||||1614.00|1452.6|1614|249.18 31288309|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC GROSS & MICRO LEVEL VI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1614.00||||1614.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|GEHA [1415]|GEHA [141500]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|CORESOURCE [1315]|CORESOURCE [131500]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.00||||119.00|9.34|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|CHAMPVA [1240]|CHAMP VA [124000]|119.00||||119.00|89.25|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.00||||119.00|8.27|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.00||||119.00|8.99|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|||119.00||||119.00|35.7|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.00||||119.00|57.06|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.00||||119.00|119|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.00||||119.00|24.99|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|UMR [2035]|UMR OPTIONS [203501]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.00||||119.00|10.28|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.00||||119.00|51.17|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MULTIPLAN [1680]|IHC HS [168011]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|AETNA [1015]|AETNA ACO WILCO [101532]|119.00||||119.00|11.97|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.00||||119.00|77.35|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|HEALTHNET [1495]|HEALTHNET [149500]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|TRUSTMARK [2030]|STARMARK [203000]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.00||||119.00|5.41|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.00||||119.00|8.69|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.00||||119.00|8.99|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.00||||119.00|71.4|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.00||||119.00|50.69|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.00||||119.00|41.77|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.00||||119.00|59.62|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.00||||119.00|51.17|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.00||||119.00|59.5|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.00||||119.00|107.1|119|5.41 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MULTIPLAN [1680]|HMA [168003]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.00||||119.00||| 31288311|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC DECALCIFICATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.00||||119.00||| 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|491.00||||491.00|51.8|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|491.00||||491.00|245.99|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|491.00||||491.00|172.34|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|491.00||||491.00|209.17|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|491.00||||491.00|49.44|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|491.00||||491.00|294.6|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|491.00||||491.00|51.8|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|491.00||||491.00|75.56|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|491.00||||491.00|30.59|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|TRUSTMARK [2030]|STARMARK [203000]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|HEALTHNET [1495]|HEALTHNET [149500]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|AETNA [1015]|AETNA ACO WILCO [101532]|491.00||||491.00|97.43|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MULTIPLAN [1680]|IHC HS [168011]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MULTIPLAN [1680]|HMA [168003]|491.00||||491.00|70.63|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|FMH BENEFIT SERVICES [1390]|FMH [139000]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|FIRST HEALTH [1375]|QUALCHOICE [137513]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|491.00||||491.00|67.7|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|491.00||||491.00|211.13|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|491.00||||491.00|89.44|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|491.00||||491.00|48.03|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|UMR [2035]|UMR OPTIONS [203501]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|491.00||||491.00|68.75|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|491.00||||491.00|103.11|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|491.00||||491.00|78.23|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|491.00||||491.00|491|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|491.00||||491.00|235.43|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|491.00||||491.00|319.15|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|491.00||||491.00|211.13|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|||491.00||||491.00|147.3|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|491.00||||491.00|121.87|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|491.00||||491.00|78.23|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|491.00||||491.00|47.09|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|491.00||||491.00|71.96|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|CHAMPVA [1240]|CHAMP VA [124000]|491.00||||491.00|368.25|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|491.00||||491.00|67.7|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|491.00||||491.00|81.31|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|CORESOURCE [1315]|CORESOURCE [131500]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|GEHA [1415]|GEHA [141500]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|491.00||||491.00|441.9|491|30.59 31288312|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|491.00||||491.00||| 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|467.00||||467.00|76.78|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|467.00||||467.00|35.01|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|467.00||||467.00|200.81|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|467.00||||467.00|467|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|FMH BENEFIT SERVICES [1390]|FMH [139000]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|467.00||||467.00|46.46|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|TRUSTMARK [2030]|STARMARK [203000]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|467.00||||467.00|303.55|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|AETNA [1015]|COVENTRY HEALTHCARE [101502]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|467.00||||467.00|32.46|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MULTIPLAN [1680]|IHC HS [168011]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|467.00||||467.00|163.92|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|467.00||||467.00|66.18|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|HEALTHNET [1495]|HEALTHNET [149500]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|467.00||||467.00|200.81|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MULTIPLAN [1680]|HMA [168003]|467.00||||467.00|47.74|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|467.00||||467.00|45.75|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|467.00||||467.00|98.07|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|467.00||||467.00|280.2|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|467.00||||467.00|223.93|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|467.00||||467.00|58.56|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|467.00||||467.00|233.97|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|467.00||||467.00|61.49|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|CHAMPVA [1240]|CHAMP VA [124000]|467.00||||467.00|350.25|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|467.00||||467.00|35.01|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|467.00||||467.00|72.8|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|AETNA [1015]|AETNA ACO WILCO [101532]|467.00||||467.00|80.43|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|467.00||||467.00|198.94|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|UMR [2035]|UMR OPTIONS [203501]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|467.00||||467.00|33.41|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|||467.00||||467.00|140.1|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|467.00||||467.00|45.75|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|467.00||||467.00|19.27|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|467.00||||467.00|31.82|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|GEHA [1415]|GEHA [141500]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|FIRST HEALTH [1375]|QUALCHOICE [137513]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|467.00||||467.00|63.67|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|CORESOURCE [1315]|CORESOURCE [131500]|467.00||||467.00|420.3|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|467.00||||467.00|63.67|467|19.27 31288313|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN II|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|467.00||||467.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202.00||||202.00|121.2|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|TRUSTMARK [2030]|STARMARK [203000]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202.00||||202.00|86.86|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|202.00||||202.00|101.2|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|HEALTHNET [1495]|HEALTHNET [149500]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.00||||202.00|71.78|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|AETNA [1015]|AETNA ACO WILCO [101532]|202.00||||202.00|92.23|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202.00||||202.00|202|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MULTIPLAN [1680]|IHC HS [168011]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|202.00||||202.00|42.17|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|UMR [2035]|UMR OPTIONS [203501]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.00||||202.00|86.86|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202.00||||202.00|74.32|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202.00||||202.00|42.42|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202.00||||202.00|70.9|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202.00||||202.00|101|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|202.00||||202.00|77.25|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.00||||202.00|131.3|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.00||||202.00|96.86|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202.00||||202.00|74.32|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|CHAMPVA [1240]|CHAMP VA [124000]|202.00||||202.00|151.5|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|202.00||||202.00|86.05|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|GEHA [1415]|GEHA [141500]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|202.00||||202.00|84.97|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|CORESOURCE [1315]|CORESOURCE [131500]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|||202.00||||202.00|60.6|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202.00||||202.00|68.36|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202.00||||202.00|181.8|202|42.17 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MULTIPLAN [1680]|HMA [168003]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.00||||202.00||| 31288314|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC SPECIAL STAIN HISTO W/FROZEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202.00||||202.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1105.00||||1105.00|87.58|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1105.00||||1105.00|96.34|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1105.00||||1105.00|84.26|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1105.00||||1105.00|529.85|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|UMR [2035]|UMR OPTIONS [203501]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1105.00||||1105.00|232.05|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|GEHA [1415]|GEHA [141500]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|HEALTHNET [1495]|HEALTHNET [149500]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|FMH BENEFIT SERVICES [1390]|FMH [139000]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1105.00||||1105.00|84.26|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MULTIPLAN [1680]|IHC HS [168011]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|FIRST HEALTH [1375]|QUALCHOICE [137513]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|TRUSTMARK [2030]|STARMARK [203000]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|CHAMPVA [1240]|CHAMP VA [124000]|1105.00||||1105.00|828.75|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1105.00||||1105.00|77.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|CORESOURCE [1315]|CORESOURCE [131500]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1105.00||||1105.00|475.15|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1105.00||||1105.00|334.87|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1105.00||||1105.00|553.61|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|||1105.00||||1105.00|331.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1105.00||||1105.00|1105|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|AETNA [1015]|AETNA ACO WILCO [101532]|1105.00||||1105.00|93.17|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1105.00||||1105.00|663|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1105.00||||1105.00|81.37|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1105.00||||1105.00|475.15|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1105.00||||1105.00|718.25|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1105.00||||1105.00|387.86|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1105.00||||1105.00|470.73|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1105.00||||1105.00|1105|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1105.00||||1105.00|994.5|1105|77.5 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|MULTIPLAN [1680]|HMA [168003]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1105.00||||1105.00||| 31288319|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC HISTOCHEMISTRY STAIN ENZYME|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1105.00||||1105.00||| 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|TRUSTMARK [2030]|STARMARK [203000]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|564.00||||564.00|107.11|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|AETNA [1015]|AETNA ACO WILCO [101532]|564.00||||564.00|122.19|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MULTIPLAN [1680]|HMA [168003]|564.00||||564.00|46.45|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|HEALTHNET [1495]|HEALTHNET [149500]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.00||||564.00|338.4|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|564.00||||564.00|19.27|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|564.00||||564.00|103.45|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.00||||564.00|242.52|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MULTIPLAN [1680]|IHC HS [168011]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.00||||564.00|31.59|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|564.00||||564.00|44.52|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|||564.00||||564.00|169.2|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|564.00||||564.00|122.46|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|564.00||||564.00|197.96|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|564.00||||564.00|32.52|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|UMR [2035]|UMR OPTIONS [203501]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|564.00||||564.00|98.52|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|564.00||||564.00|270.44|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|564.00||||564.00|44.52|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|CHAMPVA [1240]|CHAMP VA [124000]|564.00||||564.00|423|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|564.00||||564.00|45.21|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|564.00||||564.00|118.44|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|564.00||||564.00|564|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|564.00||||564.00|240.26|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|564.00||||564.00|111.33|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|564.00||||564.00|34.06|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|564.00||||564.00|107.11|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|GEHA [1415]|GEHA [141500]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|564.00||||564.00|366.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|CORESOURCE [1315]|CORESOURCE [131500]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|564.00||||564.00|76.78|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|564.00||||564.00|242.52|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|564.00||||564.00|34.06|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|564.00||||564.00|507.6|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|564.00||||564.00|282.56|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|564.00||||564.00|30.97|564|19.27 31288321|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REFERRED SLIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|564.00||||564.00||| 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|CHAMPVA [1240]|CHAMP VA [124000]|766.00||||766.00|574.5|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|766.00||||766.00|160.86|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|UMR [2035]|UMR OPTIONS [203501]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|766.00||||766.00|24.28|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|766.00||||766.00|26.39|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|CORESOURCE [1315]|CORESOURCE [131500]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|766.00||||766.00|68.75|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|766.00||||766.00|367.3|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|||766.00||||766.00|229.8|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|766.00||||766.00|121.87|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|766.00||||766.00|49.44|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|766.00||||766.00|459.6|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|766.00||||766.00|30.17|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|766.00||||766.00|25.5|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|TRUSTMARK [2030]|STARMARK [203000]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|GEHA [1415]|GEHA [141500]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|766.00||||766.00|27.43|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|766.00||||766.00|67.7|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|AETNA [1015]|AETNA ACO WILCO [101532]|766.00||||766.00|35.57|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|766.00||||766.00|766|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|766.00||||766.00|497.9|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|766.00||||766.00|26.39|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|766.00||||766.00|268.87|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|766.00||||766.00|67.7|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MULTIPLAN [1680]|IHC HS [168011]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|766.00||||766.00|30.59|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|HEALTHNET [1495]|HEALTHNET [149500]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|766.00||||766.00|329.38|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|FMH BENEFIT SERVICES [1390]|FMH [139000]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MULTIPLAN [1680]|HMA [168003]|766.00||||766.00|70.63|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|766.00||||766.00|326.32|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|766.00||||766.00|48.03|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|766.00||||766.00|51.8|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|766.00||||766.00|47.09|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|766.00||||766.00|383.77|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|766.00||||766.00|51.8|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|FIRST HEALTH [1375]|QUALCHOICE [137513]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|766.00||||766.00|329.38|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|766.00||||766.00|689.4|766|24.28 31288323|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH REQUIRING PREP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|766.00||||766.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|182.00||||182.00|109.2|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|182.00||||182.00|121.87|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|182.00||||182.00|63.88|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|182.00||||182.00|77.53|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|182.00||||182.00|30.59|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MULTIPLAN [1680]|IHC HS [168011]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|TRUSTMARK [2030]|STARMARK [203000]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|HEALTHNET [1495]|HEALTHNET [149500]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|AETNA [1015]|AETNA ACO WILCO [101532]|182.00||||182.00|182|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|182.00||||182.00|78.26|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|182.00||||182.00|38.22|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|182.00||||182.00|91.18|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|182.00||||182.00|182|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|182.00||||182.00|186.64|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|182.00||||182.00|78.26|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|182.00||||182.00|87.27|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|||182.00||||182.00|54.6|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|182.00||||182.00|118.3|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|182.00||||182.00|180.27|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|182.00||||182.00|186.64|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|CHAMPVA [1240]|CHAMP VA [124000]|182.00||||182.00|136.5|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|182.00||||182.00|171.68|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|FIRST HEALTH [1375]|QUALCHOICE [137513]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|UMR [2035]|UMR OPTIONS [203501]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|FMH BENEFIT SERVICES [1390]|FMH [139000]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|182.00||||182.00|182|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|CORESOURCE [1315]|CORESOURCE [131500]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|GEHA [1415]|GEHA [141500]|182.00||||182.00|163.8|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|182.00||||182.00|193.99|193.99|30.59 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MULTIPLAN [1680]|HMA [168003]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|182.00||||182.00||| 31288325|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH COMP REFERRED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|182.00||||182.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|358.00||||358.00|58.56|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|GEHA [1415]|GEHA [141500]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|358.00||||358.00|171.66|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|||358.00||||358.00|107.4|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|358.00||||358.00|51.82|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|CHAMPVA [1240]|CHAMP VA [124000]|358.00||||358.00|268.5|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|358.00||||358.00|56.34|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|358.00||||358.00|153.94|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|HEALTHNET [1495]|HEALTHNET [149500]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|AETNA [1015]|AETNA ACO WILCO [101532]|358.00||||358.00|52.48|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|358.00||||358.00|358|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|TRUSTMARK [2030]|STARMARK [203000]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|CORESOURCE [1315]|CORESOURCE [131500]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|358.00||||358.00|19.27|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|UMR [2035]|UMR OPTIONS [203501]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|358.00||||358.00|232.7|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|358.00||||358.00|214.8|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|358.00||||358.00|179.36|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|358.00||||358.00|64.41|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|358.00||||358.00|153.94|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|358.00||||358.00|75.18|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|358.00||||358.00|56.34|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|358.00||||358.00|54.42|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|358.00||||358.00|125.66|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|358.00||||358.00|152.51|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|FIRST HEALTH [1375]|QUALCHOICE [137513]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|FMH BENEFIT SERVICES [1390]|FMH [139000]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MULTIPLAN [1680]|IHC HS [168011]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|358.00||||358.00|322.2|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|358.00||||358.00|76.78|358|19.27 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MULTIPLAN [1680]|HMA [168003]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|358.00||||358.00||| 31288329|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURGERY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|358.00||||358.00||| 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MULTIPLAN [1680]|IHC HS [168011]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|AETNA [1015]|AETNA ACO WILCO [101532]|650.00||||650.00|44.07|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MULTIPLAN [1680]|HMA [168003]|650.00||||650.00|204.89|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|650.00||||650.00|39.51|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|FIRST HEALTH [1375]|QUALCHOICE [137513]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|650.00||||650.00|136.5|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|FMH BENEFIT SERVICES [1390]|FMH [139000]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|UMR [2035]|UMR OPTIONS [203501]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|650.00||||650.00|199.42|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|650.00||||650.00|34.55|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|650.00||||650.00|279.5|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|650.00||||650.00|422.5|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|650.00||||650.00|650|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|||650.00||||650.00|195|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|HEALTHNET [1495]|HEALTHNET [149500]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|TRUSTMARK [2030]|STARMARK [203000]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|650.00||||650.00|196.36|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|CHAMPVA [1240]|CHAMP VA [124000]|650.00||||650.00|487.5|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|650.00||||650.00|31.78|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|650.00||||650.00|139.32|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|650.00||||650.00|311.68|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|650.00||||650.00|95.69|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|650.00||||650.00|35.91|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|CORESOURCE [1315]|CORESOURCE [131500]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|GEHA [1415]|GEHA [141500]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|650.00||||650.00|196.36|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|650.00||||650.00|150.25|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|650.00||||650.00|345.93|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|650.00||||650.00|325.65|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|650.00||||650.00|228.15|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|650.00||||650.00|143.42|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|650.00||||650.00|390|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|650.00||||650.00|34.55|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|650.00||||650.00|276.9|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|650.00||||650.00|150.25|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|650.00||||650.00|33.38|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|650.00||||650.00|136.59|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|650.00||||650.00|585|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|650.00||||650.00|86.84|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|650.00||||650.00|279.5|650|31.78 31288331|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CNSLT FROZN SECTION SGL SPCMN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|650.00||||650.00|585|650|31.78 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|UMR [2035]|UMR OPTIONS [203501]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|265.00||||265.00|23.74|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|CORESOURCE [1315]|CORESOURCE [131500]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|265.00||||265.00|55.65|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|265.00||||265.00|127.07|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|265.00||||265.00|51.98|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|265.00||||265.00|172.25|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|||265.00||||265.00|79.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|265.00||||265.00|21.02|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|CHAMPVA [1240]|CHAMP VA [124000]|265.00||||265.00|198.75|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|265.00||||265.00|22.84|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|GEHA [1415]|GEHA [141500]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|265.00||||265.00|26.11|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|265.00||||265.00|113.95|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|AETNA [1015]|AETNA ACO WILCO [101532]|265.00||||265.00|28.96|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MULTIPLAN [1680]|IHC HS [168011]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|TRUSTMARK [2030]|STARMARK [203000]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|265.00||||265.00|13.19|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|265.00||||265.00|132.77|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|265.00||||265.00|22.07|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|265.00||||265.00|112.89|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|265.00||||265.00|22.84|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|265.00||||265.00|159|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|265.00||||265.00|265|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|265.00||||265.00|113.95|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|265.00||||265.00|93.02|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|HEALTHNET [1495]|HEALTHNET [149500]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|FMH BENEFIT SERVICES [1390]|FMH [139000]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|265.00||||265.00|132.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|FIRST HEALTH [1375]|QUALCHOICE [137513]|265.00||||265.00|238.5|265|13.19 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MULTIPLAN [1680]|HMA [168003]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|265.00||||265.00||| 31288332|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC CONSULT PATH SURG EA ADDL FRO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|265.00||||265.00||| 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|868.00||||868.00|373.24|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|868.00||||868.00|26.39|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|868.00||||868.00|520.8|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|868.00||||868.00|434.87|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|868.00||||868.00|369.77|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|868.00||||868.00|657.77|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MULTIPLAN [1680]|IHC HS [168011]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|HEALTHNET [1495]|HEALTHNET [149500]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|TRUSTMARK [2030]|STARMARK [203000]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|868.00||||868.00|627.87|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|AETNA [1015]|COVENTRY HEALTHCARE [101502]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|AETNA [1015]|AETNA ACO WILCO [101532]|868.00||||868.00|33.69|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|868.00||||868.00|25.5|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MULTIPLAN [1680]|HMA [168003]|868.00||||868.00|896.95|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|FMH BENEFIT SERVICES [1390]|FMH [139000]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|868.00||||868.00|868|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|FIRST HEALTH [1375]|QUALCHOICE [137513]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|868.00||||868.00|182.28|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|868.00||||868.00|24.28|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|UMR [2035]|UMR OPTIONS [203501]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|868.00||||868.00|657.77|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|868.00||||868.00|304.67|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|868.00||||868.00|868|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|868.00||||868.00|564.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|868.00||||868.00|868|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|868.00||||868.00|416.21|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|||868.00||||868.00|260.4|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|868.00||||868.00|859.64|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|868.00||||868.00|26.39|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|868.00||||868.00|609.93|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|868.00||||868.00|597.97|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|CHAMPVA [1240]|CHAMP VA [124000]|868.00||||868.00|651|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|868.00||||868.00|859.64|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|868.00||||868.00|373.24|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|868.00||||868.00|27.43|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|CORESOURCE [1315]|CORESOURCE [131500]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|868.00||||868.00|334.87|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|868.00||||868.00|30.17|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|GEHA [1415]|GEHA [141500]|868.00||||868.00|781.2|896.95|24.28 31288333|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT 1|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|868.00||||868.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|HEALTHNET [1495]|HEALTHNET [149500]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|136.00||||136.00|18.45|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136.00||||136.00|28.56|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|UMR [2035]|UMR OPTIONS [203501]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136.00||||136.00|65.21|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136.00||||136.00|136|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136.00||||136.00|88.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|CORESOURCE [1315]|CORESOURCE [131500]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|||136.00||||136.00|40.8|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|136.00||||136.00|20.3|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|AETNA [1015]|AETNA ACO WILCO [101532]|136.00||||136.00|22.19|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MULTIPLAN [1680]|IHC HS [168011]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136.00||||136.00|58.48|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|136.00||||136.00|57.94|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|136.00||||136.00|10.16|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136.00||||136.00|16.33|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|CHAMPVA [1240]|CHAMP VA [124000]|136.00||||136.00|102|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136.00||||136.00|47.74|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136.00||||136.00|17.15|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136.00||||136.00|17.75|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136.00||||136.00|17.75|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136.00||||136.00|81.6|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|136.00||||136.00|68.14|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|TRUSTMARK [2030]|STARMARK [203000]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136.00||||136.00|58.48|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|GEHA [1415]|GEHA [141500]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136.00||||136.00|68|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136.00||||136.00|122.4|136|10.16 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MULTIPLAN [1680]|HMA [168003]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136.00||||136.00||| 31288334|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC INTRAOP CYTO PATH CONSULT ADDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136.00||||136.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356.00||||356.00|153.08|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|356.00||||356.00|178.36|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356.00||||356.00|213.6|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|356.00||||356.00|151.66|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MULTIPLAN [1680]|IHC HS [168011]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|TRUSTMARK [2030]|STARMARK [203000]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|HEALTHNET [1495]|HEALTHNET [149500]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|AETNA [1015]|AETNA ACO WILCO [101532]|356.00||||356.00|84.52|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356.00||||356.00|124.96|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|356.00||||356.00|88.91|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356.00||||356.00|170.7|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|356.00||||356.00|38.71|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|||356.00||||356.00|106.8|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356.00||||356.00|231.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356.00||||356.00|74.76|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356.00||||356.00|153.08|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356.00||||356.00|178|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|FMH BENEFIT SERVICES [1390]|FMH [139000]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356.00||||356.00|356|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|CHAMPVA [1240]|CHAMP VA [124000]|356.00||||356.00|267|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|UMR [2035]|UMR OPTIONS [203501]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|FIRST HEALTH [1375]|QUALCHOICE [137513]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|CORESOURCE [1315]|CORESOURCE [131500]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|GEHA [1415]|GEHA [141500]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356.00||||356.00|320.4|356|38.71 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|MULTIPLAN [1680]|HMA [168003]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|356.00||||356.00||| 31288341|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC EACH ADDL STAIN PER SPEC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|356.00||||356.00||| 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|CORESOURCE [1315]|CORESOURCE [131500]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|CHAMPVA [1240]|CHAMP VA [124000]|657.00||||657.00|492.75|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|657.00||||657.00|72.08|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|657.00||||657.00|657|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|657.00||||657.00|315.03|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|UMR [2035]|UMR OPTIONS [203501]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|657.00||||657.00|105.13|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|657.00||||657.00|199.42|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|GEHA [1415]|GEHA [141500]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|657.00||||657.00|427.05|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|657.00||||657.00|139.32|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|657.00||||657.00|79.29|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|||657.00||||657.00|197.1|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|657.00||||657.00|282.51|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|AETNA [1015]|AETNA ACO WILCO [101532]|657.00||||657.00|93.64|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|HEALTHNET [1495]|HEALTHNET [149500]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MULTIPLAN [1680]|IHC HS [168011]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|657.00||||657.00|63.79|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|657.00||||657.00|196.36|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|657.00||||657.00|137.97|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|TRUSTMARK [2030]|STARMARK [203000]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|657.00||||657.00|69.35|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|FIRST HEALTH [1375]|QUALCHOICE [137513]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|657.00||||657.00|230.61|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|657.00||||657.00|66.98|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|657.00||||657.00|143.42|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|657.00||||657.00|329.16|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|657.00||||657.00|150.25|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|657.00||||657.00|394.2|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|657.00||||657.00|196.36|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|FMH BENEFIT SERVICES [1390]|FMH [139000]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|657.00||||657.00|69.35|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|657.00||||657.00|282.51|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|657.00||||657.00|86.84|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MULTIPLAN [1680]|HMA [168003]|657.00||||657.00|204.89|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|657.00||||657.00|279.88|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|657.00||||657.00|345.93|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|657.00||||657.00|591.3|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|657.00||||657.00|136.59|657|63.79 31288342|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOCYTOCHEMISTRY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|657.00||||657.00|150.25|657|63.79 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|542.00||||542.00|133.25|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|542.00||||542.00|190.24|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|542.00||||542.00|542|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|542.00||||542.00|271.54|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|542.00||||542.00|233.06|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|542.00||||542.00|230.89|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MULTIPLAN [1680]|IHC HS [168011]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|HEALTHNET [1495]|HEALTHNET [149500]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|AETNA [1015]|AETNA ACO WILCO [101532]|542.00||||542.00|175.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|542.00||||542.00|325.2|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|542.00||||542.00|152.35|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|FIRST HEALTH [1375]|QUALCHOICE [137513]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|542.00||||542.00|128.7|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|542.00||||542.00|259.89|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|542.00||||542.00|113.82|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|TRUSTMARK [2030]|STARMARK [203000]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|542.00||||542.00|122.57|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|542.00||||542.00|164.53|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|||542.00||||542.00|162.6|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|542.00||||542.00|133.25|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|UMR [2035]|UMR OPTIONS [203501]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|542.00||||542.00|233.06|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|542.00||||542.00|352.3|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|FMH BENEFIT SERVICES [1390]|FMH [139000]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|CHAMPVA [1240]|CHAMP VA [124000]|542.00||||542.00|406.5|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|542.00||||542.00|138.5|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|CORESOURCE [1315]|CORESOURCE [131500]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|GEHA [1415]|GEHA [141500]|542.00||||542.00|487.8|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|542.00||||542.00|542|542|113.82 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MULTIPLAN [1680]|HMA [168003]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|542.00||||542.00||| 31288344|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IHC/ICC EA MULTIPLEX STAIN PROCEDURE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|542.00||||542.00||| 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|CORESOURCE [1315]|CORESOURCE [131500]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|660.00||||660.00|82.4|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|660.00||||660.00|387.82|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|660.00||||660.00|89.59|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|UMR [2035]|UMR OPTIONS [203501]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|660.00||||660.00|393.86|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|660.00||||660.00|660|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|CHAMPVA [1240]|CHAMP VA [124000]|660.00||||660.00|495|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|||660.00||||660.00|198|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|660.00||||660.00|102.43|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|660.00||||660.00|93.12|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|AETNA [1015]|AETNA ACO WILCO [101532]|660.00||||660.00|97.43|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MULTIPLAN [1680]|IHC HS [168011]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|FMH BENEFIT SERVICES [1390]|FMH [139000]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|GEHA [1415]|GEHA [141500]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MULTIPLAN [1680]|HMA [168003]|660.00||||660.00|404.65|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|660.00||||660.00|275.16|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|660.00||||660.00|330.66|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|660.00||||660.00|86.53|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|660.00||||660.00|429|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|TRUSTMARK [2030]|STARMARK [203000]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|660.00||||660.00|138.6|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|660.00||||660.00|316.47|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|660.00||||660.00|283.8|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|660.00||||660.00|164.53|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|HEALTHNET [1495]|HEALTHNET [149500]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|660.00||||660.00|283.26|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|660.00||||660.00|89.59|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|660.00||||660.00|396|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|660.00||||660.00|387.82|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|660.00||||660.00|281.16|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|FIRST HEALTH [1375]|QUALCHOICE [137513]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|660.00||||660.00|231.66|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|660.00||||660.00|283.8|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|660.00||||660.00|655.46|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|660.00||||660.00|296.75|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|660.00||||660.00|269.77|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|660.00||||660.00|296.75|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|660.00||||660.00|594|660|82.4 31288346|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFLUOR STUDY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|660.00||||660.00||| 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4014.00||||4014.00|4014|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4014.00||||4014.00|1924.71|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|||4014.00||||4014.00|1204.2|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4014.00||||4014.00|309.95|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4014.00||||4014.00|2609.1|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4014.00||||4014.00|285.1|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4014.00||||4014.00|842.94|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|CHAMPVA [1240]|CHAMP VA [124000]|4014.00||||4014.00|3010.5|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4014.00||||4014.00|859.64|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4014.00||||4014.00|322.15|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|CORESOURCE [1315]|CORESOURCE [131500]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|GEHA [1415]|GEHA [141500]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4014.00||||4014.00|657.77|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4014.00||||4014.00|1334.03|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4014.00||||4014.00|2011.01|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4014.00||||4014.00|1726.02|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4014.00||||4014.00|1709.96|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4014.00||||4014.00|2408.4|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4014.00||||4014.00|309.95|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4014.00||||4014.00|657.77|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4014.00||||4014.00|299.36|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4014.00||||4014.00|1408.91|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4014.00||||4014.00|334.87|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|TRUSTMARK [2030]|STARMARK [203000]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4014.00||||4014.00|627.87|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|HEALTHNET [1495]|HEALTHNET [149500]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|AETNA [1015]|AETNA ACO WILCO [101532]|4014.00||||4014.00|375.7|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MULTIPLAN [1680]|IHC HS [168011]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4014.00||||4014.00|859.64|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|MULTIPLAN [1680]|HMA [168003]|4014.00||||4014.00|896.95|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4014.00||||4014.00|1726.02|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4014.00||||4014.00|354.37|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|FIRST HEALTH [1375]|QUALCHOICE [137513]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4014.00||||4014.00|609.93|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|FMH BENEFIT SERVICES [1390]|FMH [139000]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4014.00||||4014.00|597.97|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|UMR [2035]|UMR OPTIONS [203501]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4014.00||||4014.00|3612.6|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4014.00||||4014.00|873.03|4014|285.1 31288348|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ELECTRON MICROSCOPY DIAGNOSTC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4014.00||||4014.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|CORESOURCE [1315]|CORESOURCE [131500]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|GEHA [1415]|GEHA [141500]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132.00||||132.00|85.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.00||||132.00|63.29|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132.00||||132.00|27.72|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|FMH BENEFIT SERVICES [1390]|FMH [139000]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MULTIPLAN [1680]|IHC HS [168011]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|HEALTHNET [1495]|HEALTHNET [149500]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|TRUSTMARK [2030]|STARMARK [203000]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|UMR [2035]|UMR OPTIONS [203501]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|CHAMPVA [1240]|CHAMP VA [124000]|132.00||||132.00|99|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132.00||||132.00|132|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|||132.00||||132.00|39.6|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132.00||||132.00|29.19|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|AETNA [1015]|AETNA ACO WILCO [101532]|132.00||||132.00|63.74|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132.00||||132.00|79.2|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132.00||||132.00|56.76|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132.00||||132.00|66.13|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132.00||||132.00|56.76|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132.00||||132.00|46.33|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|FIRST HEALTH [1375]|QUALCHOICE [137513]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132.00||||132.00|56.23|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.00||||132.00|66|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132.00||||132.00|118.8|132|27.72 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MULTIPLAN [1680]|HMA [168003]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.00||||132.00||| 31288350|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOFL EACH ADDITL AB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132.00||||132.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|538.00||||538.00|105.32|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|538.00||||538.00|231.34|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|538.00||||538.00|322.8|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|HEALTHNET [1495]|HEALTHNET [149500]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|AETNA [1015]|AETNA ACO WILCO [101532]|538.00||||538.00|128.44|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MULTIPLAN [1680]|IHC HS [168011]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|FMH BENEFIT SERVICES [1390]|FMH [139000]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|FIRST HEALTH [1375]|QUALCHOICE [137513]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|538.00||||538.00|231.34|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|538.00||||538.00|120.41|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|UMR [2035]|UMR OPTIONS [203501]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|538.00||||538.00|30.59|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|538.00||||538.00|112.98|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|538.00||||538.00|101.73|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|538.00||||538.00|538|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|538.00||||538.00|257.97|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|TRUSTMARK [2030]|STARMARK [203000]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|538.00||||538.00|349.7|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|538.00||||538.00|188.84|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|||538.00||||538.00|161.4|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|538.00||||538.00|229.19|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|538.00||||538.00|105.32|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|538.00||||538.00|121.87|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|538.00||||538.00|269.54|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|538.00||||538.00|96.88|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|CHAMPVA [1240]|CHAMP VA [124000]|538.00||||538.00|403.5|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|538.00||||538.00|109.47|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|CORESOURCE [1315]|CORESOURCE [131500]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|GEHA [1415]|GEHA [141500]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|538.00||||538.00|484.2|538|30.59 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MULTIPLAN [1680]|HMA [168003]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|538.00||||538.00||| 31288356|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS NERVE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|538.00||||538.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|CORESOURCE [1315]|CORESOURCE [131500]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|GEHA [1415]|GEHA [141500]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|568.00||||568.00|85.73|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|CHAMPVA [1240]|CHAMP VA [124000]|568.00||||568.00|426|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|568.00||||568.00|272.36|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|568.00||||568.00|369.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|||568.00||||568.00|170.4|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|568.00||||568.00|568|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|UMR [2035]|UMR OPTIONS [203501]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|568.00||||568.00|94.3|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|568.00||||568.00|244.24|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MULTIPLAN [1680]|IHC HS [168011]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|568.00||||568.00|119.28|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|AETNA [1015]|AETNA ACO WILCO [101532]|568.00||||568.00|102.14|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|HEALTHNET [1495]|HEALTHNET [149500]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|TRUSTMARK [2030]|STARMARK [203000]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|568.00||||568.00|82.48|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|568.00||||568.00|164.53|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|568.00||||568.00|79.66|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|568.00||||568.00|75.87|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|568.00||||568.00|82.48|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|568.00||||568.00|340.8|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|568.00||||568.00|244.24|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|568.00||||568.00|241.97|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|568.00||||568.00|284.57|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|568.00||||568.00|199.37|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|568.00||||568.00|568|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|568.00||||568.00|511.2|568|75.87 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MULTIPLAN [1680]|HMA [168003]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|568.00||||568.00||| 31288358|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHOMETRIC ANALYSIS TUMOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|568.00||||568.00||| 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|416.00||||416.00|150.25|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|416.00||||416.00|345.93|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|416.00||||416.00|178.88|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|416.00||||416.00|208.42|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|416.00||||416.00|177.22|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|416.00||||416.00|249.6|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|416.00||||416.00|82.13|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|416.00||||416.00|150.25|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|416.00||||416.00|79.33|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|416.00||||416.00|146.02|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|HEALTHNET [1495]|HEALTHNET [149500]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|AETNA [1015]|AETNA ACO WILCO [101532]|416.00||||416.00|112.06|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MULTIPLAN [1680]|IHC HS [168011]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|416.00||||416.00|196.36|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|416.00||||416.00|178.88|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|416.00||||416.00|93.9|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MULTIPLAN [1680]|HMA [168003]|416.00||||416.00|204.89|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|416.00||||416.00|199.42|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|416.00||||416.00|87.36|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|416.00||||416.00|416|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|TRUSTMARK [2030]|STARMARK [203000]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|416.00||||416.00|86.84|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|416.00||||416.00|199.47|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|416.00||||416.00|270.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|||416.00||||416.00|124.8|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|UMR [2035]|UMR OPTIONS [203501]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|416.00||||416.00|82.13|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|416.00||||416.00|143.42|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|416.00||||416.00|139.32|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|416.00||||416.00|136.59|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|416.00||||416.00|75.55|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|CHAMPVA [1240]|CHAMP VA [124000]|416.00||||416.00|312|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|416.00||||416.00|196.36|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|416.00||||416.00|85.36|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|CORESOURCE [1315]|CORESOURCE [131500]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|GEHA [1415]|GEHA [141500]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|416.00||||416.00|374.4|416|75.55 31288360|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC TUMOR IMMUNO HISTOCHEM/MANUAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|416.00||||416.00||| 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|GEHA [1415]|GEHA [141500]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|CORESOURCE [1315]|CORESOURCE [131500]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1100.00||||1100.00|84.63|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1100.00||||1100.00|74.89|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1100.00||||1100.00|81.42|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1100.00||||1100.00|715|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1100.00||||1100.00|527.45|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1100.00||||1100.00|387.82|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|UMR [2035]|UMR OPTIONS [203501]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1100.00||||1100.00|275.16|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1100.00||||1100.00|93.09|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MULTIPLAN [1680]|IHC HS [168011]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|TRUSTMARK [2030]|STARMARK [203000]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1100.00||||1100.00|393.86|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1100.00||||1100.00|231|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|CHAMPVA [1240]|CHAMP VA [124000]|1100.00||||1100.00|825|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1100.00||||1100.00|1100|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|HEALTHNET [1495]|HEALTHNET [149500]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1100.00||||1100.00|164.53|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|||1100.00||||1100.00|330|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1100.00||||1100.00|78.64|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MULTIPLAN [1680]|HMA [168003]|1100.00||||1100.00|404.65|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1100.00||||1100.00|387.82|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1100.00||||1100.00|296.75|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1100.00||||1100.00|81.42|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1100.00||||1100.00|660|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|AETNA [1015]|AETNA ACO WILCO [101532]|1100.00||||1100.00|113.48|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1100.00||||1100.00|283.26|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1100.00||||1100.00|473|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1100.00||||1100.00|551.1|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1100.00||||1100.00|473|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1100.00||||1100.00|468.6|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1100.00||||1100.00|386.1|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1100.00||||1100.00|655.46|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1100.00||||1100.00|269.77|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1100.00||||1100.00|296.75|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1100.00||||1100.00|990|1100|74.89 31288361|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IMMUNOHISTOCHEM TUMOR QN/SQN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1100.00||||1100.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107.00||||107.00|41.04|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107.00||||107.00|37.56|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107.00||||107.00|46.01|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107.00||||107.00|64.2|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107.00||||107.00|24.35|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107.00||||107.00|25.21|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|TRUSTMARK [2030]|STARMARK [203000]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|107.00||||107.00|45.58|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|HEALTHNET [1495]|HEALTHNET [149500]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|AETNA [1015]|AETNA ACO WILCO [101532]|107.00||||107.00|28.74|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MULTIPLAN [1680]|IHC HS [168011]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|FIRST HEALTH [1375]|QUALCHOICE [137513]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107.00||||107.00|46.01|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|UMR [2035]|UMR OPTIONS [203501]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107.00||||107.00|22.47|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107.00||||107.00|107|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|107.00||||107.00|10.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107.00||||107.00|51.31|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107.00||||107.00|69.55|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|||107.00||||107.00|32.1|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107.00||||107.00|25.21|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|107.00||||107.00|53.61|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|107.00||||107.00|28.82|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107.00||||107.00|23.19|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|CHAMPVA [1240]|CHAMP VA [124000]|107.00||||107.00|80.25|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|107.00||||107.00|26.2|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|CORESOURCE [1315]|CORESOURCE [131500]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|GEHA [1415]|GEHA [141500]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|FMH BENEFIT SERVICES [1390]|FMH [139000]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107.00||||107.00|96.3|107|10.3 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|MULTIPLAN [1680]|HMA [168003]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107.00||||107.00||| 31288363|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC XM ARCHIVE TISSUE MOLEC ANALY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|107.00||||107.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|||370.00||||370.00|111|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|370.00||||370.00|240.5|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|370.00||||370.00|370|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|GEHA [1415]|GEHA [141500]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|370.00||||370.00|159.1|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|UMR [2035]|UMR OPTIONS [203501]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|CHAMPVA [1240]|CHAMP VA [124000]|370.00||||370.00|277.5|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|CORESOURCE [1315]|CORESOURCE [131500]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|370.00||||370.00|77.7|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|HEALTHNET [1495]|HEALTHNET [149500]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|370.00||||370.00|177.42|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|370.00||||370.00|59.03|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|AETNA [1015]|AETNA ACO WILCO [101532]|370.00||||370.00|129.06|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MULTIPLAN [1680]|IHC HS [168011]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|TRUSTMARK [2030]|STARMARK [203000]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|370.00||||370.00|222|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|370.00||||370.00|185.37|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|370.00||||370.00|159.1|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|370.00||||370.00|129.87|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|370.00||||370.00|157.62|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|370.00||||370.00|185|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|370.00||||370.00|333|370|59.03 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MULTIPLAN [1680]|HMA [168003]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|370.00||||370.00||| 31288364|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRIDIZATION EA ADDL PROBE STAIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|370.00||||370.00||| 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469.00||||469.00|345.93|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|469.00||||469.00|234.97|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|469.00||||469.00|199.79|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469.00||||469.00|281.4|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469.00||||469.00|136.21|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469.00||||469.00|150.25|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469.00||||469.00|131.56|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469.00||||469.00|143.42|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|469.00||||469.00|86.84|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|HEALTHNET [1495]|HEALTHNET [149500]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|AETNA [1015]|AETNA ACO WILCO [101532]|469.00||||469.00|175.8|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MULTIPLAN [1680]|IHC HS [168011]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|469.00||||469.00|196.36|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469.00||||469.00|201.67|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469.00||||469.00|139.32|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469.00||||469.00|199.42|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MULTIPLAN [1680]|HMA [168003]|469.00||||469.00|204.89|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469.00||||469.00|98.49|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469.00||||469.00|469|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|TRUSTMARK [2030]|STARMARK [203000]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|469.00||||469.00|155.73|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469.00||||469.00|224.89|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469.00||||469.00|304.85|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|||469.00||||469.00|140.7|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|UMR [2035]|UMR OPTIONS [203501]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469.00||||469.00|136.21|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469.00||||469.00|201.67|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469.00||||469.00|164.62|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469.00||||469.00|136.59|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|FIRST HEALTH [1375]|QUALCHOICE [137513]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469.00||||469.00|125.29|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|CHAMPVA [1240]|CHAMP VA [124000]|469.00||||469.00|351.75|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469.00||||469.00|150.25|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|469.00||||469.00|196.36|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|469.00||||469.00|141.57|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|CORESOURCE [1315]|CORESOURCE [131500]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|FMH BENEFIT SERVICES [1390]|FMH [139000]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|GEHA [1415]|GEHA [141500]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469.00||||469.00|422.1|469|86.84 31288365|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH QUALITATIVE INITIAL PER SPEC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|469.00||||469.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|CORESOURCE [1315]|CORESOURCE [131500]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|CHAMPVA [1240]|CHAMP VA [124000]|1568.00||||1568.00|1176|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|GEHA [1415]|GEHA [141500]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1568.00||||1568.00|71.96|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1568.00||||1568.00|78.23|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1568.00||||1568.00|1019.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1568.00||||1568.00|329.28|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|UMR [2035]|UMR OPTIONS [203501]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1568.00||||1568.00|89.44|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|FMH BENEFIT SERVICES [1390]|FMH [139000]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MULTIPLAN [1680]|IHC HS [168011]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|TRUSTMARK [2030]|STARMARK [203000]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1568.00||||1568.00|81.31|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|HEALTHNET [1495]|HEALTHNET [149500]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1568.00||||1568.00|1568|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1568.00||||1568.00|751.86|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|||1568.00||||1568.00|470.4|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1568.00||||1568.00|164.53|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1568.00||||1568.00|75.56|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|AETNA [1015]|AETNA ACO WILCO [101532]|1568.00||||1568.00|98.37|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1568.00||||1568.00|78.23|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1568.00||||1568.00|940.8|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1568.00||||1568.00|785.57|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1568.00||||1568.00|674.24|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1568.00||||1568.00|674.24|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1568.00||||1568.00|550.37|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|FIRST HEALTH [1375]|QUALCHOICE [137513]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1568.00||||1568.00|667.97|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1568.00||||1568.00|655.46|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1568.00||||1568.00|1411.2|1568|71.96 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MULTIPLAN [1680]|HMA [168003]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1568.00||||1568.00||| 31288367|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC IN SITU HYBRID EA PROBE AUTO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1568.00||||1568.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|931.00||||931.00|466.43|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|931.00||||931.00|326.78|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|931.00||||931.00|396.61|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|931.00||||931.00|86.3|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|931.00||||931.00|558.6|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|931.00||||931.00|400.33|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|HEALTHNET [1495]|HEALTHNET [149500]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|AETNA [1015]|AETNA ACO WILCO [101532]|931.00||||931.00|112.54|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|FIRST HEALTH [1375]|QUALCHOICE [137513]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|FMH BENEFIT SERVICES [1390]|FMH [139000]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|UMR [2035]|UMR OPTIONS [203501]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MULTIPLAN [1680]|IHC HS [168011]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|931.00||||931.00|195.51|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|931.00||||931.00|655.46|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|931.00||||931.00|931|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|TRUSTMARK [2030]|STARMARK [203000]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|931.00||||931.00|446.41|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|931.00||||931.00|164.53|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|931.00||||931.00|89.35|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|931.00||||931.00|605.15|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|||931.00||||931.00|279.3|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|931.00||||931.00|89.35|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|931.00||||931.00|102.16|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|931.00||||931.00|82.19|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|CHAMPVA [1240]|CHAMP VA [124000]|931.00||||931.00|698.25|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|931.00||||931.00|92.87|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|CORESOURCE [1315]|CORESOURCE [131500]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|GEHA [1415]|GEHA [141500]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|931.00||||931.00|400.33|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|931.00||||931.00|837.9|931|82.19 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|MULTIPLAN [1680]|HMA [168003]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|931.00||||931.00||| 31288368|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MORPHM ANAL IN SITU HYBRD MNL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|931.00||||931.00||| 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|GEHA [1415]|GEHA [141500]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1458.00||||1458.00|196.36|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1458.00||||1458.00|309|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|||1458.00||||1458.00|437.4|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1458.00||||1458.00|947.7|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1458.00||||1458.00|1458|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|CORESOURCE [1315]|CORESOURCE [131500]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|UMR [2035]|UMR OPTIONS [203501]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1458.00||||1458.00|339.9|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|FMH BENEFIT SERVICES [1390]|FMH [139000]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1458.00||||1458.00|139.32|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MULTIPLAN [1680]|IHC HS [168011]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1458.00||||1458.00|196.36|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MULTIPLAN [1680]|HMA [168003]|1458.00||||1458.00|204.89|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|AETNA [1015]|AETNA ACO WILCO [101532]|1458.00||||1458.00|373.14|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|CHAMPVA [1240]|CHAMP VA [124000]|1458.00||||1458.00|1093.5|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1458.00||||1458.00|199.42|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1458.00||||1458.00|306.18|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|TRUSTMARK [2030]|STARMARK [203000]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1458.00||||1458.00|273.46|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1458.00||||1458.00|699.11|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1458.00||||1458.00|86.84|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1458.00||||1458.00|297.29|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1458.00||||1458.00|287.14|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|HEALTHNET [1495]|HEALTHNET [149500]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1458.00||||1458.00|150.25|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1458.00||||1458.00|297.29|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1458.00||||1458.00|874.8|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1458.00||||1458.00|143.42|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|FIRST HEALTH [1375]|QUALCHOICE [137513]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1458.00||||1458.00|626.94|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1458.00||||1458.00|730.46|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1458.00||||1458.00|511.76|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1458.00||||1458.00|621.11|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1458.00||||1458.00|626.94|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1458.00||||1458.00|345.93|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1458.00||||1458.00|136.59|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1458.00||||1458.00|150.25|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1458.00||||1458.00|1312.2|1458|86.84 31288374|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC M/PHMTRC ANAL ISH COMPUTER EA MULTIPRB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1458.00||||1458.00||| 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1236.00||||1236.00|150.25|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1236.00||||1236.00|345.93|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1236.00||||1236.00|531.48|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1236.00||||1236.00|433.84|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1236.00||||1236.00|143.42|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1236.00||||1236.00|741.6|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1236.00||||1236.00|338.95|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1236.00||||1236.00|150.25|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1236.00||||1236.00|327.37|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1236.00||||1236.00|526.54|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|HEALTHNET [1495]|HEALTHNET [149500]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1236.00||||1236.00|619.24|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|AETNA [1015]|AETNA ACO WILCO [101532]|1236.00||||1236.00|428.55|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MULTIPLAN [1680]|IHC HS [168011]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1236.00||||1236.00|196.36|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1236.00||||1236.00|531.48|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1236.00||||1236.00|387.53|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1236.00||||1236.00|199.42|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1236.00||||1236.00|1236|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MULTIPLAN [1680]|HMA [168003]|1236.00||||1236.00|204.89|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|TRUSTMARK [2030]|STARMARK [203000]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1236.00||||1236.00|86.84|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1236.00||||1236.00|592.66|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1236.00||||1236.00|803.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|||1236.00||||1236.00|370.8|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|UMR [2035]|UMR OPTIONS [203501]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1236.00||||1236.00|338.95|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1236.00||||1236.00|139.32|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1236.00||||1236.00|136.59|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1236.00||||1236.00|311.77|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|CHAMPVA [1240]|CHAMP VA [124000]|1236.00||||1236.00|927|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1236.00||||1236.00|259.56|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1236.00||||1236.00|196.36|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1236.00||||1236.00|352.3|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|CORESOURCE [1315]|CORESOURCE [131500]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|GEHA [1415]|GEHA [141500]|1236.00||||1236.00|1112.4|1236|86.84 31288377|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC ISH M/PHMTRC ALYS QN/SEMI-QN EA MULT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1236.00||||1236.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|GEHA [1415]|GEHA [141500]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|CORESOURCE [1315]|CORESOURCE [131500]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|||1342.00||||1342.00|402.6|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1342.00||||1342.00|872.3|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1342.00||||1342.00|643.49|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|UMR [2035]|UMR OPTIONS [203501]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MULTIPLAN [1680]|IHC HS [168011]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|TRUSTMARK [2030]|STARMARK [203000]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1342.00||||1342.00|281.82|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|CHAMPVA [1240]|CHAMP VA [124000]|1342.00||||1342.00|1006.5|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1342.00||||1342.00|1342|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|HEALTHNET [1495]|HEALTHNET [149500]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1342.00||||1342.00|78.06|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1342.00||||1342.00|805.2|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|AETNA [1015]|AETNA ACO WILCO [101532]|1342.00||||1342.00|170.77|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1342.00||||1342.00|577.06|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1342.00||||1342.00|672.34|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1342.00||||1342.00|577.06|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1342.00||||1342.00|471.04|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1342.00||||1342.00|571.69|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1342.00||||1342.00|671|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1342.00||||1342.00|1207.8|1342|78.06 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MULTIPLAN [1680]|HMA [168003]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1342.00||||1342.00||| 31288381|EAP|0312 - LABORATORY PATHOLOGY-HISTOLOGY|HC MICRODISECTION MANUAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1342.00||||1342.00||| 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|425.51||||425.51|191.74|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|425.51||||425.51|254.28|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|425.51||||425.51|149.35|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|425.51||||425.51|181.27|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|425.51||||425.51|255.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|425.51||||425.51|183.02|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|425.51||||425.51|250.59|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MULTIPLAN [1680]|HMA [168003]|425.51||||425.51|148.93|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|425.51||||425.51|182.97|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|425.51||||425.51|206.46|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|425.51||||425.51|177.79|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|425.51||||425.51|89.36|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|425.51||||425.51|180.58|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|425.51||||425.51|174.43|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|425.51||||425.51|191.74|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|425.51||||425.51|204.03|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|UMR [2035]|UMR OPTIONS [203501]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|425.51||||425.51|276.58|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|||425.51||||425.51|127.65|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|425.51||||425.51|184.76|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|425.51||||425.51|182.97|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|425.51||||425.51|213.18|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|425.51||||425.51|180.58|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|425.51||||425.51|174.31|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|425.51||||425.51|250.59|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|425.51||||425.51|166.12|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|425.51||||425.51|319.13|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|425.51||||425.51|187.69|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|GEHA [1415]|GEHA [141500]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|425.51||||425.51|382.96|382.96|89.36 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|425.51||||425.51||| 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|425.51||||425.51||| 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|425.51||||425.51||| 31310|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALTEPLASE 2 MG INTRA-CATHETER SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|425.51||||425.51||| 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|UMR [2035]|UMR OPTIONS [203501]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|869.00||||869.00|443.67|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|869.00||||869.00|373.67|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|FMH BENEFIT SERVICES [1390]|FMH [139000]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MULTIPLAN [1680]|IHC HS [168011]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|869.00||||869.00|387.82|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MULTIPLAN [1680]|HMA [168003]|869.00||||869.00|404.65|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|HEALTHNET [1495]|HEALTHNET [149500]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|AETNA [1015]|AETNA ACO WILCO [101532]|869.00||||869.00|255.18|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|TRUSTMARK [2030]|STARMARK [203000]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|869.00||||869.00|164.53|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|FIRST HEALTH [1375]|QUALCHOICE [137513]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|869.00||||869.00|374.79|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|869.00||||869.00|296.75|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|869.00||||869.00|388.05|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|869.00||||869.00|521.4|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|869.00||||869.00|275.16|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|869.00||||869.00|283.26|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|869.00||||869.00|373.67|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|869.00||||869.00|435.37|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|869.00||||869.00|370.19|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|869.00||||869.00|305.02|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|869.00||||869.00|655.46|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|869.00||||869.00|296.75|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|CORESOURCE [1315]|CORESOURCE [131500]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|869.00||||869.00|403.33|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|869.00||||869.00|387.82|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|CHAMPVA [1240]|CHAMP VA [124000]|869.00||||869.00|651.75|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|869.00||||869.00|356.93|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|GEHA [1415]|GEHA [141500]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|869.00||||869.00|388.05|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|||869.00||||869.00|260.7|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|869.00||||869.00|564.85|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|869.00||||869.00|416.69|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|869.00||||869.00|869|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|869.00||||869.00|269.77|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|869.00||||869.00|182.49|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|869.00||||869.00|393.86|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|869.00||||869.00|782.1|869|164.53 31400416|EAP|0314 - LABORATORY PATHOLOGY-BIOPSY|HC PROSTATE NEEDLE BX CMS PT ANY QTY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|869.00||||869.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 31576|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|||117.69||||117.69|35.31|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117.69||||117.69|56.43|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|117.69||||117.69|24.71|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117.69||||117.69|50.61|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|117.69||||117.69|76.5|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|117.69||||117.69|88.27|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117.69||||117.69|70.61|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|117.69||||117.69|50.61|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|117.69||||117.69|58.96|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|117.69||||117.69|41.31|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|117.69||||117.69|50.14|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|117.69||||117.69|105.92|105.92|24.71 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|117.69||||117.69||| 3187|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|117.69||||117.69||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132.56||||132.56|66.41|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132.56||||132.56|46.53|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132.56||||132.56|56.47|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132.56||||132.56|57|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132.56||||132.56|27.84|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132.56||||132.56|79.54|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132.56||||132.56|57|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.56||||132.56|63.56|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132.56||||132.56|86.16|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|||132.56||||132.56|39.77|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|132.56||||132.56|99.42|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132.56||||132.56|119.3|119.3|27.84 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132.56||||132.56||| 3189|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOCINONIDE 0.05 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132.56||||132.56||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA [141500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|119.24||||119.24|89.43|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|119.24||||119.24|89.43|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|||119.24||||119.24|35.77|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|||119.24||||119.24|35.77|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.24||||119.24|77.51|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.24||||119.24|77.51|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.24||||119.24|57.18|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.24||||119.24|25.04|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.24||||119.24|25.04|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.24||||119.24|10.97|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.24||||119.24|51.27|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.24||||119.24|51.27|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|119.24||||119.24|41.73|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|119.24||||119.24|41.73|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.24||||119.24|10.97|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.24||||119.24|57.18|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.24||||119.24|71.54|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.24||||119.24|71.54|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.24||||119.24|51.27|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.24||||119.24|59.74|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.24||||119.24|41.85|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.24||||119.24|50.8|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.24||||119.24|51.27|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.24||||119.24|59.74|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.24||||119.24|50.8|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.24||||119.24|41.85|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.24||||119.24|107.32|107.32|10.97 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.24||||119.24||| 31921|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 150 MG/ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.24||||119.24||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|436.16||||436.16|187.55|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|436.16||||436.16|218.52|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|436.16||||436.16|185.8|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|436.16||||436.16|187.55|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|436.16||||436.16|218.52|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|436.16||||436.16|185.8|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|436.16||||436.16|261.7|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|436.16||||436.16|261.7|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|436.16||||436.16|152.66|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|436.16||||436.16|187.55|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|436.16||||436.16|187.55|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|436.16||||436.16|152.66|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|436.16||||436.16|69.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|436.16||||436.16|69.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|436.16||||436.16|91.59|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|436.16||||436.16|91.59|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|436.16||||436.16|209.14|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|436.16||||436.16|209.14|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|436.16||||436.16|283.5|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|436.16||||436.16|283.5|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|||436.16||||436.16|130.85|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|||436.16||||436.16|130.85|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|436.16||||436.16|153.09|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|436.16||||436.16|153.09|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|436.16||||436.16|327.12|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|436.16||||436.16|327.12|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|436.16||||436.16|392.54|392.54|69.54 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|436.16||||436.16||| 31922|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERTAPENEM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|436.16||||436.16||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|CORESOURCE [1315]|CORESOURCE [131500]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|469.00||||469.00|81.36|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469.00||||469.00|72.01|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469.00||||469.00|78.28|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|||469.00||||469.00|140.7|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469.00||||469.00|304.85|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469.00||||469.00|469|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|UMR [2035]|UMR OPTIONS [203501]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|469.00||||469.00|89.5|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469.00||||469.00|201.67|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|FIRST HEALTH [1375]|QUALCHOICE [137513]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|FMH BENEFIT SERVICES [1390]|FMH [139000]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MULTIPLAN [1680]|IHC HS [168011]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469.00||||469.00|98.49|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|HEALTHNET [1495]|HEALTHNET [149500]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|AETNA [1015]|AETNA ACO WILCO [101532]|469.00||||469.00|36.28|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|TRUSTMARK [2030]|STARMARK [203000]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469.00||||469.00|224.89|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469.00||||469.00|75.61|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|CHAMPVA [1240]|CHAMP VA [124000]|469.00||||469.00|351.75|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469.00||||469.00|78.28|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469.00||||469.00|281.4|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|GEHA [1415]|GEHA [141500]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469.00||||469.00|201.67|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|469.00||||469.00|234.97|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469.00||||469.00|164.62|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|469.00||||469.00|199.79|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469.00||||469.00|148.92|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469.00||||469.00|422.1|469|36.28 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MULTIPLAN [1680]|HMA [168003]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469.00||||469.00||| 32070030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC EYE FOREIGN BODY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469.00||||469.00||| 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|631.00||||631.00|81.31|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|631.00||||631.00|148.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|631.00||||631.00|271.33|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|631.00||||631.00|316.13|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|631.00||||631.00|221.48|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|631.00||||631.00|77.62|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|631.00||||631.00|378.6|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|631.00||||631.00|78.28|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|631.00||||631.00|81.31|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|631.00||||631.00|75.61|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|631.00||||631.00|43.62|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|631.00||||631.00|106.27|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|631.00||||631.00|271.33|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MULTIPLAN [1680]|HMA [168003]|631.00||||631.00|110.88|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|631.00||||631.00|89.5|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|631.00||||631.00|75.4|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|UMR [2035]|UMR OPTIONS [203501]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|631.00||||631.00|107.93|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|631.00||||631.00|132.51|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|631.00||||631.00|631|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|631.00||||631.00|302.56|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|631.00||||631.00|410.15|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|631.00||||631.00|268.81|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|||631.00||||631.00|189.3|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|631.00||||631.00|78.28|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|631.00||||631.00|73.92|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|631.00||||631.00|72.01|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|631.00||||631.00|473.25|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|631.00||||631.00|106.27|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|631.00||||631.00|81.36|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|GEHA [1415]|GEHA [141500]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|631.00||||631.00|567.9|631|43.62 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|631.00||||631.00||| 32070100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE < 4 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|631.00||||631.00||| 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|GEHA [1415]|GEHA [141500]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|669.00||||669.00|130.23|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|669.00||||669.00|153.38|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|669.00||||669.00|501.75|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|669.00||||669.00|115.25|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|669.00||||669.00|125.3|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|||669.00||||669.00|200.7|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|669.00||||669.00|434.85|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|669.00||||669.00|320.79|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|669.00||||669.00|669|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|669.00||||669.00|140.49|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|669.00||||669.00|108.82|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|669.00||||669.00|143.26|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|669.00||||669.00|287.67|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|669.00||||669.00|155.77|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|669.00||||669.00|153.38|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MULTIPLAN [1680]|HMA [168003]|669.00||||669.00|160.04|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|669.00||||669.00|47.28|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|669.00||||669.00|121.01|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|669.00||||669.00|117.36|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|669.00||||669.00|125.3|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|669.00||||669.00|401.4|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|669.00||||669.00|112.03|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|669.00||||669.00|287.67|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|669.00||||669.00|335.17|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|669.00||||669.00|234.82|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|669.00||||669.00|284.99|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|669.00||||669.00|268.93|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|669.00||||669.00|106.69|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|669.00||||669.00|602.1|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|669.00||||669.00|117.36|669|47.28 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|669.00||||669.00||| 32070110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC MANDIBLE COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|669.00||||669.00||| 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|469.00||||469.00|81.31|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|469.00||||469.00|148.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|469.00||||469.00|201.67|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|469.00||||469.00|234.97|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|469.00||||469.00|164.62|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|469.00||||469.00|199.79|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|469.00||||469.00|77.62|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|469.00||||469.00|78.28|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|469.00||||469.00|81.31|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|469.00||||469.00|75.61|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|469.00||||469.00|35.06|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|469.00||||469.00|106.27|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|469.00||||469.00|110.88|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|469.00||||469.00|201.67|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|469.00||||469.00|89.5|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|469.00||||469.00|75.4|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|469.00||||469.00|107.93|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|469.00||||469.00|98.49|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|469.00||||469.00|281.4|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|469.00||||469.00|469|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|469.00||||469.00|224.89|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|469.00||||469.00|304.85|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|||469.00||||469.00|140.7|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|469.00||||469.00|78.28|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|469.00||||469.00|73.92|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|469.00||||469.00|72.01|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|469.00||||469.00|351.75|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|469.00||||469.00|106.27|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|469.00||||469.00|81.36|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|GEHA [1415]|GEHA [141500]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|469.00||||469.00|422.1|469|35.06 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|469.00||||469.00||| 32070140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES LMT < 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|469.00||||469.00||| 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|632.00||||632.00|130.23|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|632.00||||632.00|149.25|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|632.00||||632.00|115.25|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|||632.00||||632.00|189.6|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|632.00||||632.00|410.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|632.00||||632.00|632|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|632.00||||632.00|151.58|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|632.00||||632.00|143.26|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|632.00||||632.00|271.76|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|632.00||||632.00|105.9|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|632.00||||632.00|132.72|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|632.00||||632.00|149.25|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|632.00||||632.00|155.73|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|632.00||||632.00|303.04|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|632.00||||632.00|125.3|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|632.00||||632.00|52.17|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|632.00||||632.00|121.01|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|632.00||||632.00|474|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|632.00||||632.00|114.2|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|632.00||||632.00|125.3|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|632.00||||632.00|379.2|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|632.00||||632.00|109.01|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|632.00||||632.00|271.76|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|632.00||||632.00|316.63|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|632.00||||632.00|221.83|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|GEHA [1415]|GEHA [141500]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|632.00||||632.00|269.23|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|632.00||||632.00|268.93|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|632.00||||632.00|103.82|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|632.00||||632.00|568.8|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|632.00||||632.00|114.2|632|52.17 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|632.00||||632.00||| 32070150|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FACIAL BONES CMPLT 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|632.00||||632.00||| 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|466.00||||466.00|148.92|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|466.00||||466.00|200.38|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|466.00||||466.00|233.47|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|466.00||||466.00|163.57|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|466.00||||466.00|79.77|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|466.00||||466.00|279.6|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|466.00||||466.00|78.28|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|466.00||||466.00|83.56|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|466.00||||466.00|75.61|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|466.00||||466.00|44.23|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|466.00||||466.00|113.95|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|466.00||||466.00|109.21|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|466.00||||466.00|200.38|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|466.00||||466.00|89.5|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|466.00||||466.00|77.49|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|466.00||||466.00|110.91|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|466.00||||466.00|97.86|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|466.00||||466.00|466|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|466.00||||466.00|223.45|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|466.00||||466.00|198.52|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|466.00||||466.00|302.9|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|||466.00||||466.00|139.8|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|466.00||||466.00|78.28|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|466.00||||466.00|83.56|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|466.00||||466.00|75.97|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|466.00||||466.00|72.01|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|466.00||||466.00|349.5|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|466.00||||466.00|109.21|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|466.00||||466.00|81.36|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|GEHA [1415]|GEHA [141500]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|466.00||||466.00|419.4|466|44.23 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|466.00||||466.00||| 32070160|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NASAL BONES COMPLETE 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|466.00||||466.00||| 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|GEHA [1415]|GEHA [141500]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|692.00||||692.00|153.38|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|692.00||||692.00|519|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|692.00||||692.00|115.25|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|692.00||||692.00|125.3|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|||692.00||||692.00|207.6|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|692.00||||692.00|449.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|692.00||||692.00|331.81|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|692.00||||692.00|145.32|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|692.00||||692.00|108.82|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|692.00||||692.00|143.26|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|692.00||||692.00|297.56|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|692.00||||692.00|155.77|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|692.00||||692.00|692|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|692.00||||692.00|153.38|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MULTIPLAN [1680]|HMA [168003]|692.00||||692.00|160.04|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|692.00||||692.00|51.56|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|692.00||||692.00|121.01|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|692.00||||692.00|130.23|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|692.00||||692.00|117.36|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|692.00||||692.00|125.3|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|692.00||||692.00|415.2|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|692.00||||692.00|112.03|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|692.00||||692.00|297.56|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|692.00||||692.00|346.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|692.00||||692.00|242.89|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|692.00||||692.00|294.79|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|692.00||||692.00|268.93|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|692.00||||692.00|106.69|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|692.00||||692.00|622.8|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|692.00||||692.00|117.36|692|51.56 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|692.00||||692.00||| 32070200|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ORBITS COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|692.00||||692.00||| 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|410.00||||410.00|83.56|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|410.00||||410.00|148.92|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|410.00||||410.00|176.3|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|410.00||||410.00|143.91|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|410.00||||410.00|174.66|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|410.00||||410.00|79.77|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|410.00||||410.00|78.28|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|410.00||||410.00|83.56|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|410.00||||410.00|75.61|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|410.00||||410.00|39.34|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|410.00||||410.00|109.21|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|410.00||||410.00|113.95|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|410.00||||410.00|176.3|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|410.00||||410.00|89.5|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|410.00||||410.00|77.49|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|410.00||||410.00|110.91|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|410.00||||410.00|86.1|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|410.00||||410.00|246|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|410.00||||410.00|410|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|410.00||||410.00|196.6|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|410.00||||410.00|205.41|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|410.00||||410.00|266.5|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|||410.00||||410.00|123|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|410.00||||410.00|78.28|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|410.00||||410.00|75.97|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|410.00||||410.00|72.01|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|410.00||||410.00|307.5|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|410.00||||410.00|109.21|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|410.00||||410.00|81.36|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|GEHA [1415]|GEHA [141500]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|410.00||||410.00|369|410|39.34 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|410.00||||410.00||| 32070210|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL < 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|410.00||||410.00||| 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|682.00||||682.00|130.23|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|682.00||||682.00|109.21|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|682.00||||682.00|511.5|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|682.00||||682.00|115.25|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|||682.00||||682.00|204.6|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|682.00||||682.00|443.3|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|682.00||||682.00|682|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|682.00||||682.00|143.22|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|682.00||||682.00|110.91|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|682.00||||682.00|143.26|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|682.00||||682.00|293.26|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|682.00||||682.00|77.49|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|682.00||||682.00|109.21|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|682.00||||682.00|113.95|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|682.00||||682.00|327.02|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|682.00||||682.00|125.3|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|682.00||||682.00|45.44|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|682.00||||682.00|121.01|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|682.00||||682.00|83.56|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|682.00||||682.00|125.3|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|682.00||||682.00|409.2|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|GEHA [1415]|GEHA [141500]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|682.00||||682.00|79.77|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|682.00||||682.00|293.26|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|682.00||||682.00|341.68|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|682.00||||682.00|239.38|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|682.00||||682.00|290.53|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|682.00||||682.00|148.92|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|682.00||||682.00|75.97|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|682.00||||682.00|613.8|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|682.00||||682.00|83.56|682|45.44 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|682.00||||682.00||| 32070220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SINUS PARANASAL COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|682.00||||682.00||| 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|606.00||||606.00|268.93|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|606.00||||606.00|260.58|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|606.00||||606.00|303.61|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|606.00||||606.00|212.71|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|606.00||||606.00|258.16|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|606.00||||606.00|109.01|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|606.00||||606.00|363.6|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|606.00||||606.00|125.3|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|606.00||||606.00|114.2|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|606.00||||606.00|121.01|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|606.00||||606.00|43.62|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|606.00||||606.00|149.25|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MULTIPLAN [1680]|HMA [168003]|606.00||||606.00|155.73|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|606.00||||606.00|260.58|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|606.00||||606.00|143.26|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|606.00||||606.00|105.9|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|UMR [2035]|UMR OPTIONS [203501]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|606.00||||606.00|155.77|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|606.00||||606.00|127.26|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|606.00||||606.00|606|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|606.00||||606.00|290.58|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|606.00||||606.00|393.9|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|||606.00||||606.00|181.8|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|606.00||||606.00|125.3|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|606.00||||606.00|114.2|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|606.00||||606.00|103.82|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|606.00||||606.00|115.25|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|606.00||||606.00|454.5|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|606.00||||606.00|149.25|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|606.00||||606.00|130.23|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|GEHA [1415]|GEHA [141500]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|606.00||||606.00|545.4|606|43.62 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|606.00||||606.00||| 32070250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL < 4 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|606.00||||606.00||| 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|GEHA [1415]|GEHA [141500]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|763.00||||763.00|149.25|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|763.00||||763.00|572.25|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|763.00||||763.00|115.25|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|763.00||||763.00|125.3|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|||763.00||||763.00|228.9|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|763.00||||763.00|495.95|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|763.00||||763.00|365.86|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|763.00||||763.00|160.23|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|763.00||||763.00|105.9|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|763.00||||763.00|143.26|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|763.00||||763.00|328.09|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|763.00||||763.00|151.58|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|763.00||||763.00|763|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|763.00||||763.00|149.25|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MULTIPLAN [1680]|HMA [168003]|763.00||||763.00|155.73|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|763.00||||763.00|51.56|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|763.00||||763.00|121.01|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|763.00||||763.00|114.2|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|763.00||||763.00|130.23|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|763.00||||763.00|125.3|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|763.00||||763.00|457.8|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|763.00||||763.00|109.01|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|763.00||||763.00|328.09|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|763.00||||763.00|382.26|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|763.00||||763.00|267.81|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|763.00||||763.00|325.04|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|763.00||||763.00|268.93|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|763.00||||763.00|103.82|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|763.00||||763.00|686.7|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|763.00||||763.00|114.2|763|51.56 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|763.00||||763.00||| 32070260|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SKULL COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|763.00||||763.00||| 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|494.00||||494.00|81.31|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|494.00||||494.00|148.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|494.00||||494.00|212.42|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|494.00||||494.00|173.39|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|494.00||||494.00|210.44|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|494.00||||494.00|77.62|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|494.00||||494.00|296.4|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|494.00||||494.00|78.28|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|494.00||||494.00|81.31|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|494.00||||494.00|75.61|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|TRUSTMARK [2030]|STARMARK [203000]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|AETNA [1015]|AETNA ACO WILCO [101532]|494.00||||494.00|38.73|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|HEALTHNET [1495]|HEALTHNET [149500]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|494.00||||494.00|106.27|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MULTIPLAN [1680]|HMA [168003]|494.00||||494.00|110.88|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MULTIPLAN [1680]|IHC HS [168011]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|494.00||||494.00|212.42|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|494.00||||494.00|89.5|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|494.00||||494.00|75.4|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|UMR [2035]|UMR OPTIONS [203501]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|494.00||||494.00|107.93|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|494.00||||494.00|103.74|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|494.00||||494.00|494|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|494.00||||494.00|236.87|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|494.00||||494.00|247.49|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|494.00||||494.00|321.1|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|||494.00||||494.00|148.2|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|494.00||||494.00|78.28|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|494.00||||494.00|73.92|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|494.00||||494.00|72.01|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|CHAMPVA [1240]|CHAMP VA [124000]|494.00||||494.00|370.5|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|494.00||||494.00|106.27|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|494.00||||494.00|81.36|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|CORESOURCE [1315]|CORESOURCE [131500]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|GEHA [1415]|GEHA [141500]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|494.00||||494.00|444.6|494|38.73 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|494.00||||494.00||| 32070328|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT UNILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|494.00||||494.00||| 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|GEHA [1415]|GEHA [141500]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|CORESOURCE [1315]|CORESOURCE [131500]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|792.00||||792.00|81.36|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|792.00||||792.00|109.21|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|792.00||||792.00|72.01|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|||792.00||||792.00|237.6|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|792.00||||792.00|514.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|792.00||||792.00|379.76|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|792.00||||792.00|792|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|792.00||||792.00|110.91|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|UMR [2035]|UMR OPTIONS [203501]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|792.00||||792.00|89.5|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|792.00||||792.00|340.56|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|792.00||||792.00|77.49|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|792.00||||792.00|166.32|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MULTIPLAN [1680]|IHC HS [168011]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|792.00||||792.00|109.21|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MULTIPLAN [1680]|HMA [168003]|792.00||||792.00|113.95|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|HEALTHNET [1495]|HEALTHNET [149500]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|792.00||||792.00|78.28|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|792.00||||792.00|63.79|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|TRUSTMARK [2030]|STARMARK [203000]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|792.00||||792.00|75.61|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|CHAMPVA [1240]|CHAMP VA [124000]|792.00||||792.00|594|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|792.00||||792.00|83.56|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|792.00||||792.00|78.28|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|792.00||||792.00|475.2|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|792.00||||792.00|79.77|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|792.00||||792.00|340.56|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|792.00||||792.00|396.79|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|792.00||||792.00|277.99|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|792.00||||792.00|337.39|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|792.00||||792.00|148.92|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|792.00||||792.00|75.97|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|792.00||||792.00|712.8|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|792.00||||792.00|83.56|792|63.79 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|792.00||||792.00||| 32070330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TEMPOROMANDIBULAR JOINT BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|792.00||||792.00||| 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|565.00||||565.00|148.92|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|565.00||||565.00|242.95|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|565.00||||565.00|283.07|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|565.00||||565.00|198.32|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|565.00||||565.00|79.77|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|565.00||||565.00|339|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|565.00||||565.00|78.28|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|565.00||||565.00|83.56|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|565.00||||565.00|75.61|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|TRUSTMARK [2030]|STARMARK [203000]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|AETNA [1015]|AETNA ACO WILCO [101532]|565.00||||565.00|37.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MULTIPLAN [1680]|IHC HS [168011]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MULTIPLAN [1680]|HMA [168003]|565.00||||565.00|113.95|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|565.00||||565.00|109.21|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|FMH BENEFIT SERVICES [1390]|FMH [139000]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|FIRST HEALTH [1375]|QUALCHOICE [137513]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|565.00||||565.00|242.95|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|HEALTHNET [1495]|HEALTHNET [149500]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|565.00||||565.00|89.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|565.00||||565.00|77.49|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|UMR [2035]|UMR OPTIONS [203501]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|565.00||||565.00|110.91|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|565.00||||565.00|118.65|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|565.00||||565.00|565|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|565.00||||565.00|240.69|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|565.00||||565.00|270.92|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|565.00||||565.00|367.25|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|||565.00||||565.00|169.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|565.00||||565.00|78.28|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|565.00||||565.00|81.31|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|565.00||||565.00|75.97|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|565.00||||565.00|72.01|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|CHAMPVA [1240]|CHAMP VA [124000]|565.00||||565.00|423.75|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|565.00||||565.00|109.21|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|565.00||||565.00|81.36|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|CORESOURCE [1315]|CORESOURCE [131500]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|GEHA [1415]|GEHA [141500]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|565.00||||565.00|508.5|565|37.5 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|565.00||||565.00||| 32070360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NECK SOFT TISSUE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|565.00||||565.00||| 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|330.00||||330.00|85.17|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|GEHA [1415]|GEHA [141500]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|330.00||||330.00|109.21|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|CHAMPVA [1240]|CHAMP VA [124000]|330.00||||330.00|247.5|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|330.00||||330.00|81.94|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|||330.00||||330.00|99|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|330.00||||330.00|158.24|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|330.00||||330.00|214.5|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|330.00||||330.00|69.3|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|330.00||||330.00|110.91|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|UMR [2035]|UMR OPTIONS [203501]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|330.00||||330.00|77.49|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|330.00||||330.00|93.68|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|330.00||||330.00|141.9|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|FIRST HEALTH [1375]|QUALCHOICE [137513]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|FMH BENEFIT SERVICES [1390]|FMH [139000]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MULTIPLAN [1680]|IHC HS [168011]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|330.00||||330.00|109.21|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MULTIPLAN [1680]|HMA [168003]|330.00||||330.00|113.95|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|HEALTHNET [1495]|HEALTHNET [149500]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|330.00||||330.00|330|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|AETNA [1015]|AETNA ACO WILCO [101532]|330.00||||330.00|27.12|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|TRUSTMARK [2030]|STARMARK [203000]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|330.00||||330.00|79.14|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|CORESOURCE [1315]|CORESOURCE [131500]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|330.00||||330.00|83.56|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|330.00||||330.00|81.94|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|330.00||||330.00|141.9|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|330.00||||330.00|165.33|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|330.00||||330.00|115.83|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|330.00||||330.00|140.58|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|330.00||||330.00|198|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|330.00||||330.00|79.77|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|330.00||||330.00|148.92|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|330.00||||330.00|75.97|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|330.00||||330.00|83.56|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|330.00||||330.00|297|330|27.12 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|330.00||||330.00||| 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|330.00||||330.00||| 32071045|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST SINGLE VIEW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|330.00||||330.00||| 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|440.00||||440.00|81.31|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|440.00||||440.00|148.92|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|440.00||||440.00|79.77|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|440.00||||440.00|189.2|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|440.00||||440.00|220.44|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|440.00||||440.00|154.44|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|440.00||||440.00|187.44|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|440.00||||440.00|81.94|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|440.00||||440.00|83.56|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|440.00||||440.00|35.67|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|440.00||||440.00|109.21|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|440.00||||440.00|113.95|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|440.00||||440.00|189.2|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|440.00||||440.00|93.68|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|440.00||||440.00|77.49|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|440.00||||440.00|110.91|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|440.00||||440.00|92.4|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|440.00||||440.00|79.14|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|440.00||||440.00|440|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|440.00||||440.00|286|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|440.00||||440.00|264|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|440.00||||440.00|210.98|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|440.00||||440.00|29.37|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|||440.00||||440.00|132|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|440.00||||440.00|81.94|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|440.00||||440.00|73.92|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|440.00||||440.00|75.97|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|440.00||||440.00|330|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|440.00||||440.00|109.21|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|GEHA [1415]|GEHA [141500]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|440.00||||440.00|396|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|440.00||||440.00|85.17|440|29.37 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|440.00||||440.00||| 32071046|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHEST 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|440.00||||440.00||| 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|633.00||||633.00|81.36|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|633.00||||633.00|109.21|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|633.00||||633.00|72.01|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|633.00||||633.00|78.28|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|||633.00||||633.00|189.9|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|633.00||||633.00|411.45|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|633.00||||633.00|633|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|633.00||||633.00|110.91|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|633.00||||633.00|77.49|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|633.00||||633.00|89.5|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|633.00||||633.00|272.19|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|633.00||||633.00|109.21|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|633.00||||633.00|113.95|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|633.00||||633.00|132.93|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|633.00||||633.00|303.52|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|633.00||||633.00|39.95|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|633.00||||633.00|75.61|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|633.00||||633.00|474.75|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|633.00||||633.00|83.56|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|633.00||||633.00|78.28|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|633.00||||633.00|379.8|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|GEHA [1415]|GEHA [141500]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|633.00||||633.00|79.77|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|633.00||||633.00|272.19|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|633.00||||633.00|317.13|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|633.00||||633.00|222.18|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|633.00||||633.00|269.66|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|633.00||||633.00|148.92|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|633.00||||633.00|75.97|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|633.00||||633.00|569.7|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|633.00||||633.00|81.31|633|39.95 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|633.00||||633.00||| 32071100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|633.00||||633.00||| 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|696.00||||696.00|117.36|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|696.00||||696.00|268.93|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|696.00||||696.00|299.28|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|696.00||||696.00|348.7|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|696.00||||696.00|244.3|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|696.00||||696.00|109.01|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|696.00||||696.00|417.6|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|696.00||||696.00|125.3|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|696.00||||696.00|117.36|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|696.00||||696.00|121.01|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|AETNA [1015]|AETNA ACO WILCO [101532]|696.00||||696.00|44.23|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MULTIPLAN [1680]|IHC HS [168011]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|696.00||||696.00|153.38|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|FMH BENEFIT SERVICES [1390]|FMH [139000]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|FIRST HEALTH [1375]|QUALCHOICE [137513]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|696.00||||696.00|299.28|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MULTIPLAN [1680]|HMA [168003]|696.00||||696.00|160.04|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|HEALTHNET [1495]|HEALTHNET [149500]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|696.00||||696.00|143.26|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|696.00||||696.00|108.82|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|TRUSTMARK [2030]|STARMARK [203000]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|UMR [2035]|UMR OPTIONS [203501]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|696.00||||696.00|155.77|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|696.00||||696.00|146.16|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|696.00||||696.00|696|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|696.00||||696.00|333.73|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|696.00||||696.00|452.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|696.00||||696.00|296.5|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|||696.00||||696.00|208.8|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|696.00||||696.00|125.3|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|696.00||||696.00|106.69|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|696.00||||696.00|115.25|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|CHAMPVA [1240]|CHAMP VA [124000]|696.00||||696.00|522|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|696.00||||696.00|153.38|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|696.00||||696.00|130.23|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|CORESOURCE [1315]|CORESOURCE [131500]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|GEHA [1415]|GEHA [141500]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|696.00||||696.00|626.4|696|44.23 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|696.00||||696.00||| 32071101|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS UNILAT W/CHEST 3+ VIEW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|696.00||||696.00||| 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|GEHA [1415]|GEHA [141500]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|655.00||||655.00|130.23|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|655.00||||655.00|149.25|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|655.00||||655.00|491.25|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|655.00||||655.00|115.25|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|655.00||||655.00|125.3|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|||655.00||||655.00|196.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|655.00||||655.00|425.75|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|655.00||||655.00|314.07|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|655.00||||655.00|655|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|655.00||||655.00|137.55|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|655.00||||655.00|105.9|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|655.00||||655.00|143.26|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|655.00||||655.00|281.65|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|655.00||||655.00|151.58|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|655.00||||655.00|149.25|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|655.00||||655.00|155.73|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|655.00||||655.00|45.44|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|655.00||||655.00|121.01|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|655.00||||655.00|114.2|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|655.00||||655.00|125.3|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|655.00||||655.00|393|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|655.00||||655.00|109.01|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|655.00||||655.00|281.65|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|655.00||||655.00|328.16|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|655.00||||655.00|229.91|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|655.00||||655.00|279.03|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|655.00||||655.00|268.93|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|655.00||||655.00|103.82|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|655.00||||655.00|589.5|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|655.00||||655.00|114.2|655|45.44 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|655.00||||655.00||| 32071110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|655.00||||655.00||| 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1062.00||||1062.00|117.36|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1062.00||||1062.00|268.93|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1062.00||||1062.00|456.66|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1062.00||||1062.00|532.06|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1062.00||||1062.00|372.76|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1062.00||||1062.00|452.41|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1062.00||||1062.00|112.03|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1062.00||||1062.00|125.3|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1062.00||||1062.00|117.36|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1062.00||||1062.00|121.01|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|1062.00||||1062.00|55.84|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1062.00||||1062.00|153.38|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MULTIPLAN [1680]|HMA [168003]|1062.00||||1062.00|160.04|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1062.00||||1062.00|456.66|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1062.00||||1062.00|143.26|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1062.00||||1062.00|108.82|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1062.00||||1062.00|155.77|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1062.00||||1062.00|223.02|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1062.00||||1062.00|637.2|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1062.00||||1062.00|1062|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1062.00||||1062.00|509.23|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1062.00||||1062.00|690.3|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|||1062.00||||1062.00|318.6|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1062.00||||1062.00|125.3|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1062.00||||1062.00|106.69|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1062.00||||1062.00|115.25|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|1062.00||||1062.00|796.5|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1062.00||||1062.00|153.38|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1062.00||||1062.00|130.23|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|GEHA [1415]|GEHA [141500]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1062.00||||1062.00|955.8|1062|55.84 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1062.00||||1062.00||| 32071111|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC RIBS BILAT W/CHEST 4+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1062.00||||1062.00||| 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|554.00||||554.00|81.36|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|554.00||||554.00|109.21|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|554.00||||554.00|72.01|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|||554.00||||554.00|166.2|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|554.00||||554.00|360.1|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|554.00||||554.00|554|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|554.00||||554.00|110.91|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|554.00||||554.00|89.5|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|554.00||||554.00|238.22|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|554.00||||554.00|77.49|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|554.00||||554.00|116.34|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|554.00||||554.00|109.21|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|554.00||||554.00|113.95|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|554.00||||554.00|265.64|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|554.00||||554.00|78.28|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|554.00||||554.00|36.28|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|554.00||||554.00|75.61|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|554.00||||554.00|415.5|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|554.00||||554.00|83.56|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|GEHA [1415]|GEHA [141500]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|554.00||||554.00|78.28|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|554.00||||554.00|332.4|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|554.00||||554.00|79.77|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|554.00||||554.00|238.22|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|554.00||||554.00|277.55|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|554.00||||554.00|194.45|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|554.00||||554.00|236|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|554.00||||554.00|148.92|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|554.00||||554.00|75.97|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|554.00||||554.00|498.6|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|554.00||||554.00|83.56|554|36.28 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|554.00||||554.00||| 32071120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNUM 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|554.00||||554.00||| 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|484.00||||484.00|148.92|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|484.00||||484.00|208.12|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|484.00||||484.00|242.48|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|484.00||||484.00|169.88|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|484.00||||484.00|79.77|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|484.00||||484.00|290.4|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|484.00||||484.00|78.28|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|484.00||||484.00|83.56|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|484.00||||484.00|75.61|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|484.00||||484.00|45.44|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|484.00||||484.00|109.21|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|484.00||||484.00|113.95|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|484.00||||484.00|208.12|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|484.00||||484.00|89.5|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|484.00||||484.00|77.49|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|484.00||||484.00|110.91|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|484.00||||484.00|101.64|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|484.00||||484.00|484|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|484.00||||484.00|232.08|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|484.00||||484.00|206.18|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|484.00||||484.00|314.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|||484.00||||484.00|145.2|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|484.00||||484.00|78.28|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|484.00||||484.00|83.56|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|484.00||||484.00|75.97|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|484.00||||484.00|72.01|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|484.00||||484.00|363|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|484.00||||484.00|109.21|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|484.00||||484.00|81.36|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|GEHA [1415]|GEHA [141500]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|484.00||||484.00|435.6|484|45.44 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|484.00||||484.00||| 32071130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC STERNO-CLAVICULAR JOINT(S) 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|484.00||||484.00||| 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|AETNA [1015]|AETNA ACO WILCO [101532]|448.00||||448.00|26.51|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|TRUSTMARK [2030]|STARMARK [203000]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|448.00||||448.00|75.61|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|448.00||||448.00|83.56|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|448.00||||448.00|78.28|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|448.00||||448.00|268.8|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|448.00||||448.00|79.77|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|448.00||||448.00|192.64|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|448.00||||448.00|224.45|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|448.00||||448.00|157.25|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|448.00||||448.00|190.85|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|448.00||||448.00|148.92|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|448.00||||448.00|83.56|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|UMR [2035]|UMR OPTIONS [203501]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|CORESOURCE [1315]|CORESOURCE [131500]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|448.00||||448.00|214.82|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MULTIPLAN [1680]|HMA [168003]|448.00||||448.00|113.95|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MULTIPLAN [1680]|IHC HS [168011]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|448.00||||448.00|192.64|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|448.00||||448.00|78.28|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|||448.00||||448.00|134.4|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|448.00||||448.00|110.91|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|448.00||||448.00|448|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|448.00||||448.00|81.36|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|CHAMPVA [1240]|CHAMP VA [124000]|448.00||||448.00|336|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|448.00||||448.00|94.08|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|GEHA [1415]|GEHA [141500]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|448.00||||448.00|89.5|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|HEALTHNET [1495]|HEALTHNET [149500]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|448.00||||448.00|72.01|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|448.00||||448.00|109.21|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|448.00||||448.00|109.21|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|448.00||||448.00|403.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|448.00||||448.00|291.2|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|448.00||||448.00|75.97|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|448.00||||448.00|77.49|448|26.51 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|448.00||||448.00||| 32072020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE SINGLE VIEW ANY LEVEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|448.00||||448.00||| 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|617.00||||617.00|216.57|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|617.00||||617.00|81.31|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|617.00||||617.00|109.21|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|617.00||||617.00|73.92|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|617.00||||617.00|401.05|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|617.00||||617.00|83.56|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|617.00||||617.00|148.92|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|617.00||||617.00|262.84|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|617.00||||617.00|370.2|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|617.00||||617.00|130.23|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|617.00||||617.00|77.62|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|617.00||||617.00|43.62|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|617.00||||617.00|309.12|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|617.00||||617.00|121.01|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|617.00||||617.00|462.75|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|617.00||||617.00|295.85|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|617.00||||617.00|125.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|617.00||||617.00|77.49|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|617.00||||617.00|265.31|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|617.00||||617.00|129.57|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|617.00||||617.00|617|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|617.00||||617.00|107.93|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|617.00||||617.00|265.31|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|||617.00||||617.00|185.1|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|617.00||||617.00|125.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|617.00||||617.00|73.92|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|617.00||||617.00|109.21|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|GEHA [1415]|GEHA [141500]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|617.00||||617.00|115.25|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|617.00||||617.00|555.3|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|617.00||||617.00|143.26|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|617.00||||617.00|75.97|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|617.00||||617.00|113.95|617|43.62 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|617.00||||617.00||| 32072040|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|617.00||||617.00||| 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|797.00||||797.00|112.03|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|797.00||||797.00|478.2|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|797.00||||797.00|339.52|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|797.00||||797.00|117.36|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|797.00||||797.00|268.93|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|797.00||||797.00|125.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|797.00||||797.00|121.01|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|797.00||||797.00|279.75|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|797.00||||797.00|115.25|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|||797.00||||797.00|239.1|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|797.00||||797.00|399.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|797.00||||797.00|143.26|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|797.00||||797.00|108.82|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|797.00||||797.00|797|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|797.00||||797.00|155.77|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|797.00||||797.00|153.38|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|797.00||||797.00|130.23|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|797.00||||797.00|342.71|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|797.00||||797.00|125.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|797.00||||797.00|167.37|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|797.00||||797.00|597.75|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|UMR [2035]|UMR OPTIONS [203501]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|797.00||||797.00|342.71|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|797.00||||797.00|518.05|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|797.00||||797.00|59.51|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|797.00||||797.00|382.16|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|797.00||||797.00|117.36|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|797.00||||797.00|153.38|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|GEHA [1415]|GEHA [141500]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|MULTIPLAN [1680]|HMA [168003]|797.00||||797.00|160.04|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|797.00||||797.00|106.69|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|797.00||||797.00|717.3|797|59.51 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|797.00||||797.00||| 32072050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 4 OR 5 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|797.00||||797.00||| 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|867.00||||867.00|143.26|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|867.00||||867.00|372.81|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|867.00||||867.00|117.36|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|867.00||||867.00|268.93|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|867.00||||867.00|117.36|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|867.00||||867.00|112.03|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|867.00||||867.00|520.2|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|867.00||||867.00|369.34|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|867.00||||867.00|125.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|867.00||||867.00|304.32|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|867.00||||867.00|372.81|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|867.00||||867.00|121.01|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|867.00||||867.00|71.73|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|867.00||||867.00|563.55|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MULTIPLAN [1680]|HMA [168003]|867.00||||867.00|160.04|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|867.00||||867.00|155.77|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|867.00||||867.00|182.07|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|GEHA [1415]|GEHA [141500]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|867.00||||867.00|108.82|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|867.00||||867.00|434.37|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|867.00||||867.00|125.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|867.00||||867.00|115.25|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|867.00||||867.00|867|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|||867.00||||867.00|260.1|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|867.00||||867.00|130.23|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|867.00||||867.00|780.3|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|867.00||||867.00|415.73|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|867.00||||867.00|153.38|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|867.00||||867.00|650.25|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|867.00||||867.00|153.38|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|867.00||||867.00|106.69|867|71.73 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|867.00||||867.00||| 32072052|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CERVICAL SPINE 6+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|867.00||||867.00||| 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|634.00||||634.00|117.36|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|634.00||||634.00|112.03|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|634.00||||634.00|268.93|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|634.00||||634.00|380.4|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|634.00||||634.00|270.08|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|634.00||||634.00|272.62|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|634.00||||634.00|317.63|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|634.00||||634.00|222.53|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|634.00||||634.00|634|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|634.00||||634.00|115.25|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|634.00||||634.00|153.38|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|634.00||||634.00|130.23|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|634.00||||634.00|143.26|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|634.00||||634.00|272.62|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|634.00||||634.00|133.14|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|GEHA [1415]|GEHA [141500]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|634.00||||634.00|125.3|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|634.00||||634.00|117.36|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|634.00||||634.00|412.1|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|634.00||||634.00|103.82|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|634.00||||634.00|160.04|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|634.00||||634.00|39.34|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|634.00||||634.00|153.38|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|634.00||||634.00|304|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|||634.00||||634.00|190.2|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|634.00||||634.00|121.01|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|634.00||||634.00|475.5|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|634.00||||634.00|155.77|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|634.00||||634.00|106.69|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|634.00||||634.00|125.3|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|634.00||||634.00|108.82|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|634.00||||634.00|570.6|634|39.34 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|634.00||||634.00||| 32072070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|634.00||||634.00||| 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|692.00||||692.00|268.93|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|692.00||||692.00|112.03|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|692.00||||692.00|297.56|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|692.00||||692.00|294.79|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|692.00||||692.00|415.2|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|692.00||||692.00|297.56|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|692.00||||692.00|346.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|692.00||||692.00|117.36|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|692.00||||692.00|117.36|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|692.00||||692.00|43.62|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|692.00||||692.00|103.82|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|692.00||||692.00|143.26|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|692.00||||692.00|125.3|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|692.00||||692.00|145.32|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|692.00||||692.00|692|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|||692.00||||692.00|207.6|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|692.00||||692.00|160.04|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|692.00||||692.00|125.3|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|GEHA [1415]|GEHA [141500]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|692.00||||692.00|449.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|692.00||||692.00|153.38|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|692.00||||692.00|115.25|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|692.00||||692.00|519|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|692.00||||692.00|155.77|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|692.00||||692.00|153.38|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|692.00||||692.00|108.82|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|692.00||||692.00|331.81|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|692.00||||692.00|242.89|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|692.00||||692.00|130.23|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|692.00||||692.00|106.69|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|692.00||||692.00|121.01|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|692.00||||692.00|622.8|692|43.62 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|692.00||||692.00||| 32072072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|692.00||||692.00||| 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|GEHA [1415]|GEHA [141500]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|704.00||||704.00|130.23|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|704.00||||704.00|302.72|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|704.00||||704.00|528|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|704.00||||704.00|115.25|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|704.00||||704.00|153.38|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|704.00||||704.00|704|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|704.00||||704.00|337.57|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|704.00||||704.00|143.26|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|704.00||||704.00|147.84|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|704.00||||704.00|125.3|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|704.00||||704.00|457.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|704.00||||704.00|268.93|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|704.00||||704.00|108.82|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MULTIPLAN [1680]|HMA [168003]|704.00||||704.00|160.04|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|704.00||||704.00|153.38|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|704.00||||704.00|49.72|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|704.00||||704.00|117.36|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|704.00||||704.00|155.77|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|704.00||||704.00|125.3|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|704.00||||704.00|299.9|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|704.00||||704.00|302.72|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|704.00||||704.00|352.7|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|704.00||||704.00|247.1|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|||704.00||||704.00|211.2|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|704.00||||704.00|121.01|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|704.00||||704.00|422.4|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|704.00||||704.00|117.36|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|704.00||||704.00|112.03|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|704.00||||704.00|106.69|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|704.00||||704.00|633.6|704|49.72 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|704.00||||704.00||| 32072074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC THORACIC SPINE 4+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|704.00||||704.00||| 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.00||||464.00|197.66|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.00||||464.00|162.86|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.00||||464.00|79.77|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.00||||464.00|278.4|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.00||||464.00|78.28|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.00||||464.00|199.52|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.00||||464.00|77.49|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.00||||464.00|109.21|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|464.00||||464.00|38.73|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.00||||464.00|199.52|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.00||||464.00|97.44|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.00||||464.00|464|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.00||||464.00|110.91|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.00||||464.00|75.61|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.00||||464.00|78.28|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.00||||464.00|89.5|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.00||||464.00|83.56|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.00||||464.00|148.92|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|464.00||||464.00|113.95|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.00||||464.00|222.49|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.00||||464.00|109.21|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.00||||464.00|232.46|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|464.00||||464.00|348|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|GEHA [1415]|GEHA [141500]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.00||||464.00|301.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|||464.00||||464.00|139.2|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.00||||464.00|81.36|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.00||||464.00|75.97|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.00||||464.00|417.6|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.00||||464.00|72.01|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.00||||464.00|83.56|464|38.73 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|464.00||||464.00||| 32072080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE THORACOLUMBAR JUNCTION 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.00||||464.00||| 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|575.00||||575.00|109.21|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|575.00||||575.00|83.37|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|GEHA [1415]|GEHA [141500]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|575.00||||575.00|80.21|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|575.00||||575.00|373.75|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|575.00||||575.00|275.71|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|575.00||||575.00|575|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|575.00||||575.00|120.75|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|UMR [2035]|UMR OPTIONS [203501]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|FMH BENEFIT SERVICES [1390]|FMH [139000]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|575.00||||575.00|247.25|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|FIRST HEALTH [1375]|QUALCHOICE [137513]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MULTIPLAN [1680]|HMA [168003]|575.00||||575.00|113.95|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|575.00||||575.00|109.21|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|HEALTHNET [1495]|HEALTHNET [149500]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|CORESOURCE [1315]|CORESOURCE [131500]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MULTIPLAN [1680]|IHC HS [168011]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|AETNA [1015]|AETNA ACO WILCO [101532]|575.00||||575.00|46.05|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|575.00||||575.00|77.49|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|TRUSTMARK [2030]|STARMARK [203000]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|575.00||||575.00|77.47|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|575.00||||575.00|91.7|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|||575.00||||575.00|172.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|575.00||||575.00|244.95|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|575.00||||575.00|201.83|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|575.00||||575.00|83.56|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|CHAMPVA [1240]|CHAMP VA [124000]|575.00||||575.00|431.25|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|575.00||||575.00|345|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|575.00||||575.00|288.08|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|575.00||||575.00|73.78|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|575.00||||575.00|79.77|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|575.00||||575.00|247.25|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|575.00||||575.00|110.91|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|575.00||||575.00|148.92|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|575.00||||575.00|75.97|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|575.00||||575.00|83.56|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|575.00||||575.00|517.5|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|575.00||||575.00|80.21|575|46.05 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|575.00||||575.00||| 32072081|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L-SPINE SCOLIOSIS 1 VIEW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|575.00||||575.00||| 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|632.00||||632.00|132.84|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|632.00||||632.00|271.76|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|632.00||||632.00|316.63|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|632.00||||632.00|269.23|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|632.00||||632.00|114.2|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|632.00||||632.00|379.2|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|632.00||||632.00|114.2|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|632.00||||632.00|268.93|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|632.00||||632.00|128.3|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|632.00||||632.00|155.73|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|632.00||||632.00|132.72|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|632.00||||632.00|151.87|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|632.00||||632.00|271.76|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|632.00||||632.00|105.9|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|632.00||||632.00|632|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|632.00||||632.00|303.04|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|632.00||||632.00|149.25|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|632.00||||632.00|138.07|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|632.00||||632.00|410.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|632.00||||632.00|132.84|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|632.00||||632.00|474|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|632.00||||632.00|221.83|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|632.00||||632.00|149.25|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|632.00||||632.00|83.96|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|632.00||||632.00|122.19|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|632.00||||632.00|151.58|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|632.00||||632.00|109.01|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|||632.00||||632.00|189.6|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|GEHA [1415]|GEHA [141500]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|632.00||||632.00|103.82|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|632.00||||632.00|568.8|632|83.96 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|632.00||||632.00||| 32072082|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC T-L SPINE SCOLIOSIS EVAL 2 OR 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|632.00||||632.00||| 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|582.00||||582.00|115.25|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|GEHA [1415]|GEHA [141500]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|582.00||||582.00|130.23|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|582.00||||582.00|106.69|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|582.00||||582.00|125.3|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|582.00||||582.00|143.26|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|582.00||||582.00|378.3|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|582.00||||582.00|122.22|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|582.00||||582.00|151.58|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|582.00||||582.00|105.9|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|582.00||||582.00|436.5|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|582.00||||582.00|43.62|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|582.00||||582.00|149.25|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|582.00||||582.00|250.26|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|582.00||||582.00|582|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|582.00||||582.00|155.73|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|||582.00||||582.00|174.6|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|582.00||||582.00|268.93|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|582.00||||582.00|121.01|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|582.00||||582.00|114.2|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|582.00||||582.00|250.26|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|582.00||||582.00|149.25|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|582.00||||582.00|109.01|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|582.00||||582.00|247.93|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|582.00||||582.00|204.28|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|582.00||||582.00|523.8|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|582.00||||582.00|103.82|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|582.00||||582.00|279.07|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|582.00||||582.00|291.58|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|582.00||||582.00|349.2|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|582.00||||582.00|125.3|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|582.00||||582.00|114.2|582|43.62 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|582.00||||582.00||| 32072100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|582.00||||582.00||| 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|896.00||||896.00|125.3|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|896.00||||896.00|385.28|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|896.00||||896.00|268.93|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|896.00||||896.00|448.9|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|896.00||||896.00|314.5|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|896.00||||896.00|112.03|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|896.00||||896.00|381.7|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|896.00||||896.00|537.6|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|896.00||||896.00|103.82|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|896.00||||896.00|121.01|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|896.00||||896.00|153.38|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|896.00||||896.00|60.73|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MULTIPLAN [1680]|HMA [168003]|896.00||||896.00|160.04|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|896.00||||896.00|188.16|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|896.00||||896.00|385.28|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|896.00||||896.00|155.77|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|896.00||||896.00|896|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|896.00||||896.00|143.26|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|896.00||||896.00|117.36|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|896.00||||896.00|130.23|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|896.00||||896.00|582.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|896.00||||896.00|153.38|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|896.00||||896.00|429.63|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|896.00||||896.00|125.3|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|896.00||||896.00|672|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|896.00||||896.00|115.25|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|896.00||||896.00|108.82|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|GEHA [1415]|GEHA [141500]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|896.00||||896.00|117.36|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|896.00||||896.00|106.69|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|||896.00||||896.00|268.8|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|896.00||||896.00|806.4|896|60.73 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|896.00||||896.00||| 32072110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE LUMBOSACRAL 4+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|896.00||||896.00||| 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|966.00||||966.00|724.5|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|966.00||||966.00|115.25|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|966.00||||966.00|130.23|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|966.00||||966.00|153.38|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|966.00||||966.00|125.3|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|||966.00||||966.00|289.8|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|966.00||||966.00|966|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|966.00||||966.00|463.2|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|966.00||||966.00|202.86|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|966.00||||966.00|121.01|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|966.00||||966.00|415.38|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|966.00||||966.00|153.38|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MULTIPLAN [1680]|HMA [168003]|966.00||||966.00|160.04|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|966.00||||966.00|71.73|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|966.00||||966.00|143.26|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|966.00||||966.00|108.82|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|966.00||||966.00|627.9|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|GEHA [1415]|GEHA [141500]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|966.00||||966.00|411.52|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|966.00||||966.00|117.36|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|966.00||||966.00|579.6|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|966.00||||966.00|483.97|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|966.00||||966.00|268.93|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|966.00||||966.00|339.07|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|966.00||||966.00|117.36|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|966.00||||966.00|106.69|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|966.00||||966.00|155.77|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|966.00||||966.00|112.03|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|966.00||||966.00|125.3|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|966.00||||966.00|869.4|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|966.00||||966.00|415.38|966|71.73 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|966.00||||966.00||| 32072114|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SPINE L/S COMPLETE W/BENDING 6+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|966.00||||966.00||| 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|866.00||||866.00|117.36|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|866.00||||866.00|372.38|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|866.00||||866.00|112.03|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|866.00||||866.00|433.87|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|866.00||||866.00|368.92|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|866.00||||866.00|519.6|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|866.00||||866.00|125.3|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|866.00||||866.00|117.36|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|866.00||||866.00|268.93|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|866.00||||866.00|121.01|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|866.00||||866.00|130.23|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|866.00||||866.00|372.38|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|866.00||||866.00|155.77|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|866.00||||866.00|108.82|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|866.00||||866.00|143.26|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|866.00||||866.00|160.04|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|866.00||||866.00|153.38|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|866.00||||866.00|153.38|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|866.00||||866.00|866|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|866.00||||866.00|181.86|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|866.00||||866.00|415.25|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|866.00||||866.00|562.9|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|||866.00||||866.00|259.8|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|866.00||||866.00|303.97|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|866.00||||866.00|125.3|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|866.00||||866.00|649.5|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|866.00||||866.00|115.25|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|GEHA [1415]|GEHA [141500]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|866.00||||866.00|54.62|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|866.00||||866.00|779.4|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|866.00||||866.00|106.69|866|54.62 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|866.00||||866.00||| 32072120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC L-SPINE BENDING ONLY 2 OR 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|866.00||||866.00||| 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|||425.00||||425.00|127.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|425.00||||425.00|153.38|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|GEHA [1415]|GEHA [141500]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|425.00||||425.00|130.23|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|425.00||||425.00|125.3|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|425.00||||425.00|143.26|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|425.00||||425.00|276.25|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|425.00||||425.00|89.25|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|425.00||||425.00|425|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|425.00||||425.00|108.82|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|425.00||||425.00|41.77|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|425.00||||425.00|153.38|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|425.00||||425.00|160.04|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|425.00||||425.00|182.75|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|425.00||||425.00|203.79|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|425.00||||425.00|268.93|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|425.00||||425.00|121.01|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|425.00||||425.00|117.36|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|425.00||||425.00|318.75|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|425.00||||425.00|112.03|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|425.00||||425.00|182.75|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|425.00||||425.00|181.05|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|425.00||||425.00|382.5|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|425.00||||425.00|106.69|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|425.00||||425.00|117.36|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|425.00||||425.00|155.77|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|425.00||||425.00|115.25|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|425.00||||425.00|149.18|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|425.00||||425.00|125.3|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|425.00||||425.00|212.93|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|425.00||||425.00|255|425|41.77 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|425.00||||425.00||| 32072170|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS 1 OR 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|425.00||||425.00||| 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|490.00||||490.00|318.5|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|490.00||||490.00|160.04|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|490.00||||490.00|143.26|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|490.00||||490.00|102.9|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|490.00||||490.00|108.82|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|490.00||||490.00|155.77|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|490.00||||490.00|490|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|490.00||||490.00|210.7|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|490.00||||490.00|130.23|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|490.00||||490.00|153.38|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|490.00||||490.00|234.96|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|490.00||||490.00|125.3|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|||490.00||||490.00|147|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|490.00||||490.00|367.5|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|490.00||||490.00|115.25|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|GEHA [1415]|GEHA [141500]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|490.00||||490.00|153.38|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|490.00||||490.00|112.03|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|490.00||||490.00|117.36|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|490.00||||490.00|245.49|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|490.00||||490.00|171.99|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|490.00||||490.00|208.74|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|490.00||||490.00|210.7|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|490.00||||490.00|294|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|490.00||||490.00|125.3|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|490.00||||490.00|268.93|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|490.00||||490.00|117.36|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|490.00||||490.00|121.01|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|490.00||||490.00|106.69|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|490.00||||490.00|49.72|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|490.00||||490.00|441|490|49.72 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|490.00||||490.00||| 32072190|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC PELVIS COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|490.00||||490.00||| 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|497.00||||497.00|130.23|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|497.00||||497.00|372.75|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|497.00||||497.00|115.25|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|497.00||||497.00|125.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|||497.00||||497.00|149.1|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|497.00||||497.00|238.31|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|497.00||||497.00|497|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|497.00||||497.00|104.37|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|497.00||||497.00|155.77|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|497.00||||497.00|108.82|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|497.00||||497.00|213.71|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|497.00||||497.00|143.26|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|497.00||||497.00|153.38|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|497.00||||497.00|160.04|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|497.00||||497.00|43.62|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|497.00||||497.00|323.05|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|497.00||||497.00|121.01|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|497.00||||497.00|103.82|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|497.00||||497.00|117.36|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|497.00||||497.00|125.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|497.00||||497.00|213.71|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|497.00||||497.00|249|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|GEHA [1415]|GEHA [141500]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|497.00||||497.00|149.25|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|497.00||||497.00|268.93|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|497.00||||497.00|211.72|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|497.00||||497.00|117.36|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|497.00||||497.00|174.45|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|497.00||||497.00|106.69|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|497.00||||497.00|109.01|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|497.00||||497.00|298.2|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|497.00||||497.00|447.3|497|43.62 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|497.00||||497.00||| 32072202|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACROILIAC JOINTS 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|497.00||||497.00||| 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|492.00||||492.00|81.31|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|492.00||||492.00|211.56|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|492.00||||492.00|148.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|492.00||||492.00|246.49|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|492.00||||492.00|209.59|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|492.00||||492.00|295.2|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|492.00||||492.00|78.28|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|492.00||||492.00|81.31|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|492.00||||492.00|75.97|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|492.00||||492.00|106.27|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|492.00||||492.00|113.95|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|492.00||||492.00|211.56|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|492.00||||492.00|75.4|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|492.00||||492.00|89.5|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|492.00||||492.00|110.91|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|492.00||||492.00|103.32|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|492.00||||492.00|75.61|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|492.00||||492.00|492|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|492.00||||492.00|37.5|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|492.00||||492.00|235.91|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|492.00||||492.00|319.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|492.00||||492.00|79.77|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|492.00||||492.00|172.69|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|||492.00||||492.00|147.6|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|492.00||||492.00|78.28|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|492.00||||492.00|369|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|492.00||||492.00|106.27|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|GEHA [1415]|GEHA [141500]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|492.00||||492.00|72.01|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|492.00||||492.00|73.92|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|492.00||||492.00|442.8|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|492.00||||492.00|81.36|492|37.5 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|492.00||||492.00||| 32072220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SACRUM/COCCYX 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|492.00||||492.00||| 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|GEHA [1415]|GEHA [141500]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|499.00||||499.00|81.36|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|499.00||||499.00|109.21|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|499.00||||499.00|374.25|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|499.00||||499.00|78.28|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|||499.00||||499.00|149.7|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|499.00||||499.00|324.35|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|499.00||||499.00|239.27|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|499.00||||499.00|499|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|499.00||||499.00|104.79|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|UMR [2035]|UMR OPTIONS [203501]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|499.00||||499.00|77.49|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|499.00||||499.00|214.57|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MULTIPLAN [1680]|HMA [168003]|499.00||||499.00|113.95|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|499.00||||499.00|109.21|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|499.00||||499.00|35.67|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|499.00||||499.00|89.5|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|499.00||||499.00|75.61|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|499.00||||499.00|72.01|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|499.00||||499.00|110.91|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|499.00||||499.00|83.56|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|499.00||||499.00|78.28|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|499.00||||499.00|79.77|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|499.00||||499.00|212.57|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|499.00||||499.00|83.56|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|499.00||||499.00|449.1|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|499.00||||499.00|75.97|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|499.00||||499.00|148.92|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|499.00||||499.00|175.15|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|499.00||||499.00|214.57|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|499.00||||499.00|299.4|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|499.00||||499.00|250|499|35.67 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|499.00||||499.00||| 32073000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CLAVICLE COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|499.00||||499.00||| 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|473.00||||473.00|109.01|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|473.00||||473.00|114.2|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|473.00||||473.00|268.93|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|473.00||||473.00|236.97|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|473.00||||473.00|201.5|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|473.00||||473.00|283.8|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|473.00||||473.00|78.28|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|473.00||||473.00|75.61|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MULTIPLAN [1680]|HMA [168003]|473.00||||473.00|155.73|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|473.00||||473.00|149.25|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|473.00||||473.00|203.39|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|473.00||||473.00|89.5|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|473.00||||473.00|105.9|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|UMR [2035]|UMR OPTIONS [203501]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|473.00||||473.00|151.58|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|473.00||||473.00|99.33|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|473.00||||473.00|473|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|473.00||||473.00|114.2|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|473.00||||473.00|39.34|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|473.00||||473.00|226.8|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|473.00||||473.00|307.45|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|||473.00||||473.00|141.9|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|473.00||||473.00|166.02|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|473.00||||473.00|203.39|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|473.00||||473.00|78.28|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|473.00||||473.00|72.01|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|473.00||||473.00|81.36|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|473.00||||473.00|149.25|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|473.00||||473.00|354.75|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|GEHA [1415]|GEHA [141500]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|473.00||||473.00|103.82|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|473.00||||473.00|425.7|473|39.34 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|473.00||||473.00||| 32073010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SCAPULA COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|473.00||||473.00||| 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|395.00||||395.00|81.36|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|395.00||||395.00|109.21|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|CORESOURCE [1315]|CORESOURCE [131500]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|CHAMPVA [1240]|CHAMP VA [124000]|395.00||||395.00|296.25|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|395.00||||395.00|72.01|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|395.00||||395.00|78.28|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|||395.00||||395.00|118.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|395.00||||395.00|189.4|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|395.00||||395.00|395|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|395.00||||395.00|82.95|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|395.00||||395.00|110.91|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|395.00||||395.00|77.49|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|395.00||||395.00|169.85|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|FIRST HEALTH [1375]|QUALCHOICE [137513]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|FMH BENEFIT SERVICES [1390]|FMH [139000]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MULTIPLAN [1680]|HMA [168003]|395.00||||395.00|113.95|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|GEHA [1415]|GEHA [141500]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MULTIPLAN [1680]|IHC HS [168011]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|395.00||||395.00|109.21|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|HEALTHNET [1495]|HEALTHNET [149500]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|AETNA [1015]|AETNA ACO WILCO [101532]|395.00||||395.00|27.12|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|395.00||||395.00|256.75|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|395.00||||395.00|89.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|TRUSTMARK [2030]|STARMARK [203000]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|395.00||||395.00|75.61|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|395.00||||395.00|83.56|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|UMR [2035]|UMR OPTIONS [203501]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|395.00||||395.00|78.28|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|395.00||||395.00|169.85|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|395.00||||395.00|148.92|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|395.00||||395.00|355.5|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|395.00||||395.00|83.56|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|395.00||||395.00|75.97|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|395.00||||395.00|138.65|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|395.00||||395.00|168.27|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|395.00||||395.00|197.9|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|395.00||||395.00|79.77|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|395.00||||395.00|237|395|27.12 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|395.00||||395.00||| 32073020|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER 1 VIEW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|395.00||||395.00||| 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|515.00||||515.00|81.31|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|515.00||||515.00|75.97|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|515.00||||515.00|73.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|515.00||||515.00|148.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|515.00||||515.00|221.45|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|515.00||||515.00|258.02|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|515.00||||515.00|219.39|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|515.00||||515.00|77.62|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|515.00||||515.00|309|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|515.00||||515.00|81.31|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|515.00||||515.00|73.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|515.00||||515.00|73.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|515.00||||515.00|75.97|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|515.00||||515.00|106.27|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|515.00||||515.00|73.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|515.00||||515.00|221.45|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|515.00||||515.00|75.4|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|515.00||||515.00|75.97|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|515.00||||515.00|143.26|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|515.00||||515.00|110.91|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|515.00||||515.00|73.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|515.00||||515.00|108.15|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|515.00||||515.00|110.88|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|515.00||||515.00|73.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|515.00||||515.00|121.01|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|515.00||||515.00|515|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|515.00||||515.00|125.3|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|515.00||||515.00|35.67|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|515.00||||515.00|246.94|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|515.00||||515.00|334.75|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|||515.00||||515.00|154.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|515.00||||515.00|180.77|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|515.00||||515.00|125.3|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|515.00||||515.00|75.97|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|515.00||||515.00|73.92|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|515.00||||515.00|106.27|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|GEHA [1415]|GEHA [141500]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|515.00||||515.00|130.23|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|515.00||||515.00|115.25|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|515.00||||515.00|386.25|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|515.00||||515.00|463.5|515|35.67 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|515.00||||515.00||| 32073030|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHOULDER COMPLETE 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|515.00||||515.00||| 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|||504.00||||504.00|151.2|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|GEHA [1415]|GEHA [141500]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|504.00||||504.00|109.21|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|504.00||||504.00|378|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|504.00||||504.00|81.36|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|504.00||||504.00|78.28|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|504.00||||504.00|327.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|504.00||||504.00|241.67|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|504.00||||504.00|504|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|504.00||||504.00|105.84|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|504.00||||504.00|77.49|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|504.00||||504.00|216.72|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|504.00||||504.00|113.95|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|504.00||||504.00|109.21|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|504.00||||504.00|37.5|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|504.00||||504.00|75.61|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|504.00||||504.00|110.91|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|504.00||||504.00|83.56|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|504.00||||504.00|72.01|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|504.00||||504.00|78.28|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|504.00||||504.00|79.77|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|504.00||||504.00|176.9|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|504.00||||504.00|214.7|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|504.00||||504.00|453.6|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|504.00||||504.00|83.56|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|504.00||||504.00|89.5|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|504.00||||504.00|148.92|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|504.00||||504.00|252.5|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|504.00||||504.00|75.97|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|504.00||||504.00|216.72|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|504.00||||504.00|302.4|504|37.5 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|504.00||||504.00||| 32073060|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HUMERUS 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|504.00||||504.00||| 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|396.00||||396.00|77.62|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|396.00||||396.00|83.56|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|396.00||||396.00|198.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|396.00||||396.00|139|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|396.00||||396.00|168.7|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|396.00||||396.00|237.6|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|396.00||||396.00|78.28|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|396.00||||396.00|83.56|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|396.00||||396.00|75.61|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|396.00||||396.00|113.95|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|396.00||||396.00|89.5|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|396.00||||396.00|77.49|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|396.00||||396.00|170.28|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|396.00||||396.00|110.91|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|396.00||||396.00|83.16|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|396.00||||396.00|396|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|396.00||||396.00|189.88|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|396.00||||396.00|32.61|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|396.00||||396.00|257.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|||396.00||||396.00|118.8|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|396.00||||396.00|78.28|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|396.00||||396.00|170.28|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|396.00||||396.00|72.01|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|396.00||||396.00|81.36|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|396.00||||396.00|148.92|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|GEHA [1415]|GEHA [141500]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|396.00||||396.00|109.21|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|396.00||||396.00|75.97|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|396.00||||396.00|109.21|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|396.00||||396.00|356.4|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|396.00||||396.00|297|396|32.61 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|396.00||||396.00||| 32073070|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|396.00||||396.00||| 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|447.00||||447.00|81.36|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|447.00||||447.00|335.25|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|447.00||||447.00|72.01|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|447.00||||447.00|78.28|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|||447.00||||447.00|134.1|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|447.00||||447.00|290.55|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|447.00||||447.00|214.34|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|447.00||||447.00|447|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|447.00||||447.00|93.87|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|447.00||||447.00|110.91|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|447.00||||447.00|77.49|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|447.00||||447.00|192.21|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|447.00||||447.00|89.5|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|447.00||||447.00|109.21|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|447.00||||447.00|113.95|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|447.00||||447.00|36.28|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|447.00||||447.00|75.61|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|GEHA [1415]|GEHA [141500]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|447.00||||447.00|83.56|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|447.00||||447.00|109.21|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|447.00||||447.00|78.28|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|447.00||||447.00|192.21|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|447.00||||447.00|148.92|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|447.00||||447.00|81.31|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|447.00||||447.00|75.97|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|447.00||||447.00|190.42|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|447.00||||447.00|402.3|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|447.00||||447.00|156.9|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|447.00||||447.00|223.95|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|447.00||||447.00|268.2|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|447.00||||447.00|77.62|447|36.28 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|447.00||||447.00||| 32073080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ELBOW COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|447.00||||447.00||| 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|364.00||||364.00|83.56|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|364.00||||364.00|156.52|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|364.00||||364.00|148.92|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|364.00||||364.00|182.36|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|364.00||||364.00|155.06|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|364.00||||364.00|218.4|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|364.00||||364.00|83.56|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|364.00||||364.00|73.92|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|364.00||||364.00|109.21|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|364.00||||364.00|156.52|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|364.00||||364.00|77.49|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|364.00||||364.00|89.5|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|364.00||||364.00|110.91|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|364.00||||364.00|113.95|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|364.00||||364.00|76.44|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|364.00||||364.00|75.61|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|364.00||||364.00|364|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|364.00||||364.00|78.28|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|364.00||||364.00|40.56|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|364.00||||364.00|174.54|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|364.00||||364.00|236.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|||364.00||||364.00|109.2|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|364.00||||364.00|78.28|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|364.00||||364.00|79.77|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|364.00||||364.00|127.76|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|364.00||||364.00|109.21|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|GEHA [1415]|GEHA [141500]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|364.00||||364.00|81.36|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|364.00||||364.00|273|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|364.00||||364.00|72.01|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|364.00||||364.00|75.97|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|364.00||||364.00|327.6|364|40.56 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|364.00||||364.00||| 32073100|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|364.00||||364.00||| 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|GEHA [1415]|GEHA [141500]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|481.00||||481.00|81.36|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|481.00||||481.00|360.75|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|481.00||||481.00|72.01|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|481.00||||481.00|73.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|481.00||||481.00|73.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|481.00||||481.00|78.28|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|481.00||||481.00|312.65|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|481.00||||481.00|230.64|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|481.00||||481.00|481|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|481.00||||481.00|73.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|481.00||||481.00|101.01|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|481.00||||481.00|77.49|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|481.00||||481.00|206.83|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|481.00||||481.00|73.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|481.00||||481.00|106.27|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|481.00||||481.00|110.88|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|481.00||||481.00|73.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|481.00||||481.00|73.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|481.00||||481.00|47.89|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|481.00||||481.00|73.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|481.00||||481.00|89.5|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|||481.00||||481.00|144.3|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|481.00||||481.00|75.97|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|481.00||||481.00|75.61|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|481.00||||481.00|110.91|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|481.00||||481.00|75.97|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|481.00||||481.00|81.31|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|481.00||||481.00|78.28|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|481.00||||481.00|288.6|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|481.00||||481.00|77.62|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|481.00||||481.00|109.21|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|481.00||||481.00|204.91|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|481.00||||481.00|81.31|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|481.00||||481.00|75.97|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|481.00||||481.00|75.97|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|481.00||||481.00|148.92|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|481.00||||481.00|168.83|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|481.00||||481.00|240.98|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|481.00||||481.00|206.83|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|481.00||||481.00|432.9|481|47.89 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|481.00||||481.00||| 32073110|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC WRIST COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|481.00||||481.00||| 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|375.00||||375.00|117.36|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|375.00||||375.00|161.25|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|375.00||||375.00|159.75|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|375.00||||375.00|112.03|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|375.00||||375.00|225|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|375.00||||375.00|125.3|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|375.00||||375.00|121.01|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|375.00||||375.00|35.67|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|375.00||||375.00|153.38|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|375.00||||375.00|160.04|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|375.00||||375.00|143.26|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|375.00||||375.00|108.82|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|375.00||||375.00|161.25|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|375.00||||375.00|155.77|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|375.00||||375.00|78.75|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|375.00||||375.00|375|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|375.00||||375.00|117.36|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|375.00||||375.00|179.81|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|375.00||||375.00|243.75|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|||375.00||||375.00|112.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|375.00||||375.00|125.3|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|375.00||||375.00|106.69|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|375.00||||375.00|115.25|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|375.00||||375.00|131.63|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|375.00||||375.00|268.93|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|375.00||||375.00|187.88|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|375.00||||375.00|153.38|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|375.00||||375.00|130.23|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|375.00||||375.00|281.25|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|GEHA [1415]|GEHA [141500]|375.00||||375.00|337.5|375|35.67 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|375.00||||375.00||| 32073120|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|375.00||||375.00||| 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|445.00||||445.00|81.36|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|445.00||||445.00|333.75|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|445.00||||445.00|72.01|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|445.00||||445.00|78.28|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|||445.00||||445.00|133.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|445.00||||445.00|213.38|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|445.00||||445.00|445|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|445.00||||445.00|93.45|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|445.00||||445.00|110.91|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|445.00||||445.00|75.97|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|445.00||||445.00|77.49|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|445.00||||445.00|89.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|445.00||||445.00|191.35|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|445.00||||445.00|113.95|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|445.00||||445.00|106.27|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|445.00||||445.00|42.4|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|445.00||||445.00|289.25|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|445.00||||445.00|75.61|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|445.00||||445.00|75.97|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|445.00||||445.00|81.31|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|GEHA [1415]|GEHA [141500]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|445.00||||445.00|106.27|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|445.00||||445.00|78.28|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|445.00||||445.00|222.95|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|445.00||||445.00|189.57|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|445.00||||445.00|73.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|445.00||||445.00|148.92|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|445.00||||445.00|81.31|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|445.00||||445.00|400.5|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|445.00||||445.00|75.97|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|445.00||||445.00|156.2|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|445.00||||445.00|191.35|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|445.00||||445.00|77.62|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|445.00||||445.00|267|445|42.4 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|445.00||||445.00||| 32073130|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HAND 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|445.00||||445.00||| 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|353.00||||353.00|83.56|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|353.00||||353.00|83.56|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|353.00||||353.00|148.92|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|353.00||||353.00|151.79|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|353.00||||353.00|150.38|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|353.00||||353.00|79.77|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|353.00||||353.00|211.8|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|353.00||||353.00|75.61|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|353.00||||353.00|109.21|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|353.00||||353.00|151.79|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|353.00||||353.00|77.49|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|353.00||||353.00|89.5|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|353.00||||353.00|110.91|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|353.00||||353.00|74.13|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|353.00||||353.00|113.95|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|353.00||||353.00|353|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|353.00||||353.00|169.26|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|353.00||||353.00|229.45|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|353.00||||353.00|78.28|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|353.00||||353.00|176.85|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|||353.00||||353.00|105.9|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|353.00||||353.00|123.9|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|353.00||||353.00|78.28|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|353.00||||353.00|109.21|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|GEHA [1415]|GEHA [141500]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|353.00||||353.00|46.05|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|353.00||||353.00|81.36|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|353.00||||353.00|72.01|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|353.00||||353.00|264.75|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|353.00||||353.00|317.7|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|353.00||||353.00|75.97|353|46.05 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|353.00||||353.00||| 32073140|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FINGER(S) 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|353.00||||353.00||| 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|452.00||||452.00|80.21|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|452.00||||452.00|293.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|452.00||||452.00|216.73|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|452.00||||452.00|452|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|452.00||||452.00|94.92|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|452.00||||452.00|110.91|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|452.00||||452.00|77.49|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|452.00||||452.00|194.36|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|FIRST HEALTH [1375]|QUALCHOICE [137513]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|FMH BENEFIT SERVICES [1390]|FMH [139000]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MULTIPLAN [1680]|IHC HS [168011]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|452.00||||452.00|91.7|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|HEALTHNET [1495]|HEALTHNET [149500]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|AETNA [1015]|AETNA ACO WILCO [101532]|452.00||||452.00|36.89|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|UMR [2035]|UMR OPTIONS [203501]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|TRUSTMARK [2030]|STARMARK [203000]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|452.00||||452.00|109.21|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MULTIPLAN [1680]|HMA [168003]|452.00||||452.00|113.95|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|452.00||||452.00|77.47|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|452.00||||452.00|83.56|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|||452.00||||452.00|135.6|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|452.00||||452.00|80.21|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|452.00||||452.00|79.77|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|452.00||||452.00|192.55|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|452.00||||452.00|73.78|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|452.00||||452.00|83.56|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|452.00||||452.00|148.92|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|452.00||||452.00|158.65|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|452.00||||452.00|226.45|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|452.00||||452.00|75.97|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|452.00||||452.00|194.36|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|452.00||||452.00|271.2|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|GEHA [1415]|GEHA [141500]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|CORESOURCE [1315]|CORESOURCE [131500]|452.00||||452.00|406.8|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|452.00||||452.00|83.37|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|452.00||||452.00|109.21|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|CHAMPVA [1240]|CHAMP VA [124000]|452.00||||452.00|339|452|36.89 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|452.00||||452.00||| 32073501|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT LTD 1 VIEW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|452.00||||452.00||| 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|496.00||||496.00|83.56|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|496.00||||496.00|148.92|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|496.00||||496.00|213.28|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|496.00||||496.00|248.5|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|496.00||||496.00|174.1|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|496.00||||496.00|211.3|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|496.00||||496.00|297.6|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|496.00||||496.00|80.21|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|496.00||||496.00|73.92|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|496.00||||496.00|77.47|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|496.00||||496.00|54.62|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|496.00||||496.00|109.21|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MULTIPLAN [1680]|HMA [168003]|496.00||||496.00|113.95|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|496.00||||496.00|213.28|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|496.00||||496.00|91.7|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|496.00||||496.00|77.49|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|496.00||||496.00|110.91|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|496.00||||496.00|83.56|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|496.00||||496.00|104.16|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|496.00||||496.00|496|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|496.00||||496.00|79.77|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|496.00||||496.00|237.83|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|496.00||||496.00|322.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|||496.00||||496.00|148.8|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|496.00||||496.00|80.21|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|496.00||||496.00|75.97|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|496.00||||496.00|73.78|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|496.00||||496.00|372|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|496.00||||496.00|109.21|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|496.00||||496.00|83.37|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|GEHA [1415]|GEHA [141500]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|496.00||||496.00|446.4|496|54.62 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|496.00||||496.00||| 32073502|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIP UNILAT 2-3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|496.00||||496.00||| 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|GEHA [1415]|GEHA [141500]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|526.00||||526.00|138.07|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|526.00||||526.00|394.5|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|526.00||||526.00|122.19|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|526.00||||526.00|132.84|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|||526.00||||526.00|157.8|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|526.00||||526.00|252.22|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|526.00||||526.00|526|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|526.00||||526.00|110.46|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|526.00||||526.00|155.77|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|526.00||||526.00|108.82|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|526.00||||526.00|151.87|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|526.00||||526.00|226.18|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|526.00||||526.00|153.38|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|526.00||||526.00|160.04|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|526.00||||526.00|341.9|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|526.00||||526.00|46.68|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|526.00||||526.00|128.3|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|526.00||||526.00|153.38|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|526.00||||526.00|117.36|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|526.00||||526.00|132.84|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|526.00||||526.00|315.6|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|526.00||||526.00|112.03|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|526.00||||526.00|226.18|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|526.00||||526.00|263.53|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|526.00||||526.00|184.63|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|526.00||||526.00|224.08|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|526.00||||526.00|268.93|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|526.00||||526.00|106.69|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|526.00||||526.00|473.4|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|526.00||||526.00|117.36|526|46.68 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|526.00||||526.00||| 32073521|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|526.00||||526.00||| 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|725.00||||725.00|117.36|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|725.00||||725.00|363.23|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|725.00||||725.00|254.48|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|725.00||||725.00|308.85|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|725.00||||725.00|112.03|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|725.00||||725.00|435|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|725.00||||725.00|132.84|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|725.00||||725.00|117.36|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|725.00||||725.00|60.12|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MULTIPLAN [1680]|HMA [168003]|725.00||||725.00|160.04|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|725.00||||725.00|153.38|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|725.00||||725.00|311.75|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|725.00||||725.00|151.87|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|725.00||||725.00|108.82|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|UMR [2035]|UMR OPTIONS [203501]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|725.00||||725.00|155.77|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|725.00||||725.00|152.25|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|725.00||||725.00|128.3|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|725.00||||725.00|725|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|725.00||||725.00|347.64|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|725.00||||725.00|471.25|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|725.00||||725.00|311.75|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|||725.00||||725.00|217.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|725.00||||725.00|132.84|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|725.00||||725.00|268.93|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|725.00||||725.00|106.69|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|725.00||||725.00|122.19|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|725.00||||725.00|543.75|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|725.00||||725.00|153.38|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|725.00||||725.00|138.07|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|GEHA [1415]|GEHA [141500]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|725.00||||725.00|652.5|725|60.12 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|725.00||||725.00||| 32073522|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HIPS BILAT 3-4 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|725.00||||725.00||| 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|GEHA [1415]|GEHA [141500]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|516.00||||516.00|83.37|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|516.00||||516.00|109.21|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|516.00||||516.00|387|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|516.00||||516.00|80.21|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|||516.00||||516.00|154.8|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|516.00||||516.00|335.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|516.00||||516.00|247.42|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|516.00||||516.00|516|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|516.00||||516.00|108.36|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|516.00||||516.00|110.91|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|516.00||||516.00|77.49|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|516.00||||516.00|91.7|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|516.00||||516.00|221.88|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|516.00||||516.00|109.21|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|516.00||||516.00|113.95|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|516.00||||516.00|41.77|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|516.00||||516.00|73.78|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|516.00||||516.00|77.47|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|516.00||||516.00|83.56|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|516.00||||516.00|80.21|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|516.00||||516.00|309.6|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|516.00||||516.00|79.77|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|516.00||||516.00|221.88|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|516.00||||516.00|258.52|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|516.00||||516.00|181.12|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|516.00||||516.00|219.82|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|516.00||||516.00|148.92|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|516.00||||516.00|75.97|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|516.00||||516.00|464.4|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|516.00||||516.00|83.56|516|41.77 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|516.00||||516.00||| 32073552|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FEMUR 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|516.00||||516.00||| 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|446.00||||446.00|81.31|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|446.00||||446.00|148.92|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|446.00||||446.00|223.45|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|446.00||||446.00|156.55|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|446.00||||446.00|190|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|446.00||||446.00|267.6|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|446.00||||446.00|78.28|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|446.00||||446.00|75.61|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|446.00||||446.00|41.17|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|446.00||||446.00|109.21|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|446.00||||446.00|113.95|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|446.00||||446.00|191.78|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|446.00||||446.00|89.5|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|446.00||||446.00|77.49|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|446.00||||446.00|110.91|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|446.00||||446.00|83.56|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|446.00||||446.00|93.66|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|446.00||||446.00|446|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|446.00||||446.00|77.62|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|446.00||||446.00|213.86|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|446.00||||446.00|289.9|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|||446.00||||446.00|133.8|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|446.00||||446.00|191.78|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|446.00||||446.00|78.28|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|446.00||||446.00|73.92|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|446.00||||446.00|75.97|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|446.00||||446.00|72.01|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|446.00||||446.00|334.5|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|446.00||||446.00|109.21|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|446.00||||446.00|81.36|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|GEHA [1415]|GEHA [141500]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|446.00||||446.00|401.4|446|41.17 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|446.00||||446.00||| 32073560|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 1 OR 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|446.00||||446.00||| 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|GEHA [1415]|GEHA [141500]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|500.00||||500.00|130.23|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|500.00||||500.00|109.21|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|500.00||||500.00|375|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|500.00||||500.00|115.25|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|500.00||||500.00|73.92|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|500.00||||500.00|125.3|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|||500.00||||500.00|150|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|500.00||||500.00|239.75|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|500.00||||500.00|500|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|500.00||||500.00|73.92|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|500.00||||500.00|105|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|500.00||||500.00|110.91|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|UMR [2035]|UMR OPTIONS [203501]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|500.00||||500.00|75.97|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|500.00||||500.00|75.4|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|500.00||||500.00|143.26|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|500.00||||500.00|215|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|500.00||||500.00|73.92|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|500.00||||500.00|73.92|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|500.00||||500.00|106.27|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MULTIPLAN [1680]|HMA [168003]|500.00||||500.00|110.88|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|500.00||||500.00|75.97|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|500.00||||500.00|73.92|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|500.00||||500.00|325|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|500.00||||500.00|47.89|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|500.00||||500.00|75.97|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|500.00||||500.00|121.01|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|500.00||||500.00|75.97|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|500.00||||500.00|81.31|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|500.00||||500.00|125.3|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|500.00||||500.00|300|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|500.00||||500.00|79.77|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|500.00||||500.00|215|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|500.00||||500.00|250.5|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|500.00||||500.00|175.5|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|500.00||||500.00|213|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|500.00||||500.00|73.92|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|500.00||||500.00|148.92|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|500.00||||500.00|75.97|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|500.00||||500.00|450|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|500.00||||500.00|81.31|500|47.89 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|500.00||||500.00||| 32073562|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE 3 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|500.00||||500.00||| 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|710.00||||710.00|114.2|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|710.00||||710.00|305.3|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|710.00||||710.00|302.46|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|710.00||||710.00|355.71|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|710.00||||710.00|249.21|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|710.00||||710.00|112.03|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|710.00||||710.00|426|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|710.00||||710.00|117.36|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|710.00||||710.00|52.17|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MULTIPLAN [1680]|HMA [168003]|710.00||||710.00|160.04|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|710.00||||710.00|153.38|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|710.00||||710.00|305.3|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|710.00||||710.00|143.26|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|710.00||||710.00|108.82|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|710.00||||710.00|121.01|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|710.00||||710.00|155.77|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|710.00||||710.00|149.1|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|710.00||||710.00|125.3|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|710.00||||710.00|710|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|710.00||||710.00|340.45|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|710.00||||710.00|461.5|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|||710.00||||710.00|213|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|710.00||||710.00|268.93|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|710.00||||710.00|125.3|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|710.00||||710.00|106.69|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|710.00||||710.00|115.25|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|710.00||||710.00|532.5|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|710.00||||710.00|153.38|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|710.00||||710.00|130.23|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|GEHA [1415]|GEHA [141500]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|710.00||||710.00|639|710|52.17 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|710.00||||710.00||| 32073564|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEE COMPLETE 4+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|710.00||||710.00||| 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|GEHA [1415]|GEHA [141500]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|460.00||||460.00|81.36|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|460.00||||460.00|109.21|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|CHAMPVA [1240]|CHAMP VA [124000]|460.00||||460.00|345|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|460.00||||460.00|78.28|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|460.00||||460.00|299|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|460.00||||460.00|220.57|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|460.00||||460.00|460|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|460.00||||460.00|96.6|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|460.00||||460.00|110.91|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|UMR [2035]|UMR OPTIONS [203501]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|460.00||||460.00|77.49|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|460.00||||460.00|89.5|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|460.00||||460.00|197.8|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MULTIPLAN [1680]|IHC HS [168011]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|460.00||||460.00|109.21|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MULTIPLAN [1680]|HMA [168003]|460.00||||460.00|113.95|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|HEALTHNET [1495]|HEALTHNET [149500]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|AETNA [1015]|AETNA ACO WILCO [101532]|460.00||||460.00|49.11|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|||460.00||||460.00|138|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|TRUSTMARK [2030]|STARMARK [203000]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|460.00||||460.00|72.01|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|460.00||||460.00|75.61|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|460.00||||460.00|83.56|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|CORESOURCE [1315]|CORESOURCE [131500]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|460.00||||460.00|78.28|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|460.00||||460.00|276|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|460.00||||460.00|79.77|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|460.00||||460.00|197.8|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|460.00||||460.00|161.46|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|460.00||||460.00|230.46|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|460.00||||460.00|195.96|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|460.00||||460.00|148.92|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|460.00||||460.00|75.97|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|460.00||||460.00|414|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|460.00||||460.00|83.56|460|49.11 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|460.00||||460.00||| 32073565|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC KNEES BOTH STANDING ANTEROPOSTERIOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|460.00||||460.00||| 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|451.00||||451.00|83.56|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|451.00||||451.00|148.92|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|451.00||||451.00|225.95|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|451.00||||451.00|193.93|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|451.00||||451.00|192.13|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|451.00||||451.00|270.6|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|451.00||||451.00|78.28|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|451.00||||451.00|83.56|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|451.00||||451.00|75.61|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|451.00||||451.00|73.92|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|451.00||||451.00|109.21|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|451.00||||451.00|113.95|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|451.00||||451.00|193.93|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|451.00||||451.00|89.5|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|451.00||||451.00|77.49|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|451.00||||451.00|36.89|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|451.00||||451.00|110.91|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|451.00||||451.00|94.71|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|451.00||||451.00|451|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|451.00||||451.00|79.77|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|451.00||||451.00|216.25|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|451.00||||451.00|293.15|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|||451.00||||451.00|135.3|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|451.00||||451.00|158.3|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|451.00||||451.00|78.28|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|451.00||||451.00|75.97|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|451.00||||451.00|72.01|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|451.00||||451.00|338.25|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|451.00||||451.00|109.21|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|451.00||||451.00|81.36|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|GEHA [1415]|GEHA [141500]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|451.00||||451.00|405.9|451|36.89 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|451.00||||451.00||| 32073590|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TIBIA & FIBULA 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|451.00||||451.00||| 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|GEHA [1415]|GEHA [141500]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|459.00||||459.00|130.23|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|459.00||||459.00|344.25|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|459.00||||459.00|115.25|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|459.00||||459.00|125.3|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|||459.00||||459.00|137.7|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|459.00||||459.00|298.35|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|459.00||||459.00|220.09|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|459.00||||459.00|459|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|459.00||||459.00|96.39|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|459.00||||459.00|110.91|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|459.00||||459.00|77.49|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|459.00||||459.00|143.26|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|459.00||||459.00|197.37|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|459.00||||459.00|109.21|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|459.00||||459.00|113.95|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|459.00||||459.00|38.73|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|459.00||||459.00|109.21|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|459.00||||459.00|121.01|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|459.00||||459.00|83.56|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|459.00||||459.00|125.3|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|459.00||||459.00|275.4|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|459.00||||459.00|79.77|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|459.00||||459.00|161.11|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|459.00||||459.00|197.37|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|459.00||||459.00|229.96|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|459.00||||459.00|195.53|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|459.00||||459.00|148.92|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|459.00||||459.00|75.97|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|459.00||||459.00|413.1|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|459.00||||459.00|83.56|459|38.73 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|459.00||||459.00||| 32073600|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|459.00||||459.00||| 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|492.00||||492.00|81.31|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|492.00||||492.00|148.92|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|492.00||||492.00|246.49|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|492.00||||492.00|172.69|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|492.00||||492.00|209.59|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|492.00||||492.00|77.62|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|492.00||||492.00|295.2|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|492.00||||492.00|83.56|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|492.00||||492.00|121.01|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|492.00||||492.00|42.4|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|492.00||||492.00|109.21|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|492.00||||492.00|113.95|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|492.00||||492.00|211.56|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|492.00||||492.00|143.26|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|492.00||||492.00|77.49|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|492.00||||492.00|110.91|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|492.00||||492.00|103.32|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|492.00||||492.00|125.3|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|492.00||||492.00|492|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|492.00||||492.00|211.56|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|492.00||||492.00|235.91|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|492.00||||492.00|319.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|||492.00||||492.00|147.6|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|492.00||||492.00|125.3|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|492.00||||492.00|75.97|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|492.00||||492.00|115.25|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|492.00||||492.00|369|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|492.00||||492.00|109.21|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|492.00||||492.00|130.23|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|GEHA [1415]|GEHA [141500]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|492.00||||492.00|442.8|492|42.4 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|492.00||||492.00||| 32073610|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ANKLE COMPLETE 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|492.00||||492.00||| 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|GEHA [1415]|GEHA [141500]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|445.00||||445.00|81.36|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|445.00||||445.00|109.21|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|445.00||||445.00|333.75|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|445.00||||445.00|72.01|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|445.00||||445.00|78.28|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|445.00||||445.00|289.25|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|445.00||||445.00|213.38|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|445.00||||445.00|445|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|445.00||||445.00|93.45|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|445.00||||445.00|110.91|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|445.00||||445.00|77.49|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|445.00||||445.00|89.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|445.00||||445.00|191.35|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|445.00||||445.00|109.21|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|445.00||||445.00|113.95|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|||445.00||||445.00|133.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|445.00||||445.00|33.22|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|445.00||||445.00|75.61|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|445.00||||445.00|83.56|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|445.00||||445.00|78.28|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|445.00||||445.00|267|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|445.00||||445.00|79.77|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|445.00||||445.00|156.2|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|445.00||||445.00|191.35|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|445.00||||445.00|222.95|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|445.00||||445.00|189.57|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|445.00||||445.00|148.92|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|445.00||||445.00|75.97|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|445.00||||445.00|400.5|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|445.00||||445.00|83.56|445|33.22 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|445.00||||445.00||| 32073620|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|445.00||||445.00||| 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|616.00||||616.00|81.31|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|616.00||||616.00|75.97|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|616.00||||616.00|148.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|616.00||||616.00|308.62|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|616.00||||616.00|264.88|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|616.00||||616.00|262.42|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|616.00||||616.00|77.62|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|616.00||||616.00|369.6|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|616.00||||616.00|78.28|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|616.00||||616.00|75.61|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|616.00||||616.00|39.34|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|616.00||||616.00|106.27|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|616.00||||616.00|110.88|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|616.00||||616.00|264.88|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|616.00||||616.00|89.5|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|616.00||||616.00|77.49|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|616.00||||616.00|75.97|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|616.00||||616.00|107.93|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|616.00||||616.00|81.31|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|616.00||||616.00|129.36|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|616.00||||616.00|616|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|616.00||||616.00|295.37|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|616.00||||616.00|400.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|||616.00||||616.00|184.8|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|616.00||||616.00|216.22|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|616.00||||616.00|78.28|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|616.00||||616.00|73.92|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|616.00||||616.00|72.01|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|616.00||||616.00|462|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|616.00||||616.00|109.21|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|616.00||||616.00|81.36|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|GEHA [1415]|GEHA [141500]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|616.00||||616.00|554.4|616|39.34 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|616.00||||616.00||| 32073630|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOOT COMPLETE 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|616.00||||616.00||| 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|GEHA [1415]|GEHA [141500]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|391.00||||391.00|81.36|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|391.00||||391.00|293.25|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|391.00||||391.00|72.01|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|391.00||||391.00|78.28|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|||391.00||||391.00|117.3|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.00||||391.00|187.48|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|391.00||||391.00|391|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|391.00||||391.00|82.11|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|391.00||||391.00|110.91|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|391.00||||391.00|77.49|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|391.00||||391.00|89.5|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|391.00||||391.00|168.13|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|391.00||||391.00|109.21|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|391.00||||391.00|113.95|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|391.00||||391.00|32.61|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|391.00||||391.00|254.15|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|391.00||||391.00|109.21|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|391.00||||391.00|75.61|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|391.00||||391.00|83.56|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|391.00||||391.00|78.28|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|391.00||||391.00|234.6|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391.00||||391.00|79.77|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|391.00||||391.00|137.24|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|391.00||||391.00|195.89|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|391.00||||391.00|168.13|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|391.00||||391.00|166.57|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|391.00||||391.00|148.92|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.00||||391.00|75.97|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|391.00||||391.00|351.9|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|391.00||||391.00|83.56|391|32.61 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|391.00||||391.00||| 32073650|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CALCANEUS 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|391.00||||391.00||| 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|324.00||||324.00|81.31|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|324.00||||324.00|113.72|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|324.00||||324.00|162.32|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|324.00||||324.00|138.02|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|324.00||||324.00|77.62|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|324.00||||324.00|194.4|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|324.00||||324.00|81.31|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|324.00||||324.00|75.61|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MULTIPLAN [1680]|HMA [168003]|324.00||||324.00|110.88|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|324.00||||324.00|106.27|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|324.00||||324.00|139.32|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|324.00||||324.00|89.5|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|324.00||||324.00|38.11|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|324.00||||324.00|75.4|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|324.00||||324.00|107.93|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|324.00||||324.00|68.04|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|324.00||||324.00|324|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|324.00||||324.00|155.36|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|324.00||||324.00|210.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|324.00||||324.00|78.28|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|324.00||||324.00|139.32|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|||324.00||||324.00|97.2|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|324.00||||324.00|148.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|324.00||||324.00|78.28|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|324.00||||324.00|73.92|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|324.00||||324.00|72.01|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|324.00||||324.00|243|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|324.00||||324.00|106.27|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|324.00||||324.00|81.36|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|GEHA [1415]|GEHA [141500]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|324.00||||324.00|291.6|324|38.11 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|324.00||||324.00||| 32073660|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TOE(S) 2+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|324.00||||324.00||| 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|436.00||||436.00|85.17|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|GEHA [1415]|GEHA [141500]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|CORESOURCE [1315]|CORESOURCE [131500]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|436.00||||436.00|109.21|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|CHAMPVA [1240]|CHAMP VA [124000]|436.00||||436.00|327|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|436.00||||436.00|75.97|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|436.00||||436.00|81.94|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|436.00||||436.00|209.06|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|436.00||||436.00|283.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|436.00||||436.00|436|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|436.00||||436.00|91.56|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|436.00||||436.00|110.91|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|436.00||||436.00|75.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|436.00||||436.00|93.68|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|436.00||||436.00|187.48|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|FIRST HEALTH [1375]|QUALCHOICE [137513]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|UMR [2035]|UMR OPTIONS [203501]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|FMH BENEFIT SERVICES [1390]|FMH [139000]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MULTIPLAN [1680]|IHC HS [168011]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|436.00||||436.00|106.27|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MULTIPLAN [1680]|HMA [168003]|436.00||||436.00|110.88|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|HEALTHNET [1495]|HEALTHNET [149500]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|AETNA [1015]|AETNA ACO WILCO [101532]|436.00||||436.00|33.22|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|||436.00||||436.00|130.8|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|TRUSTMARK [2030]|STARMARK [203000]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|436.00||||436.00|75.97|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|436.00||||436.00|79.14|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|436.00||||436.00|81.31|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|436.00||||436.00|81.94|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|436.00||||436.00|187.48|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|436.00||||436.00|218.44|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|436.00||||436.00|153.04|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|436.00||||436.00|185.74|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|436.00||||436.00|261.6|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|436.00||||436.00|79.77|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|436.00||||436.00|73.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|436.00||||436.00|148.92|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|436.00||||436.00|75.97|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|436.00||||436.00|81.31|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|436.00||||436.00|392.4|436|33.22 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|436.00||||436.00||| 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|436.00||||436.00||| 32074018|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 1 VIEW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|436.00||||436.00||| 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|479.00||||479.00|268.93|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|479.00||||479.00|112.03|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|479.00||||479.00|287.4|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|479.00||||479.00|205.97|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|479.00||||479.00|239.98|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|479.00||||479.00|204.05|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|479.00||||479.00|156.65|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|479.00||||479.00|151.3|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|479.00||||479.00|103.82|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|479.00||||479.00|39.95|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|479.00||||479.00|153.38|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|479.00||||479.00|160.04|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|479.00||||479.00|205.97|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|479.00||||479.00|179.11|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|479.00||||479.00|108.82|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|479.00||||479.00|155.77|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|479.00||||479.00|117.36|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|479.00||||479.00|100.59|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|479.00||||479.00|479|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|479.00||||479.00|168.13|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|479.00||||479.00|311.35|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|479.00||||479.00|229.68|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|||479.00||||479.00|143.7|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|479.00||||479.00|156.65|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|479.00||||479.00|117.36|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|479.00||||479.00|106.69|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|479.00||||479.00|359.25|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|479.00||||479.00|153.38|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|GEHA [1415]|GEHA [141500]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|479.00||||479.00|431.1|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|479.00||||479.00|162.82|479|39.95 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|479.00||||479.00||| 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|479.00||||479.00||| 32074019|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|479.00||||479.00||| 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|GEHA [1415]|GEHA [141500]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|CORESOURCE [1315]|CORESOURCE [131500]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|908.00||||908.00|130.23|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|CHAMPVA [1240]|CHAMP VA [124000]|908.00||||908.00|681|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|908.00||||908.00|115.25|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|908.00||||908.00|125.3|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|||908.00||||908.00|272.4|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|908.00||||908.00|435.39|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|908.00||||908.00|908|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|908.00||||908.00|190.68|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|908.00||||908.00|155.77|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|UMR [2035]|UMR OPTIONS [203501]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|908.00||||908.00|105.9|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|908.00||||908.00|143.26|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|908.00||||908.00|390.44|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|FIRST HEALTH [1375]|QUALCHOICE [137513]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|FMH BENEFIT SERVICES [1390]|FMH [139000]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MULTIPLAN [1680]|IHC HS [168011]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|908.00||||908.00|149.25|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MULTIPLAN [1680]|HMA [168003]|908.00||||908.00|155.73|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|HEALTHNET [1495]|HEALTHNET [149500]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|AETNA [1015]|AETNA ACO WILCO [101532]|908.00||||908.00|52.17|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|908.00||||908.00|590.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|TRUSTMARK [2030]|STARMARK [203000]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|908.00||||908.00|149.25|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|908.00||||908.00|121.01|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|908.00||||908.00|114.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|908.00||||908.00|125.3|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|908.00||||908.00|544.8|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|908.00||||908.00|109.01|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|908.00||||908.00|318.71|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|908.00||||908.00|390.44|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|908.00||||908.00|454.91|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|908.00||||908.00|386.81|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|908.00||||908.00|103.82|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|908.00||||908.00|268.93|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|908.00||||908.00|106.69|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|908.00||||908.00|817.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|908.00||||908.00|114.2|908|52.17 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|908.00||||908.00||| 32074022|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABDOMEN AP/DECUB/ERECT/CHEST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|908.00||||908.00||| 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1285.00||||1285.00|190.8|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1285.00||||1285.00|451.04|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1285.00||||1285.00|552.55|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1285.00||||1285.00|547.41|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1285.00||||1285.00|182.12|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1285.00||||1285.00|771|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1285.00||||1285.00|115.48|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1285.00||||1285.00|190.8|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1285.00||||1285.00|111.53|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|TRUSTMARK [2030]|STARMARK [203000]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|AETNA [1015]|AETNA ACO WILCO [101532]|1285.00||||1285.00|108.4|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|HEALTHNET [1495]|HEALTHNET [149500]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MULTIPLAN [1680]|IHC HS [168011]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1285.00||||1285.00|249.35|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MULTIPLAN [1680]|HMA [168003]|1285.00||||1285.00|260.18|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1285.00||||1285.00|552.55|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1285.00||||1285.00|132.03|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1285.00||||1285.00|176.92|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|UMR [2035]|UMR OPTIONS [203501]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1285.00||||1285.00|253.24|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1285.00||||1285.00|269.85|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1285.00||||1285.00|1285|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1285.00||||1285.00|616.16|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1285.00||||1285.00|835.25|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1285.00||||1285.00|643.79|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|||1285.00||||1285.00|385.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1285.00||||1285.00|115.48|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1285.00||||1285.00|482.2|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1285.00||||1285.00|173.45|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1285.00||||1285.00|106.22|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|CHAMPVA [1240]|CHAMP VA [124000]|1285.00||||1285.00|963.75|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1285.00||||1285.00|249.35|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1285.00||||1285.00|120.03|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|CORESOURCE [1315]|CORESOURCE [131500]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|GEHA [1415]|GEHA [141500]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1285.00||||1285.00|1156.5|1285|106.22 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1285.00||||1285.00||| 32074220|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ESOPHAGUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1285.00||||1285.00||| 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|GEHA [1415]|GEHA [141500]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1415.00||||1415.00|120.03|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1415.00||||1415.00|249.35|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|CHAMPVA [1240]|CHAMP VA [124000]|1415.00||||1415.00|1061.25|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1415.00||||1415.00|115.48|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|||1415.00||||1415.00|424.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1415.00||||1415.00|919.75|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1415.00||||1415.00|678.49|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1415.00||||1415.00|1415|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1415.00||||1415.00|297.15|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1415.00||||1415.00|253.24|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1415.00||||1415.00|176.92|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1415.00||||1415.00|132.03|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1415.00||||1415.00|608.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|FIRST HEALTH [1375]|QUALCHOICE [137513]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|UMR [2035]|UMR OPTIONS [203501]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|FMH BENEFIT SERVICES [1390]|FMH [139000]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MULTIPLAN [1680]|IHC HS [168011]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1415.00||||1415.00|249.35|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MULTIPLAN [1680]|HMA [168003]|1415.00||||1415.00|260.18|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|HEALTHNET [1495]|HEALTHNET [149500]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|AETNA [1015]|AETNA ACO WILCO [101532]|1415.00||||1415.00|173.19|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|TRUSTMARK [2030]|STARMARK [203000]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1415.00||||1415.00|106.22|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1415.00||||1415.00|111.53|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1415.00||||1415.00|190.8|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|CORESOURCE [1315]|CORESOURCE [131500]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1415.00||||1415.00|115.48|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1415.00||||1415.00|849|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1415.00||||1415.00|182.12|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1415.00||||1415.00|496.67|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1415.00||||1415.00|708.92|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1415.00||||1415.00|602.79|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1415.00||||1415.00|608.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1415.00||||1415.00|268.93|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1415.00||||1415.00|173.45|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1415.00||||1415.00|1273.5|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1415.00||||1415.00|190.8|1415|106.22 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1415.00||||1415.00||| 32074230|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SWALLOW FUNC W/CINE/VID MODIF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1415.00||||1415.00||| 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1333.00||||1333.00|190.8|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1333.00||||1333.00|482.2|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1333.00||||1333.00|467.88|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1333.00||||1333.00|573.19|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1333.00||||1333.00|567.86|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1333.00||||1333.00|799.8|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1333.00||||1333.00|115.48|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1333.00||||1333.00|111.53|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|TRUSTMARK [2030]|STARMARK [203000]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|AETNA [1015]|AETNA ACO WILCO [101532]|1333.00||||1333.00|150.58|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|HEALTHNET [1495]|HEALTHNET [149500]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MULTIPLAN [1680]|IHC HS [168011]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MULTIPLAN [1680]|HMA [168003]|1333.00||||1333.00|260.18|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1333.00||||1333.00|249.35|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|FMH BENEFIT SERVICES [1390]|FMH [139000]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|FIRST HEALTH [1375]|QUALCHOICE [137513]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1333.00||||1333.00|573.19|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1333.00||||1333.00|132.03|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1333.00||||1333.00|176.92|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|UMR [2035]|UMR OPTIONS [203501]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1333.00||||1333.00|253.24|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1333.00||||1333.00|190.8|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1333.00||||1333.00|279.93|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1333.00||||1333.00|1333|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1333.00||||1333.00|182.12|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1333.00||||1333.00|639.17|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1333.00||||1333.00|866.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|||1333.00||||1333.00|399.9|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1333.00||||1333.00|667.83|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1333.00||||1333.00|115.48|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1333.00||||1333.00|173.45|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1333.00||||1333.00|106.22|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|CHAMPVA [1240]|CHAMP VA [124000]|1333.00||||1333.00|999.75|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1333.00||||1333.00|249.35|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1333.00||||1333.00|120.03|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|CORESOURCE [1315]|CORESOURCE [131500]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|GEHA [1415]|GEHA [141500]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1333.00||||1333.00|1199.7|1333|106.22 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1333.00||||1333.00||| 32074240|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/O KUB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1333.00||||1333.00||| 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|GEHA [1415]|GEHA [141500]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|CORESOURCE [1315]|CORESOURCE [131500]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1385.00||||1385.00|120.03|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1385.00||||1385.00|249.35|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|CHAMPVA [1240]|CHAMP VA [124000]|1385.00||||1385.00|1038.75|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1385.00||||1385.00|106.22|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1385.00||||1385.00|115.48|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|||1385.00||||1385.00|415.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1385.00||||1385.00|900.25|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1385.00||||1385.00|1385|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1385.00||||1385.00|290.85|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1385.00||||1385.00|253.24|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|UMR [2035]|UMR OPTIONS [203501]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1385.00||||1385.00|176.92|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1385.00||||1385.00|132.03|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1385.00||||1385.00|595.55|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|FIRST HEALTH [1375]|QUALCHOICE [137513]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|FMH BENEFIT SERVICES [1390]|FMH [139000]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MULTIPLAN [1680]|IHC HS [168011]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1385.00||||1385.00|249.35|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MULTIPLAN [1680]|HMA [168003]|1385.00||||1385.00|260.18|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|HEALTHNET [1495]|HEALTHNET [149500]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1385.00||||1385.00|664.11|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|AETNA [1015]|AETNA ACO WILCO [101532]|1385.00||||1385.00|175.03|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|TRUSTMARK [2030]|STARMARK [203000]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1385.00||||1385.00|111.53|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1385.00||||1385.00|190.8|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1385.00||||1385.00|115.48|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1385.00||||1385.00|831|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1385.00||||1385.00|182.12|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1385.00||||1385.00|486.14|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1385.00||||1385.00|693.89|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1385.00||||1385.00|595.55|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1385.00||||1385.00|590.01|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1385.00||||1385.00|482.2|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1385.00||||1385.00|173.45|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1385.00||||1385.00|1246.5|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1385.00||||1385.00|190.8|1385|106.22 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1385.00||||1385.00||| 32074246|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UGI W/AIR CONTRAST W/O KUB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1385.00||||1385.00||| 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1859.00||||1859.00|190.8|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1859.00||||1859.00|268.93|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1859.00||||1859.00|799.37|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1859.00||||1859.00|931.36|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1859.00||||1859.00|652.51|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1859.00||||1859.00|791.93|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1859.00||||1859.00|177.22|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1859.00||||1859.00|1115.4|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1859.00||||1859.00|190.8|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1859.00||||1859.00|111.53|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|TRUSTMARK [2030]|STARMARK [203000]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|AETNA [1015]|AETNA ACO WILCO [101532]|1859.00||||1859.00|153.64|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|HEALTHNET [1495]|HEALTHNET [149500]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MULTIPLAN [1680]|IHC HS [168011]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MULTIPLAN [1680]|HMA [168003]|1859.00||||1859.00|260.18|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1859.00||||1859.00|249.35|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1859.00||||1859.00|799.37|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1859.00||||1859.00|132.03|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1859.00||||1859.00|176.92|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|UMR [2035]|UMR OPTIONS [203501]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1859.00||||1859.00|168.78|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1859.00||||1859.00|253.24|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1859.00||||1859.00|115.48|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1859.00||||1859.00|390.39|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1859.00||||1859.00|1859|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1859.00||||1859.00|1208.35|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1859.00||||1859.00|891.39|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|||1859.00||||1859.00|557.7|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1859.00||||1859.00|115.48|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1859.00||||1859.00|173.45|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1859.00||||1859.00|106.22|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|CHAMPVA [1240]|CHAMP VA [124000]|1859.00||||1859.00|1394.25|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1859.00||||1859.00|249.35|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1859.00||||1859.00|120.03|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|CORESOURCE [1315]|CORESOURCE [131500]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|GEHA [1415]|GEHA [141500]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1859.00||||1859.00|1673.1|1859|106.22 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1859.00||||1859.00||| 32074250|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SM BOWEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1859.00||||1859.00||| 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|GEHA [1415]|GEHA [141500]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1285.00||||1285.00|120.03|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1285.00||||1285.00|249.35|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|CHAMPVA [1240]|CHAMP VA [124000]|1285.00||||1285.00|963.75|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1285.00||||1285.00|115.48|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1285.00||||1285.00|616.16|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1285.00||||1285.00|835.25|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1285.00||||1285.00|1285|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1285.00||||1285.00|269.85|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1285.00||||1285.00|253.24|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|UMR [2035]|UMR OPTIONS [203501]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1285.00||||1285.00|176.92|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1285.00||||1285.00|132.03|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1285.00||||1285.00|552.55|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MULTIPLAN [1680]|HMA [168003]|1285.00||||1285.00|260.18|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MULTIPLAN [1680]|IHC HS [168011]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1285.00||||1285.00|249.35|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|HEALTHNET [1495]|HEALTHNET [149500]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|AETNA [1015]|AETNA ACO WILCO [101532]|1285.00||||1285.00|217.82|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|||1285.00||||1285.00|385.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|TRUSTMARK [2030]|STARMARK [203000]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1285.00||||1285.00|106.22|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1285.00||||1285.00|111.53|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1285.00||||1285.00|190.8|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|CORESOURCE [1315]|CORESOURCE [131500]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1285.00||||1285.00|115.48|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1285.00||||1285.00|771|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1285.00||||1285.00|182.12|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1285.00||||1285.00|552.55|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1285.00||||1285.00|643.79|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1285.00||||1285.00|451.04|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1285.00||||1285.00|547.41|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1285.00||||1285.00|482.2|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1285.00||||1285.00|173.45|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1285.00||||1285.00|1156.5|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1285.00||||1285.00|190.8|1285|106.22 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1285.00||||1285.00||| 32074270|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1285.00||||1285.00||| 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1690.00||||1690.00|190.8|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1690.00||||1690.00|482.2|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1690.00||||1690.00|846.69|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1690.00||||1690.00|593.19|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1690.00||||1690.00|719.94|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1690.00||||1690.00|1014|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1690.00||||1690.00|186.76|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1690.00||||1690.00|190.8|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1690.00||||1690.00|180.38|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|TRUSTMARK [2030]|STARMARK [203000]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|HEALTHNET [1495]|HEALTHNET [149500]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MULTIPLAN [1680]|IHC HS [168011]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1690.00||||1690.00|249.35|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MULTIPLAN [1680]|HMA [168003]|1690.00||||1690.00|260.18|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1690.00||||1690.00|726.7|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1690.00||||1690.00|213.53|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1690.00||||1690.00|176.92|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|UMR [2035]|UMR OPTIONS [203501]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|AETNA [1015]|AETNA ACO WILCO [101532]|1690.00||||1690.00|305.83|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1690.00||||1690.00|253.24|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1690.00||||1690.00|354.9|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1690.00||||1690.00|1690|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1690.00||||1690.00|182.12|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1690.00||||1690.00|1098.5|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1690.00||||1690.00|810.36|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|||1690.00||||1690.00|507|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1690.00||||1690.00|726.7|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1690.00||||1690.00|186.76|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1690.00||||1690.00|173.45|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1690.00||||1690.00|171.78|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|CHAMPVA [1240]|CHAMP VA [124000]|1690.00||||1690.00|1267.5|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1690.00||||1690.00|249.35|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1690.00||||1690.00|194.11|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|CORESOURCE [1315]|CORESOURCE [131500]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|GEHA [1415]|GEHA [141500]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1690.00||||1690.00|1521|1690|171.78 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1690.00||||1690.00||| 32074280|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC COLON BARIUM ENEMA W/AIR CONT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1690.00||||1690.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|GEHA [1415]|GEHA [141500]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|CORESOURCE [1315]|CORESOURCE [131500]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|CHAMPVA [1240]|CHAMP VA [124000]|1654.00||||1654.00|1240.5|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|||1654.00||||1654.00|496.2|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1654.00||||1654.00|793.09|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1654.00||||1654.00|1075.1|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1654.00||||1654.00|1654|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1654.00||||1654.00|347.34|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|UMR [2035]|UMR OPTIONS [203501]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1654.00||||1654.00|711.22|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MULTIPLAN [1680]|IHC HS [168011]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|HEALTHNET [1495]|HEALTHNET [149500]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|AETNA [1015]|AETNA ACO WILCO [101532]|1654.00||||1654.00|60.38|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|TRUSTMARK [2030]|STARMARK [203000]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1654.00||||1654.00|992.4|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1654.00||||1654.00|711.22|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1654.00||||1654.00|828.65|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1654.00||||1654.00|580.55|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1654.00||||1654.00|704.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1654.00||||1654.00|827|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1654.00||||1654.00|1488.6|1654|60.38 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MULTIPLAN [1680]|HMA [168003]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1654.00||||1654.00||| 32074300|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIOGRAM INTRAOPERATIVE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1654.00||||1654.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|734.00||||734.00|367|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|734.00||||734.00|315.62|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|734.00||||734.00|367.73|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|734.00||||734.00|312.68|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|734.00||||734.00|440.4|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|TRUSTMARK [2030]|STARMARK [203000]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|HEALTHNET [1495]|HEALTHNET [149500]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MULTIPLAN [1680]|IHC HS [168011]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|FMH BENEFIT SERVICES [1390]|FMH [139000]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|FIRST HEALTH [1375]|QUALCHOICE [137513]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|AETNA [1015]|AETNA ACO WILCO [101532]|734.00||||734.00|34.87|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|734.00||||734.00|315.62|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|UMR [2035]|UMR OPTIONS [203501]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|734.00||||734.00|154.14|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|734.00||||734.00|734|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|734.00||||734.00|257.63|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|734.00||||734.00|477.1|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|734.00||||734.00|351.95|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|||734.00||||734.00|220.2|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|CHAMPVA [1240]|CHAMP VA [124000]|734.00||||734.00|550.5|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|CORESOURCE [1315]|CORESOURCE [131500]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|GEHA [1415]|GEHA [141500]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|734.00||||734.00|660.6|734|34.87 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MULTIPLAN [1680]|HMA [168003]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|734.00||||734.00||| 32074301|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHOLANGIO INTRAOP ADDED SET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|734.00||||734.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|GEHA [1415]|GEHA [141500]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|2367.00||||2367.00|1775.25|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2367.00||||2367.00|1134.98|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2367.00||||2367.00|1538.55|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2367.00||||2367.00|2367|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2367.00||||2367.00|497.07|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2367.00||||2367.00|1017.81|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|FIRST HEALTH [1375]|QUALCHOICE [137513]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|UMR [2035]|UMR OPTIONS [203501]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|FMH BENEFIT SERVICES [1390]|FMH [139000]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MULTIPLAN [1680]|IHC HS [168011]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|HEALTHNET [1495]|HEALTHNET [149500]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|||2367.00||||2367.00|710.1|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|2367.00||||2367.00|216.99|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|TRUSTMARK [2030]|STARMARK [203000]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2367.00||||2367.00|1420.2|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|CORESOURCE [1315]|CORESOURCE [131500]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2367.00||||2367.00|1017.81|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2367.00||||2367.00|1185.87|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2367.00||||2367.00|830.82|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2367.00||||2367.00|1008.34|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2367.00||||2367.00|1183.5|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2367.00||||2367.00|2130.3|2367|216.99 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MULTIPLAN [1680]|HMA [168003]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2367.00||||2367.00||| 32074330|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ERCP-BILIARY/PANCREATIC SYSTEM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2367.00||||2367.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|816.00||||816.00|408|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|816.00||||816.00|408.82|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|816.00||||816.00|286.42|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|816.00||||816.00|347.62|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|816.00||||816.00|489.6|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|TRUSTMARK [2030]|STARMARK [203000]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|816.00||||816.00|143.8|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|HEALTHNET [1495]|HEALTHNET [149500]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MULTIPLAN [1680]|IHC HS [168011]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|816.00||||816.00|350.88|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|UMR [2035]|UMR OPTIONS [203501]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|816.00||||816.00|171.36|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|816.00||||816.00|816|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|816.00||||816.00|530.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|816.00||||816.00|391.27|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|||816.00||||816.00|244.8|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|816.00||||816.00|350.88|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|CHAMPVA [1240]|CHAMP VA [124000]|816.00||||816.00|612|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|CORESOURCE [1315]|CORESOURCE [131500]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|GEHA [1415]|GEHA [141500]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|816.00||||816.00|734.4|816|143.8 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MULTIPLAN [1680]|HMA [168003]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|816.00||||816.00||| 32074340|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUID INTRO LONG GI TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|816.00||||816.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|UMR [2035]|UMR OPTIONS [203501]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|892.00||||892.00|383.56|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|FIRST HEALTH [1375]|QUALCHOICE [137513]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|FMH BENEFIT SERVICES [1390]|FMH [139000]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MULTIPLAN [1680]|IHC HS [168011]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|HEALTHNET [1495]|HEALTHNET [149500]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|AETNA [1015]|AETNA ACO WILCO [101532]|892.00||||892.00|157.46|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|TRUSTMARK [2030]|STARMARK [203000]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|892.00||||892.00|535.2|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|892.00||||892.00|446.89|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|892.00||||892.00|313.09|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|892.00||||892.00|379.99|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|892.00||||892.00|383.56|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|892.00||||892.00|446|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|892.00||||892.00|579.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|892.00||||892.00|892|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|GEHA [1415]|GEHA [141500]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|||892.00||||892.00|267.6|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|892.00||||892.00|427.71|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|CHAMPVA [1240]|CHAMP VA [124000]|892.00||||892.00|669|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|892.00||||892.00|187.32|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|CORESOURCE [1315]|CORESOURCE [131500]|892.00||||892.00|802.8|892|157.46 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MULTIPLAN [1680]|HMA [168003]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|892.00||||892.00||| 32074360|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC INTRALUMINAL DILATION STRICTURES/OBSTR RS&I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|892.00||||892.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1136.00||||1136.00|208.26|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1136.00||||1136.00|235.34|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1136.00||||1136.00|483.94|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1136.00||||1136.00|238.56|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|CHAMPVA [1240]|CHAMP VA [124000]|1136.00||||1136.00|852|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1136.00||||1136.00|738.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|HEALTHNET [1495]|HEALTHNET [149500]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1136.00||||1136.00|922.36|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|UMR [2035]|UMR OPTIONS [203501]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1136.00||||1136.00|226.42|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1136.00||||1136.00|569.14|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|TRUSTMARK [2030]|STARMARK [203000]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1136.00||||1136.00|398.74|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1136.00||||1136.00|544.71|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1136.00||||1136.00|1136|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1136.00||||1136.00|218.68|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|GEHA [1415]|GEHA [141500]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MULTIPLAN [1680]|IHC HS [168011]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1136.00||||1136.00|488.48|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1136.00||||1136.00|226.42|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1136.00||||1136.00|488.48|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1136.00||||1136.00|681.6|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|CORESOURCE [1315]|CORESOURCE [131500]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1136.00||||1136.00|258.87|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|AETNA [1015]|AETNA ACO WILCO [101532]|1136.00||||1136.00|79.07|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|||1136.00||||1136.00|340.8|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1136.00||||1136.00|1022.4|1136|79.07 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MULTIPLAN [1680]|HMA [168003]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1136.00||||1136.00||| 32074420|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM RETROGRADE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1136.00||||1136.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1227.00||||1227.00|218.68|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1227.00||||1227.00|736.2|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1227.00||||1227.00|430.68|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|TRUSTMARK [2030]|STARMARK [203000]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MULTIPLAN [1680]|IHC HS [168011]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|HEALTHNET [1495]|HEALTHNET [149500]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1227.00||||1227.00|522.7|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|GEHA [1415]|GEHA [141500]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|CHAMPVA [1240]|CHAMP VA [124000]|1227.00||||1227.00|920.25|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1227.00||||1227.00|588.35|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1227.00||||1227.00|235.34|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|AETNA [1015]|AETNA ACO WILCO [101532]|1227.00||||1227.00|654.85|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1227.00||||1227.00|922.36|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|CORESOURCE [1315]|CORESOURCE [131500]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1227.00||||1227.00|527.61|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|UMR [2035]|UMR OPTIONS [203501]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1227.00||||1227.00|258.87|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1227.00||||1227.00|226.42|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1227.00||||1227.00|797.55|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1227.00||||1227.00|257.67|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1227.00||||1227.00|208.26|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1227.00||||1227.00|226.42|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1227.00||||1227.00|527.61|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1227.00||||1227.00|614.73|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1227.00||||1227.00|1104.3|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|||1227.00||||1227.00|368.1|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1227.00||||1227.00|1227|1227|208.26 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MULTIPLAN [1680]|HMA [168003]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1227.00||||1227.00||| 32074425|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC UROGRAM ANTEGRADE PYELOSTOGRAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1227.00||||1227.00||| 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|992.00||||992.00|922.36|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|TRUSTMARK [2030]|STARMARK [203000]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|992.00||||992.00|426.56|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|992.00||||992.00|422.59|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|992.00||||992.00|595.2|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|992.00||||992.00|381.65|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|992.00||||992.00|496.99|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|992.00||||992.00|218.68|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|992.00||||992.00|226.42|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|992.00||||992.00|370.75|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|992.00||||992.00|399.82|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|992.00||||992.00|258.87|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|992.00||||992.00|475.66|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MULTIPLAN [1680]|HMA [168003]|992.00||||992.00|545.22|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|992.00||||992.00|992|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|992.00||||992.00|208.32|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|992.00||||992.00|348.19|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|UMR [2035]|UMR OPTIONS [203501]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|992.00||||992.00|235.34|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|992.00||||992.00|522.53|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|992.00||||992.00|744|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|GEHA [1415]|GEHA [141500]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|992.00||||992.00|208.26|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MULTIPLAN [1680]|IHC HS [168011]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|992.00||||992.00|39.95|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|992.00||||992.00|399.82|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|||992.00||||992.00|297.6|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|992.00||||992.00|644.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|992.00||||992.00|363.48|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|992.00||||992.00|226.42|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|992.00||||992.00|426.56|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|992.00||||992.00|522.53|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|992.00||||992.00|892.8|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|992.00||||992.00|530.68|992|39.95 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|992.00||||992.00||| 32074430|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOGRAM 3+ VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|992.00||||992.00||| 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|TRUSTMARK [2030]|STARMARK [203000]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|945.00||||945.00|318.9|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|HEALTHNET [1495]|HEALTHNET [149500]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MULTIPLAN [1680]|IHC HS [168011]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|AETNA [1015]|AETNA ACO WILCO [101532]|945.00||||945.00|391.4|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|945.00||||945.00|331.7|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|945.00||||945.00|551.1|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|945.00||||945.00|226.42|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|945.00||||945.00|406.35|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|945.00||||945.00|232.92|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|945.00||||945.00|402.57|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|945.00||||945.00|244.01|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|945.00||||945.00|567|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|945.00||||945.00|218.68|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MULTIPLAN [1680]|HMA [168003]|945.00||||945.00|332.74|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|945.00||||945.00|473.45|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|CHAMPVA [1240]|CHAMP VA [124000]|945.00||||945.00|708.75|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|945.00||||945.00|244.01|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|945.00||||945.00|226.42|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|GEHA [1415]|GEHA [141500]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|CORESOURCE [1315]|CORESOURCE [131500]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|945.00||||945.00|235.34|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|945.00||||945.00|453.13|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|945.00||||945.00|208.26|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|945.00||||945.00|318.9|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|945.00||||945.00|614.25|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|945.00||||945.00|226.26|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|945.00||||945.00|323.87|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|FMH BENEFIT SERVICES [1390]|FMH [139000]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|945.00||||945.00|406.35|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|||945.00||||945.00|283.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|945.00||||945.00|945|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|FIRST HEALTH [1375]|QUALCHOICE [137513]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|945.00||||945.00|221.83|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|UMR [2035]|UMR OPTIONS [203501]|945.00||||945.00|850.5|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|945.00||||945.00|198.45|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|945.00||||945.00|258.87|945|198.45 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|945.00||||945.00||| 32074450|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM RETRO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|945.00||||945.00||| 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1244.00||||1244.00|232.92|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1244.00||||1244.00|551.1|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1244.00||||1244.00|244.01|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1244.00||||1244.00|244.01|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1244.00||||1244.00|436.64|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1244.00||||1244.00|623.24|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1244.00||||1244.00|226.42|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1244.00||||1244.00|529.94|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1244.00||||1244.00|226.26|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MULTIPLAN [1680]|IHC HS [168011]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|HEALTHNET [1495]|HEALTHNET [149500]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1244.00||||1244.00|258.87|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1244.00||||1244.00|534.92|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|UMR [2035]|UMR OPTIONS [203501]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1244.00||||1244.00|1244|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MULTIPLAN [1680]|HMA [168003]|1244.00||||1244.00|332.74|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1244.00||||1244.00|534.92|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|AETNA [1015]|AETNA ACO WILCO [101532]|1244.00||||1244.00|127.35|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1244.00||||1244.00|323.87|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|FIRST HEALTH [1375]|QUALCHOICE [137513]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1244.00||||1244.00|261.24|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|TRUSTMARK [2030]|STARMARK [203000]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1244.00||||1244.00|218.68|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1244.00||||1244.00|746.4|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1244.00||||1244.00|318.9|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1244.00||||1244.00|318.9|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1244.00||||1244.00|226.42|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1244.00||||1244.00|808.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1244.00||||1244.00|208.26|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|CHAMPVA [1240]|CHAMP VA [124000]|1244.00||||1244.00|933|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|GEHA [1415]|GEHA [141500]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1244.00||||1244.00|235.34|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1244.00||||1244.00|221.83|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|||1244.00||||1244.00|373.2|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1244.00||||1244.00|596.5|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|FMH BENEFIT SERVICES [1390]|FMH [139000]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|CORESOURCE [1315]|CORESOURCE [131500]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1244.00||||1244.00|1119.6|1244|127.35 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1244.00||||1244.00||| 32074455|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CYSTOURETHROGRAM VOIDING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1244.00||||1244.00||| 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|GEHA [1415]|GEHA [141500]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1146.00||||1146.00|687.6|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1146.00||||1146.00|549.51|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|CHAMPVA [1240]|CHAMP VA [124000]|1146.00||||1146.00|859.5|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|CORESOURCE [1315]|CORESOURCE [131500]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1146.00||||1146.00|255.13|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1146.00||||1146.00|318.9|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1146.00||||1146.00|277.37|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|AETNA [1015]|AETNA ACO WILCO [101532]|1146.00||||1146.00|109.01|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1146.00||||1146.00|574.15|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1146.00||||1146.00|267.9|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1146.00||||1146.00|492.78|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1146.00||||1146.00|240.66|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1146.00||||1146.00|244.01|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1146.00||||1146.00|317.12|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1146.00||||1146.00|288.29|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1146.00||||1146.00|226.26|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1146.00||||1146.00|323.87|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1146.00||||1146.00|232.92|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1146.00||||1146.00|277.37|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MULTIPLAN [1680]|HMA [168003]|1146.00||||1146.00|332.74|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1146.00||||1146.00|492.78|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1146.00||||1146.00|744.9|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1146.00||||1146.00|318.9|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1146.00||||1146.00|1146|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MULTIPLAN [1680]|IHC HS [168011]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|HEALTHNET [1495]|HEALTHNET [149500]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|||1146.00||||1146.00|343.8|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1146.00||||1146.00|488.2|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1146.00||||1146.00|244.01|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1146.00||||1146.00|402.25|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1146.00||||1146.00|551.1|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|TRUSTMARK [2030]|STARMARK [203000]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1146.00||||1146.00|221.83|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|UMR [2035]|UMR OPTIONS [203501]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1146.00||||1146.00|1031.4|1146|109.01 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1146.00||||1146.00||| 32074740|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC HYSTEROSALPINGOGRAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1146.00||||1146.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|362.00||||362.00|99.25|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|362.00||||362.00|127.06|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|||362.00||||362.00|108.6|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|362.00||||362.00|76.02|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|362.00||||362.00|155.66|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|362.00||||362.00|362|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|UMR [2035]|UMR OPTIONS [203501]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|TRUSTMARK [2030]|STARMARK [203000]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|362.00||||362.00|113.48|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|362.00||||362.00|155.66|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|HEALTHNET [1495]|HEALTHNET [149500]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|AETNA [1015]|AETNA ACO WILCO [101532]|362.00||||362.00|123.08|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MULTIPLAN [1680]|IHC HS [168011]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|362.00||||362.00|99.25|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|362.00||||362.00|95.86|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|362.00||||362.00|217.2|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|GEHA [1415]|GEHA [141500]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|CORESOURCE [1315]|CORESOURCE [131500]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|362.00||||362.00|103.16|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|CHAMPVA [1240]|CHAMP VA [124000]|362.00||||362.00|271.5|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|362.00||||362.00|235.3|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|362.00||||362.00|91.29|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|362.00||||362.00|173.58|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|362.00||||362.00|154.21|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|362.00||||362.00|181.36|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|362.00||||362.00|268.93|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|362.00||||362.00|325.8|362|76.02 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MULTIPLAN [1680]|HMA [168003]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|362.00||||362.00||| 32075809|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC SHUNTOGRAM FOR NV SHUNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|362.00||||362.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2576.00||||2576.00|1107.68|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2576.00||||2576.00|2576|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2576.00||||2576.00|1097.38|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2576.00||||2576.00|2588.88|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2576.00||||2576.00|1545.6|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2576.00||||2576.00|1290.58|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2576.00||||2576.00|904.18|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2576.00||||2576.00|2500.44|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2576.00||||2576.00|2690.82|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|CORESOURCE [1315]|CORESOURCE [131500]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2576.00||||2576.00|2381.31|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|CHAMPVA [1240]|CHAMP VA [124000]|2576.00||||2576.00|1932|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2576.00||||2576.00|1235.19|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2576.00||||2576.00|1107.68|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|UMR [2035]|UMR OPTIONS [203501]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2576.00||||2576.00|2576|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2576.00||||2576.00|540.96|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|GEHA [1415]|GEHA [141500]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2576.00||||2576.00|2576|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MULTIPLAN [1680]|IHC HS [168011]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2576.00||||2576.00|2588.88|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|AETNA [1015]|AETNA ACO WILCO [101532]|2576.00||||2576.00|145.7|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|HEALTHNET [1495]|HEALTHNET [149500]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|||2576.00||||2576.00|772.8|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2576.00||||2576.00|1674.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|TRUSTMARK [2030]|STARMARK [203000]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2576.00||||2576.00|2318.4|2690.82|145.7 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|MULTIPLAN [1680]|HMA [168003]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2576.00||||2576.00||| 32075889|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC VENOGRAM HEPATIC W/HEMODYNAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2576.00||||2576.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3125.00||||3125.00|1343.75|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3125.00||||3125.00|1562.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3125.00||||3125.00|1096.88|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3125.00||||3125.00|1875|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|AETNA [1015]|AETNA ACO WILCO [101532]|3125.00||||3125.00|710.96|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|FIRST HEALTH [1375]|QUALCHOICE [137513]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|TRUSTMARK [2030]|STARMARK [203000]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MULTIPLAN [1680]|IHC HS [168011]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|FMH BENEFIT SERVICES [1390]|FMH [139000]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3125.00||||3125.00|1343.75|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|UMR [2035]|UMR OPTIONS [203501]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3125.00||||3125.00|3125|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3125.00||||3125.00|656.25|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3125.00||||3125.00|2031.25|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3125.00||||3125.00|1498.44|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|||3125.00||||3125.00|937.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3125.00||||3125.00|1331.25|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3125.00||||3125.00|1565.63|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|CORESOURCE [1315]|CORESOURCE [131500]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|GEHA [1415]|GEHA [141500]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|CHAMPVA [1240]|CHAMP VA [124000]|3125.00||||3125.00|2343.75|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|HEALTHNET [1495]|HEALTHNET [149500]|3125.00||||3125.00|2812.5|3125|656.25 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MULTIPLAN [1680]|HMA [168003]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3125.00||||3125.00||| 32075970|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC TRANSCATH BIOPSY SUPRV/INTRP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3125.00||||3125.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|GEHA [1415]|GEHA [141500]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1618.00||||1618.00|775.83|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|CORESOURCE [1315]|CORESOURCE [131500]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|||1618.00||||1618.00|485.4|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|UMR [2035]|UMR OPTIONS [203501]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|CHAMPVA [1240]|CHAMP VA [124000]|1618.00||||1618.00|1213.5|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1618.00||||1618.00|695.74|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1618.00||||1618.00|1618|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|FIRST HEALTH [1375]|QUALCHOICE [137513]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|FMH BENEFIT SERVICES [1390]|FMH [139000]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1618.00||||1618.00|339.78|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MULTIPLAN [1680]|IHC HS [168011]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|HEALTHNET [1495]|HEALTHNET [149500]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1618.00||||1618.00|1051.7|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|AETNA [1015]|AETNA ACO WILCO [101532]|1618.00||||1618.00|116.35|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|TRUSTMARK [2030]|STARMARK [203000]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1618.00||||1618.00|810.62|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1618.00||||1618.00|567.92|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1618.00||||1618.00|695.74|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1618.00||||1618.00|809|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1618.00||||1618.00|970.8|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1618.00||||1618.00|689.27|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1618.00||||1618.00|1456.2|1618|116.35 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MULTIPLAN [1680]|HMA [168003]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1618.00||||1618.00||| 32075984|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC CHANGE TUBE/DRAINAGE CATHETER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1618.00||||1618.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2597.00||||2597.00|1298.5|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MULTIPLAN [1680]|IHC HS [168011]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2597.00||||2597.00|1558.2|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|AETNA [1015]|AETNA ACO WILCO [101532]|2597.00||||2597.00|131.46|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|TRUSTMARK [2030]|STARMARK [203000]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2597.00||||2597.00|1116.71|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2597.00||||2597.00|1106.32|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|UMR [2035]|UMR OPTIONS [203501]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|HEALTHNET [1495]|HEALTHNET [149500]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2597.00||||2597.00|1301.1|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2597.00||||2597.00|1116.71|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2597.00||||2597.00|2597|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2597.00||||2597.00|545.37|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2597.00||||2597.00|1688.05|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|||2597.00||||2597.00|779.1|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2597.00||||2597.00|911.55|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|CHAMPVA [1240]|CHAMP VA [124000]|2597.00||||2597.00|1947.75|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|CORESOURCE [1315]|CORESOURCE [131500]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|GEHA [1415]|GEHA [141500]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2597.00||||2597.00|1245.26|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2597.00||||2597.00|2337.3|2597|131.46 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|MULTIPLAN [1680]|HMA [168003]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2597.00||||2597.00||| 32075989|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC GUIDED ABSCESS DRAINAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2597.00||||2597.00||| 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|708.00||||708.00|304.44|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|CORESOURCE [1315]|CORESOURCE [131500]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|GEHA [1415]|GEHA [141500]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|708.00||||708.00|318.9|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|708.00||||708.00|218.66|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|708.00||||708.00|240.53|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|708.00||||708.00|226.26|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|708.00||||708.00|193.52|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|708.00||||708.00|323.87|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|708.00||||708.00|708|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|708.00||||708.00|210.38|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|708.00||||708.00|148.68|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|UMR [2035]|UMR OPTIONS [203501]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|708.00||||708.00|460.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|708.00||||708.00|339.49|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|HEALTHNET [1495]|HEALTHNET [149500]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MULTIPLAN [1680]|IHC HS [168011]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|708.00||||708.00|318.9|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MULTIPLAN [1680]|HMA [168003]|708.00||||708.00|332.74|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|AETNA [1015]|AETNA ACO WILCO [101532]|708.00||||708.00|54.62|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|||708.00||||708.00|212.4|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|708.00||||708.00|244.01|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|708.00||||708.00|232.92|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|708.00||||708.00|551.1|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|708.00||||708.00|304.44|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|708.00||||708.00|248.51|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|708.00||||708.00|237.44|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|708.00||||708.00|210.38|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|708.00||||708.00|301.61|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|CHAMPVA [1240]|CHAMP VA [124000]|708.00||||708.00|531|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|708.00||||708.00|221.83|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|TRUSTMARK [2030]|STARMARK [203000]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|708.00||||708.00|424.8|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|708.00||||708.00|354.71|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|708.00||||708.00|203.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|708.00||||708.00|637.2|708|54.62 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|708.00||||708.00||| 32076000|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOROSCOPY UP TO 1 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|708.00||||708.00||| 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|383.00||||383.00|191.88|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|383.00||||383.00|148.92|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|383.00||||383.00|229.8|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|383.00||||383.00|83.56|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|383.00||||383.00|78.28|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|383.00||||383.00|79.77|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|383.00||||383.00|83.56|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|383.00||||383.00|164.69|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|383.00||||383.00|134.43|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|383.00||||383.00|163.16|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|383.00||||383.00|75.61|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|UMR [2035]|UMR OPTIONS [203501]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|TRUSTMARK [2030]|STARMARK [203000]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|AETNA [1015]|AETNA ACO WILCO [101532]|383.00||||383.00|31.39|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|HEALTHNET [1495]|HEALTHNET [149500]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MULTIPLAN [1680]|IHC HS [168011]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MULTIPLAN [1680]|HMA [168003]|383.00||||383.00|113.95|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|383.00||||383.00|109.21|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|FIRST HEALTH [1375]|QUALCHOICE [137513]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|383.00||||383.00|78.28|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|383.00||||383.00|164.69|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|||383.00||||383.00|114.9|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|383.00||||383.00|77.49|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|383.00||||383.00|183.65|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|383.00||||383.00|89.5|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|383.00||||383.00|80.43|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|383.00||||383.00|383|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|383.00||||383.00|81.36|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|383.00||||383.00|72.01|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|CHAMPVA [1240]|CHAMP VA [124000]|383.00||||383.00|287.25|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|383.00||||383.00|109.21|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|FMH BENEFIT SERVICES [1390]|FMH [139000]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|CORESOURCE [1315]|CORESOURCE [131500]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|GEHA [1415]|GEHA [141500]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|383.00||||383.00|248.95|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|383.00||||383.00|110.91|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|383.00||||383.00|75.97|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|383.00||||383.00|344.7|383|31.39 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|383.00||||383.00||| 32076010|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC NOSE TO RECTUM FB 1 VIEW CHILD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|383.00||||383.00||| 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1202.00||||1202.00|317.12|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|CHAMPVA [1240]|CHAMP VA [124000]|1202.00||||1202.00|901.5|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|||1202.00||||1202.00|360.6|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1202.00||||1202.00|669.28|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1202.00||||1202.00|252.42|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1202.00||||1202.00|255.13|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1202.00||||1202.00|277.37|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1202.00||||1202.00|467.58|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|UMR [2035]|UMR OPTIONS [203501]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1202.00||||1202.00|781.3|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|HEALTHNET [1495]|HEALTHNET [149500]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1202.00||||1202.00|1202|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|AETNA [1015]|AETNA ACO WILCO [101532]|1202.00||||1202.00|53.39|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MULTIPLAN [1680]|IHC HS [168011]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1202.00||||1202.00|576.36|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MULTIPLAN [1680]|HMA [168003]|1202.00||||1202.00|687.61|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|TRUSTMARK [2030]|STARMARK [203000]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1202.00||||1202.00|516.86|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1202.00||||1202.00|659.01|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1202.00||||1202.00|267.9|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1202.00||||1202.00|659.01|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1202.00||||1202.00|721.2|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1202.00||||1202.00|277.37|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1202.00||||1202.00|481.33|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|GEHA [1415]|GEHA [141500]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1202.00||||1202.00|1189.12|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1202.00||||1202.00|516.86|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1202.00||||1202.00|602.2|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|CORESOURCE [1315]|CORESOURCE [131500]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1202.00||||1202.00|288.29|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1202.00||||1202.00|1081.8|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1202.00||||1202.00|512.05|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1202.00||||1202.00|421.9|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1202.00||||1202.00|458.41|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1202.00||||1202.00|504.25|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1202.00||||1202.00|504.25|1202|53.39 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1202.00||||1202.00||| 32076080|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ABSCESS/FIST/SINUS TRACT STUDY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1202.00||||1202.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|507.00||||507.00|253.5|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|507.00||||507.00|215.98|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|TRUSTMARK [2030]|STARMARK [203000]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|HEALTHNET [1495]|HEALTHNET [149500]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|507.00||||507.00|218.01|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|FMH BENEFIT SERVICES [1390]|FMH [139000]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|UMR [2035]|UMR OPTIONS [203501]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|507.00||||507.00|243.11|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|507.00||||507.00|106.47|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|FIRST HEALTH [1375]|QUALCHOICE [137513]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|507.00||||507.00|507|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|507.00||||507.00|329.55|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|||507.00||||507.00|152.1|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|CHAMPVA [1240]|CHAMP VA [124000]|507.00||||507.00|380.25|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|GEHA [1415]|GEHA [141500]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|AETNA [1015]|AETNA ACO WILCO [101532]|507.00||||507.00|123.69|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MULTIPLAN [1680]|IHC HS [168011]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|507.00||||507.00|304.2|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|CORESOURCE [1315]|CORESOURCE [131500]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|507.00||||507.00|456.3|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|507.00||||507.00|218.01|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|507.00||||507.00|254.01|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|507.00||||507.00|177.96|507|106.47 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MULTIPLAN [1680]|HMA [168003]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|507.00||||507.00||| 32077001|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO GUIDNC RMVL/PLCMNT S&I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|507.00||||507.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|GEHA [1415]|GEHA [141500]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|CORESOURCE [1315]|CORESOURCE [131500]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|CHAMPVA [1240]|CHAMP VA [124000]|995.00||||995.00|746.25|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|995.00||||995.00|646.75|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|995.00||||995.00|477.1|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|995.00||||995.00|995|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|995.00||||995.00|208.95|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|UMR [2035]|UMR OPTIONS [203501]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|995.00||||995.00|427.85|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MULTIPLAN [1680]|IHC HS [168011]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|HEALTHNET [1495]|HEALTHNET [149500]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|AETNA [1015]|AETNA ACO WILCO [101532]|995.00||||995.00|126.74|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|995.00||||995.00|597|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|||995.00||||995.00|298.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|995.00||||995.00|497.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|995.00||||995.00|427.85|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|995.00||||995.00|498.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|995.00||||995.00|349.25|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|995.00||||995.00|423.87|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|TRUSTMARK [2030]|STARMARK [203000]|995.00||||995.00|895.5|995|126.74 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MULTIPLAN [1680]|HMA [168003]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|995.00||||995.00||| 32077002|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUORO BIOPSY/ASPIRATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|995.00||||995.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1531.00||||1531.00|658.33|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1531.00||||1531.00|537.38|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1531.00||||1531.00|652.21|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1531.00||||1531.00|765.5|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1531.00||||1531.00|918.6|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MULTIPLAN [1680]|IHC HS [168011]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|AETNA [1015]|AETNA ACO WILCO [101532]|1531.00||||1531.00|116.96|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|TRUSTMARK [2030]|STARMARK [203000]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|HEALTHNET [1495]|HEALTHNET [149500]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1531.00||||1531.00|658.33|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|UMR [2035]|UMR OPTIONS [203501]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1531.00||||1531.00|321.51|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|CHAMPVA [1240]|CHAMP VA [124000]|1531.00||||1531.00|1148.25|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|CORESOURCE [1315]|CORESOURCE [131500]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1531.00||||1531.00|767.03|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|GEHA [1415]|GEHA [141500]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|||1531.00||||1531.00|459.3|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1531.00||||1531.00|734.11|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1531.00||||1531.00|995.15|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1531.00||||1531.00|1377.9|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1531.00||||1531.00|1531|1531|116.96 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MULTIPLAN [1680]|HMA [168003]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1531.00||||1531.00||| 32077003|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FLUOR GUID NDL CATH FOR SPINL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1531.00||||1531.00||| 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|CORESOURCE [1315]|CORESOURCE [131500]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|GEHA [1415]|GEHA [141500]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|410.00||||410.00|130.23|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|410.00||||410.00|153.38|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|CHAMPVA [1240]|CHAMP VA [124000]|410.00||||410.00|307.5|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|410.00||||410.00|115.25|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|410.00||||410.00|125.3|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|||410.00||||410.00|123|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|410.00||||410.00|196.6|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|410.00||||410.00|155.77|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|UMR [2035]|UMR OPTIONS [203501]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|410.00||||410.00|108.82|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|410.00||||410.00|176.3|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|410.00||||410.00|143.26|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|410.00||||410.00|86.1|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|FIRST HEALTH [1375]|QUALCHOICE [137513]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|FMH BENEFIT SERVICES [1390]|FMH [139000]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|410.00||||410.00|410|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|410.00||||410.00|266.5|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MULTIPLAN [1680]|IHC HS [168011]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|410.00||||410.00|153.38|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MULTIPLAN [1680]|HMA [168003]|410.00||||410.00|160.04|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|HEALTHNET [1495]|HEALTHNET [149500]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|AETNA [1015]|AETNA ACO WILCO [101532]|410.00||||410.00|25.27|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|AETNA [1015]|COVENTRY HEALTHCARE [101502]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|TRUSTMARK [2030]|STARMARK [203000]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|410.00||||410.00|125.3|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|410.00||||410.00|246|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|410.00||||410.00|268.93|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|410.00||||410.00|205.41|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|410.00||||410.00|143.91|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|410.00||||410.00|174.66|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|410.00||||410.00|176.3|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|410.00||||410.00|112.03|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|410.00||||410.00|117.36|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|410.00||||410.00|117.36|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|410.00||||410.00|121.01|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|410.00||||410.00|106.69|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|410.00||||410.00|369|410|25.27 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|410.00||||410.00||| 32077072|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE AGE STUDIES.|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|410.00||||410.00||| 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|529.00||||529.00|265.03|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|529.00||||529.00|117.36|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|529.00||||529.00|227.47|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|529.00||||529.00|185.68|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|529.00||||529.00|268.93|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|529.00||||529.00|112.03|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|529.00||||529.00|317.4|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|529.00||||529.00|117.36|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|529.00||||529.00|121.01|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|HEALTHNET [1495]|HEALTHNET [149500]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MULTIPLAN [1680]|HMA [168003]|529.00||||529.00|160.04|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MULTIPLAN [1680]|IHC HS [168011]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|FMH BENEFIT SERVICES [1390]|FMH [139000]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|FIRST HEALTH [1375]|QUALCHOICE [137513]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|529.00||||529.00|153.38|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|529.00||||529.00|143.26|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|529.00||||529.00|227.47|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|529.00||||529.00|108.82|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|UMR [2035]|UMR OPTIONS [203501]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|TRUSTMARK [2030]|STARMARK [203000]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|529.00||||529.00|155.77|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|529.00||||529.00|125.3|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|529.00||||529.00|111.09|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|529.00||||529.00|343.85|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|529.00||||529.00|125.3|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|CHAMPVA [1240]|CHAMP VA [124000]|529.00||||529.00|396.75|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|529.00||||529.00|225.35|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|529.00||||529.00|153.38|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|CORESOURCE [1315]|CORESOURCE [131500]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|529.00||||529.00|115.25|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|529.00||||529.00|130.23|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|GEHA [1415]|GEHA [141500]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|529.00||||529.00|253.66|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|||529.00||||529.00|158.7|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|AETNA [1015]|AETNA ACO WILCO [101532]|529.00||||529.00|39.95|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|529.00||||529.00|106.69|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|529.00||||529.00|529|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|529.00||||529.00|476.1|529|39.95 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|529.00||||529.00||| 32077073|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE LENGTH STUDIES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|529.00||||529.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|GEHA [1415]|GEHA [141500]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|483.00||||483.00|130.23|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|483.00||||483.00|115.25|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|||483.00||||483.00|144.9|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|483.00||||483.00|231.6|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|483.00||||483.00|313.95|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|483.00||||483.00|483|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|483.00||||483.00|101.43|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|UMR [2035]|UMR OPTIONS [203501]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|483.00||||483.00|207.69|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|483.00||||483.00|143.26|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MULTIPLAN [1680]|IHC HS [168011]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|483.00||||483.00|125.3|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|483.00||||483.00|77.23|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|483.00||||483.00|121.01|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|483.00||||483.00|289.8|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|483.00||||483.00|207.69|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|483.00||||483.00|362.25|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|483.00||||483.00|241.98|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|483.00||||483.00|169.53|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|483.00||||483.00|268.93|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|483.00||||483.00|205.76|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|TRUSTMARK [2030]|STARMARK [203000]|483.00||||483.00|434.7|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|483.00||||483.00|125.3|483|77.23 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MULTIPLAN [1680]|HMA [168003]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|483.00||||483.00||| 32077074|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC OSSEOUS SURVEY LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|483.00||||483.00||| 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1130.00||||1130.00|117.36|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1130.00||||1130.00|485.9|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1130.00||||1130.00|566.13|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1130.00||||1130.00|396.63|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1130.00||||1130.00|481.38|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1130.00||||1130.00|268.93|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1130.00||||1130.00|112.03|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1130.00||||1130.00|678|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1130.00||||1130.00|117.36|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|AETNA [1015]|AETNA ACO WILCO [101532]|1130.00||||1130.00|112.07|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MULTIPLAN [1680]|IHC HS [168011]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1130.00||||1130.00|153.38|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|HEALTHNET [1495]|HEALTHNET [149500]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MULTIPLAN [1680]|HMA [168003]|1130.00||||1130.00|160.04|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|TRUSTMARK [2030]|STARMARK [203000]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1130.00||||1130.00|240.53|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1130.00||||1130.00|485.9|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1130.00||||1130.00|108.82|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|UMR [2035]|UMR OPTIONS [203501]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1130.00||||1130.00|210.38|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1130.00||||1130.00|155.77|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1130.00||||1130.00|237.3|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1130.00||||1130.00|106.69|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1130.00||||1130.00|153.38|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|CHAMPVA [1240]|CHAMP VA [124000]|1130.00||||1130.00|847.5|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|CORESOURCE [1315]|CORESOURCE [131500]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1130.00||||1130.00|218.66|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|GEHA [1415]|GEHA [141500]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1130.00||||1130.00|193.52|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1130.00||||1130.00|210.38|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|||1130.00||||1130.00|339|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1130.00||||1130.00|1017|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1130.00||||1130.00|734.5|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1130.00||||1130.00|1130|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1130.00||||1130.00|203.2|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1130.00||||1130.00|541.84|1130|106.69 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1130.00||||1130.00||| 32077075|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC BONE SURVEY COMP/METASTATIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1130.00||||1130.00||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|184.64||||184.64|79.4|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|GEHA [1415]|GEHA [141500]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|184.64||||184.64|138.48|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|||184.64||||184.64|55.39|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|184.64||||184.64|120.02|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|184.64||||184.64|38.77|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR OPTIONS [203501]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|184.64||||184.64|88.53|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|184.64||||184.64|92.5|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|184.64||||184.64|64.81|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|184.64||||184.64|78.66|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|184.64||||184.64|110.78|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|184.64||||184.64|79.4|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|184.64||||184.64|166.18|166.18|38.77 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|HMA [168003]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|184.64||||184.64||| 32215|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|184.64||||184.64||| 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|931.00||||931.00|389.06|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|931.00||||931.00|400.33|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|931.00||||931.00|466.43|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|931.00||||931.00|326.78|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|931.00||||931.00|922.36|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|931.00||||931.00|558.6|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|931.00||||931.00|371.38|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|931.00||||931.00|350.03|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|931.00||||931.00|389.06|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|HEALTHNET [1495]|HEALTHNET [149500]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MULTIPLAN [1680]|IHC HS [168011]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|931.00||||931.00|508.47|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MULTIPLAN [1680]|HMA [168003]|931.00||||931.00|530.54|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|931.00||||931.00|360.77|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|931.00||||931.00|195.51|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|931.00||||931.00|605.15|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|931.00||||931.00|350.03|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|931.00||||931.00|698.25|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|931.00||||931.00|363.81|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|GEHA [1415]|GEHA [141500]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|CORESOURCE [1315]|CORESOURCE [131500]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|931.00||||931.00|508.47|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|931.00||||931.00|321.96|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|||931.00||||931.00|279.3|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|931.00||||931.00|931|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|931.00||||931.00|446.41|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|931.00||||931.00|516.39|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|931.00||||931.00|400.33|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|931.00||||931.00|400.19|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|UMR [2035]|UMR OPTIONS [203501]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|931.00||||931.00|396.61|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|931.00||||931.00|143.25|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|TRUSTMARK [2030]|STARMARK [203000]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|931.00||||931.00|353.69|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|931.00||||931.00|338.07|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|931.00||||931.00|837.9|931|143.25 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|931.00||||931.00||| 32273040|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM SHOULDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|931.00||||931.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|CORESOURCE [1315]|CORESOURCE [131500]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|CHAMPVA [1240]|CHAMP VA [124000]|464.00||||464.00|348|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.00||||464.00|115.25|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|||464.00||||464.00|139.2|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.00||||464.00|222.49|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.00||||464.00|464|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.00||||464.00|97.44|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|GEHA [1415]|GEHA [141500]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|UMR [2035]|UMR OPTIONS [203501]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.00||||464.00|199.52|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.00||||464.00|143.26|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MULTIPLAN [1680]|IHC HS [168011]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.00||||464.00|301.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|HEALTHNET [1495]|HEALTHNET [149500]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|464.00||||464.00|46.05|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.00||||464.00|125.3|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.00||||464.00|121.01|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.00||||464.00|278.4|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.00||||464.00|199.52|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.00||||464.00|232.46|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.00||||464.00|162.86|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.00||||464.00|197.66|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.00||||464.00|130.23|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.00||||464.00|125.3|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|TRUSTMARK [2030]|STARMARK [203000]|464.00||||464.00|417.6|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.00||||464.00|148.92|464|46.05 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MULTIPLAN [1680]|HMA [168003]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.00||||464.00||| 32273050|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC ACROMIOCLAVICULAR JOINTS BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.00||||464.00||| 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|408.00||||408.00|175.44|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|408.00||||408.00|109.21|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|408.00||||408.00|75.61|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|408.00||||408.00|204.41|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|408.00||||408.00|83.56|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|408.00||||408.00|175.44|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|408.00||||408.00|143.21|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|408.00||||408.00|173.81|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|408.00||||408.00|148.92|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|408.00||||408.00|244.8|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|408.00||||408.00|79.77|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|408.00||||408.00|83.56|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|AETNA [1015]|AETNA ACO WILCO [101532]|408.00||||408.00|33.83|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|HEALTHNET [1495]|HEALTHNET [149500]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MULTIPLAN [1680]|IHC HS [168011]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MULTIPLAN [1680]|HMA [168003]|408.00||||408.00|113.95|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|FMH BENEFIT SERVICES [1390]|FMH [139000]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|FIRST HEALTH [1375]|QUALCHOICE [137513]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|408.00||||408.00|89.5|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|408.00||||408.00|77.49|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|TRUSTMARK [2030]|STARMARK [203000]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|UMR [2035]|UMR OPTIONS [203501]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|408.00||||408.00|110.91|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|408.00||||408.00|85.68|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|408.00||||408.00|78.28|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|408.00||||408.00|72.01|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|CORESOURCE [1315]|CORESOURCE [131500]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|GEHA [1415]|GEHA [141500]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|408.00||||408.00|81.36|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|408.00||||408.00|109.21|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|CHAMPVA [1240]|CHAMP VA [124000]|408.00||||408.00|306|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|408.00||||408.00|78.28|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|||408.00||||408.00|122.4|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|408.00||||408.00|75.97|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|408.00||||408.00|195.64|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|408.00||||408.00|265.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|408.00||||408.00|408|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|408.00||||408.00|367.2|408|33.83 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|408.00||||408.00||| 32273090|EAP|0320 - RADIOLOGY-DIAGNOSTIC-GENERAL|HC FOREARM 2 VIEWS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|408.00||||408.00||| 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|GEHA [1415]|GEHA [141500]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|806.00||||806.00|363.81|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|CORESOURCE [1315]|CORESOURCE [131500]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|806.00||||806.00|508.47|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|CHAMPVA [1240]|CHAMP VA [124000]|806.00||||806.00|604.5|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|||806.00||||806.00|241.8|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|806.00||||806.00|169.26|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|UMR [2035]|UMR OPTIONS [203501]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|806.00||||806.00|346.58|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MULTIPLAN [1680]|IHC HS [168011]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|TRUSTMARK [2030]|STARMARK [203000]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|806.00||||806.00|389.06|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|806.00||||806.00|350.03|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|806.00||||806.00|282.91|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|806.00||||806.00|389.06|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|806.00||||806.00|343.36|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|806.00||||806.00|403.81|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|806.00||||806.00|483.6|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|806.00||||806.00|371.38|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|806.00||||806.00|806|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|806.00||||806.00|338.07|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|806.00||||806.00|143.85|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|HEALTHNET [1495]|HEALTHNET [149500]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MULTIPLAN [1680]|HMA [168003]|806.00||||806.00|530.54|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|806.00||||806.00|321.96|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|806.00||||806.00|508.47|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|FIRST HEALTH [1375]|QUALCHOICE [137513]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|806.00||||806.00|400.19|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|806.00||||806.00|346.58|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|806.00||||806.00|725.4|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|806.00||||806.00|360.77|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|806.00||||806.00|516.39|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|806.00||||806.00|523.9|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|806.00||||806.00|386.48|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|806.00||||806.00|353.69|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|806.00||||806.00|350.03|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|806.00||||806.00|806|806|143.85 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|806.00||||806.00||| 32273525|EAP|0322 - RADIOLOGY-DIAGNOSTIC-ARTHROGRAPHY|HC ARTHROGRAM HIP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|806.00||||806.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|||10.00||||10.00|3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|||10.00||||10.00|3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|||10.00||||10.00|3|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3233|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FOLIC ACID 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|GEHA [1415]|GEHA [141500]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11274.00||||11274.00|2690.82|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11274.00||||11274.00|6289.53|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|CHAMPVA [1240]|CHAMP VA [124000]|11274.00||||11274.00|8455.5|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11274.00||||11274.00|2381.31|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11274.00||||11274.00|2588.88|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|||11274.00||||11274.00|3382.2|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11274.00||||11274.00|7328.1|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|UMR [2035]|UMR OPTIONS [203501]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11274.00||||11274.00|4847.82|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|FIRST HEALTH [1375]|QUALCHOICE [137513]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|FMH BENEFIT SERVICES [1390]|FMH [139000]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MULTIPLAN [1680]|IHC HS [168011]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|HEALTHNET [1495]|HEALTHNET [149500]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|TRUSTMARK [2030]|STARMARK [203000]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11274.00||||11274.00|2588.88|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11274.00||||11274.00|4847.82|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11274.00||||11274.00|4812.53|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11274.00||||11274.00|10460.93|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11274.00||||11274.00|3957.17|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11274.00||||11274.00|5648.27|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11274.00||||11274.00|4802.72|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11274.00||||11274.00|4593.77|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11274.00||||11274.00|6764.4|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11274.00||||11274.00|4812.53|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11274.00||||11274.00|2500.44|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|AETNA [1015]|AETNA ACO WILCO [101532]|11274.00||||11274.00|134.69|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MULTIPLAN [1680]|HMA [168003]|11274.00||||11274.00|6562.54|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11274.00||||11274.00|6289.53|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|CORESOURCE [1315]|CORESOURCE [131500]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11274.00||||11274.00|2959.9|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11274.00||||11274.00|4462.52|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11274.00||||11274.00|10146.6|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11274.00||||11274.00|6387.53|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11274.00||||11274.00|11274|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11274.00||||11274.00|2367.54|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11274.00||||11274.00|4375.02|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11274.00||||11274.00|5405.88|11274|134.69 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11274.00||||11274.00||| 32375605|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC AORTOGRAM THORACIC W/SER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11274.00||||11274.00||| 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3645.00||||3645.00|2381.31|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|CHAMPVA [1240]|CHAMP VA [124000]|3645.00||||3645.00|2733.75|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3645.00||||3645.00|3645|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|CORESOURCE [1315]|CORESOURCE [131500]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3645.00||||3645.00|2690.82|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|GEHA [1415]|GEHA [141500]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3645.00||||3645.00|2901.72|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3645.00||||3645.00|3645|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3645.00||||3645.00|1567.35|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3645.00||||3645.00|1279.4|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3645.00||||3645.00|1552.77|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3645.00||||3645.00|2769.82|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3645.00||||3645.00|2588.88|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3645.00||||3645.00|2901.72|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|TRUSTMARK [2030]|STARMARK [203000]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|AETNA [1015]|AETNA ACO WILCO [101532]|3645.00||||3645.00|139.58|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|HEALTHNET [1495]|HEALTHNET [149500]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MULTIPLAN [1680]|IHC HS [168011]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3645.00||||3645.00|3645|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MULTIPLAN [1680]|HMA [168003]|3645.00||||3645.00|3956.89|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3645.00||||3645.00|2500.44|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3645.00||||3645.00|2187|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3645.00||||3645.00|2959.9|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3645.00||||3645.00|1567.35|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3645.00||||3645.00|2690.69|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3645.00||||3645.00|1826.15|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|UMR [2035]|UMR OPTIONS [203501]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3645.00||||3645.00|3645|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3645.00||||3645.00|765.45|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3645.00||||3645.00|3645|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3645.00||||3645.00|2637.93|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3645.00||||3645.00|3280.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3645.00||||3645.00|2369.25|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3645.00||||3645.00|1747.78|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|||3645.00||||3645.00|1093.5|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3645.00||||3645.00|2588.88|3956.89|139.58 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3645.00||||3645.00||| 32375710|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EXTREMITY UNILATERAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3645.00||||3645.00||| 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14922.00||||14922.00|2690.82|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|CORESOURCE [1315]|CORESOURCE [131500]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14922.00||||14922.00|6289.53|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|CHAMPVA [1240]|CHAMP VA [124000]|14922.00||||14922.00|11191.5|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14922.00||||14922.00|2381.31|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|||14922.00||||14922.00|4476.6|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14922.00||||14922.00|7155.1|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14922.00||||14922.00|14922|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14922.00||||14922.00|3133.62|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14922.00||||14922.00|6387.53|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|UMR [2035]|UMR OPTIONS [203501]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14922.00||||14922.00|6416.46|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14922.00||||14922.00|2959.9|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14922.00||||14922.00|4462.52|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MULTIPLAN [1680]|IHC HS [168011]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14922.00||||14922.00|6289.53|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MULTIPLAN [1680]|HMA [168003]|14922.00||||14922.00|6562.54|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14922.00||||14922.00|9699.3|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|HEALTHNET [1495]|HEALTHNET [149500]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|AETNA [1015]|AETNA ACO WILCO [101532]|14922.00||||14922.00|154.25|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14922.00||||14922.00|2588.88|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|TRUSTMARK [2030]|STARMARK [203000]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14922.00||||14922.00|2500.44|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14922.00||||14922.00|4812.53|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14922.00||||14922.00|2588.88|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14922.00||||14922.00|8953.2|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|GEHA [1415]|GEHA [141500]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14922.00||||14922.00|4593.77|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14922.00||||14922.00|6416.46|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14922.00||||14922.00|7475.92|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14922.00||||14922.00|5237.62|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14922.00||||14922.00|6356.77|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14922.00||||14922.00|10460.93|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14922.00||||14922.00|4375.02|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14922.00||||14922.00|4812.53|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14922.00||||14922.00|13429.8|14922|154.25 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14922.00||||14922.00||| 32375726|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAPHY VISCERAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14922.00||||14922.00||| 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11274.00||||11274.00|4812.53|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11274.00||||11274.00|10460.93|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11274.00||||11274.00|4847.82|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11274.00||||11274.00|5648.27|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11274.00||||11274.00|3957.17|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11274.00||||11274.00|4802.72|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11274.00||||11274.00|4593.77|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11274.00||||11274.00|6764.4|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11274.00||||11274.00|4812.53|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11274.00||||11274.00|2500.44|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|AETNA [1015]|AETNA ACO WILCO [101532]|11274.00||||11274.00|172.8|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|HEALTHNET [1495]|HEALTHNET [149500]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MULTIPLAN [1680]|HMA [168003]|11274.00||||11274.00|6562.54|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MULTIPLAN [1680]|IHC HS [168011]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11274.00||||11274.00|6289.53|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11274.00||||11274.00|2959.9|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11274.00||||11274.00|4847.82|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11274.00||||11274.00|4462.52|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|TRUSTMARK [2030]|STARMARK [203000]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|UMR [2035]|UMR OPTIONS [203501]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11274.00||||11274.00|6387.53|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11274.00||||11274.00|2367.54|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11274.00||||11274.00|2588.88|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11274.00||||11274.00|11274|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11274.00||||11274.00|7328.1|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11274.00||||11274.00|5405.88|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|||11274.00||||11274.00|3382.2|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11274.00||||11274.00|2588.88|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11274.00||||11274.00|4375.02|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11274.00||||11274.00|2381.31|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|CHAMPVA [1240]|CHAMP VA [124000]|11274.00||||11274.00|8455.5|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11274.00||||11274.00|6289.53|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|CORESOURCE [1315]|CORESOURCE [131500]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11274.00||||11274.00|2690.82|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|GEHA [1415]|GEHA [141500]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11274.00||||11274.00|10146.6|11274|172.8 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11274.00||||11274.00||| 32375736|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PELVIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11274.00||||11274.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|GEHA [1415]|GEHA [141500]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7175.00||||7175.00|2690.82|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|CHAMPVA [1240]|CHAMP VA [124000]|7175.00||||7175.00|5381.25|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7175.00||||7175.00|2381.31|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7175.00||||7175.00|2588.88|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|||7175.00||||7175.00|2152.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7175.00||||7175.00|3440.41|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7175.00||||7175.00|4663.75|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7175.00||||7175.00|7175|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7175.00||||7175.00|1506.75|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|UMR [2035]|UMR OPTIONS [203501]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7175.00||||7175.00|3085.25|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7175.00||||7175.00|2959.9|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MULTIPLAN [1680]|IHC HS [168011]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|HEALTHNET [1495]|HEALTHNET [149500]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|AETNA [1015]|AETNA ACO WILCO [101532]|7175.00||||7175.00|142.64|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|TRUSTMARK [2030]|STARMARK [203000]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7175.00||||7175.00|2500.44|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7175.00||||7175.00|2588.88|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|CORESOURCE [1315]|CORESOURCE [131500]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7175.00||||7175.00|4305|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7175.00||||7175.00|3085.25|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7175.00||||7175.00|3594.68|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7175.00||||7175.00|2518.43|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7175.00||||7175.00|3056.55|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7175.00||||7175.00|6313.87|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7175.00||||7175.00|6457.5|7175|142.64 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MULTIPLAN [1680]|HMA [168003]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7175.00||||7175.00||| 32375741|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM PULMONARY UNILATERAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7175.00||||7175.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2119.00||||2119.00|2119|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2119.00||||2119.00|911.17|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2119.00||||2119.00|743.77|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2119.00||||2119.00|902.69|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2119.00||||2119.00|915.74|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2119.00||||2119.00|884.46|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|TRUSTMARK [2030]|STARMARK [203000]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|AETNA [1015]|AETNA ACO WILCO [101532]|2119.00||||2119.00|157.92|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|HEALTHNET [1495]|HEALTHNET [149500]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|FMH BENEFIT SERVICES [1390]|FMH [139000]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|FIRST HEALTH [1375]|QUALCHOICE [137513]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MULTIPLAN [1680]|IHC HS [168011]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2119.00||||2119.00|1046.97|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2119.00||||2119.00|911.17|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|UMR [2035]|UMR OPTIONS [203501]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2119.00||||2119.00|444.99|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2119.00||||2119.00|2119|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2119.00||||2119.00|1377.35|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2119.00||||2119.00|1271.4|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2119.00||||2119.00|1061.62|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2119.00||||2119.00|1016.06|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|||2119.00||||2119.00|635.7|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2119.00||||2119.00|915.74|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2119.00||||2119.00|842.32|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|CHAMPVA [1240]|CHAMP VA [124000]|2119.00||||2119.00|1589.25|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|CORESOURCE [1315]|CORESOURCE [131500]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2119.00||||2119.00|951.8|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|GEHA [1415]|GEHA [141500]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2119.00||||2119.00|1907.1|2119|157.92 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|MULTIPLAN [1680]|HMA [168003]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2119.00||||2119.00||| 32375746|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGRPH PULMONARY NONSLCTV CATH/VEN INJ RS&I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2119.00||||2119.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|GEHA [1415]|GEHA [141500]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|CORESOURCE [1315]|CORESOURCE [131500]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|||2324.00||||2324.00|697.2|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2324.00||||2324.00|1114.36|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2324.00||||2324.00|1510.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2324.00||||2324.00|2324|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|UMR [2035]|UMR OPTIONS [203501]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2324.00||||2324.00|999.32|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2324.00||||2324.00|488.04|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MULTIPLAN [1680]|IHC HS [168011]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|HEALTHNET [1495]|HEALTHNET [149500]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|AETNA [1015]|AETNA ACO WILCO [101532]|2324.00||||2324.00|112.68|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|TRUSTMARK [2030]|STARMARK [203000]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|CHAMPVA [1240]|CHAMP VA [124000]|2324.00||||2324.00|1743|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2324.00||||2324.00|1394.4|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2324.00||||2324.00|999.32|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2324.00||||2324.00|1164.32|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2324.00||||2324.00|815.72|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2324.00||||2324.00|990.02|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2324.00||||2324.00|1162|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2324.00||||2324.00|2091.6|2324|112.68 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MULTIPLAN [1680]|HMA [168003]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2324.00||||2324.00||| 32375774|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIOGRAM EACH ADDL VESSEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2324.00||||2324.00||| 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1685.00||||1685.00|660.19|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1685.00||||1685.00|1481.98|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1685.00||||1685.00|724.55|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1685.00||||1685.00|844.19|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1685.00||||1685.00|591.44|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1685.00||||1685.00|630.18|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1685.00||||1685.00|1011|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1685.00||||1685.00|660.19|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1685.00||||1685.00|884.46|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|TRUSTMARK [2030]|STARMARK [203000]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|AETNA [1015]|AETNA ACO WILCO [101532]|1685.00||||1685.00|132.24|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MULTIPLAN [1680]|IHC HS [168011]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1685.00||||1685.00|862.8|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MULTIPLAN [1680]|HMA [168003]|1685.00||||1685.00|900.25|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1685.00||||1685.00|1046.97|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1685.00||||1685.00|724.55|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1685.00||||1685.00|612.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|HEALTHNET [1495]|HEALTHNET [149500]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|UMR [2035]|UMR OPTIONS [203501]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1685.00||||1685.00|876.25|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1685.00||||1685.00|353.85|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1685.00||||1685.00|1685|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1685.00||||1685.00|915.74|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1685.00||||1685.00|717.81|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1685.00||||1685.00|1095.25|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1685.00||||1685.00|807.96|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|||1685.00||||1685.00|505.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1685.00||||1685.00|915.74|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1685.00||||1685.00|600.17|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1685.00||||1685.00|842.32|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|CHAMPVA [1240]|CHAMP VA [124000]|1685.00||||1685.00|1263.75|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1685.00||||1685.00|862.8|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|CORESOURCE [1315]|CORESOURCE [131500]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1685.00||||1685.00|951.8|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|GEHA [1415]|GEHA [141500]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1685.00||||1685.00|1516.5|1685|132.24 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1685.00||||1685.00||| 32375820|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC S&I VENOGRAM EXTREMITY UNILATERAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1685.00||||1685.00||| 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|GEHA [1415]|GEHA [141500]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1805.00||||1805.00|951.8|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|CORESOURCE [1315]|CORESOURCE [131500]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1805.00||||1805.00|1805|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|CHAMPVA [1240]|CHAMP VA [124000]|1805.00||||1805.00|1353.75|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1805.00||||1805.00|842.32|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1805.00||||1805.00|915.74|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|||1805.00||||1805.00|541.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1805.00||||1805.00|865.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1805.00||||1805.00|1173.25|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1805.00||||1805.00|1805|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1805.00||||1805.00|379.05|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1805.00||||1805.00|1805|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|UMR [2035]|UMR OPTIONS [203501]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1805.00||||1805.00|1583.69|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1805.00||||1805.00|776.15|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1805.00||||1805.00|1046.97|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MULTIPLAN [1680]|IHC HS [168011]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1805.00||||1805.00|1805|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MULTIPLAN [1680]|HMA [168003]|1805.00||||1805.00|2328.96|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|HEALTHNET [1495]|HEALTHNET [149500]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|AETNA [1015]|AETNA ACO WILCO [101532]|1805.00||||1805.00|135.3|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|TRUSTMARK [2030]|STARMARK [203000]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1805.00||||1805.00|884.46|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1805.00||||1805.00|1707.9|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1805.00||||1805.00|915.74|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1805.00||||1805.00|1083|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1805.00||||1805.00|1630.27|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1805.00||||1805.00|776.15|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1805.00||||1805.00|904.31|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1805.00||||1805.00|633.56|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1805.00||||1805.00|768.93|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1805.00||||1805.00|1805|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1805.00||||1805.00|1552.64|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1805.00||||1805.00|1707.9|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1805.00||||1805.00|1624.5|2328.96|135.3 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1805.00||||1805.00||| 32375822|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM EXTREMITY BILATERAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1805.00||||1805.00||| 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2501.00||||2501.00|2901.72|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2501.00||||2501.00|2637.93|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2501.00||||2501.00|1075.43|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2501.00||||2501.00|877.85|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2501.00||||2501.00|1065.43|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2501.00||||2501.00|1500.6|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2501.00||||2501.00|2588.88|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2501.00||||2501.00|2901.72|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|TRUSTMARK [2030]|STARMARK [203000]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2501.00||||2501.00|2637.93|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|AETNA [1015]|AETNA ACO WILCO [101532]|2501.00||||2501.00|128.57|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|HEALTHNET [1495]|HEALTHNET [149500]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MULTIPLAN [1680]|IHC HS [168011]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MULTIPLAN [1680]|HMA [168003]|2501.00||||2501.00|3956.89|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2501.00||||2501.00|2637.93|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2501.00||||2501.00|2637.93|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2501.00||||2501.00|1075.43|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2501.00||||2501.00|2690.69|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2501.00||||2501.00|2637.93|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|UMR [2035]|UMR OPTIONS [203501]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2501.00||||2501.00|525.21|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2501.00||||2501.00|2500.44|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2501.00||||2501.00|1625.65|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2501.00||||2501.00|1253|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2501.00||||2501.00|1199.23|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|||2501.00||||2501.00|750.3|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2501.00||||2501.00|2588.88|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2501.00||||2501.00|2637.93|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2501.00||||2501.00|2637.93|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2501.00||||2501.00|2381.31|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|CHAMPVA [1240]|CHAMP VA [124000]|2501.00||||2501.00|1875.75|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2501.00||||2501.00|2501|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|CORESOURCE [1315]|CORESOURCE [131500]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2501.00||||2501.00|2690.82|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|GEHA [1415]|GEHA [141500]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2501.00||||2501.00|2250.9|3956.89|128.57 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2501.00||||2501.00||| 32375825|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOCAVAGRAM INFERIOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2501.00||||2501.00||| 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2551.00||||2551.00|951.8|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|CORESOURCE [1315]|CORESOURCE [131500]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2551.00||||2551.00|862.8|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2551.00||||2551.00|842.32|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2551.00||||2551.00|915.74|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|||2551.00||||2551.00|765.3|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2551.00||||2551.00|1223.2|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2551.00||||2551.00|2551|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2551.00||||2551.00|876.25|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|UMR [2035]|UMR OPTIONS [203501]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2551.00||||2551.00|612.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2551.00||||2551.00|1096.93|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2551.00||||2551.00|1046.97|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MULTIPLAN [1680]|IHC HS [168011]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2551.00||||2551.00|862.8|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MULTIPLAN [1680]|HMA [168003]|2551.00||||2551.00|900.25|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2551.00||||2551.00|535.71|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2551.00||||2551.00|1658.15|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|HEALTHNET [1495]|HEALTHNET [149500]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|AETNA [1015]|AETNA ACO WILCO [101532]|2551.00||||2551.00|135.91|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|TRUSTMARK [2030]|STARMARK [203000]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2551.00||||2551.00|884.46|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|CHAMPVA [1240]|CHAMP VA [124000]|2551.00||||2551.00|1913.25|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2551.00||||2551.00|660.19|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2551.00||||2551.00|915.74|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2551.00||||2551.00|1530.6|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|GEHA [1415]|GEHA [141500]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2551.00||||2551.00|630.18|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2551.00||||2551.00|1096.93|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2551.00||||2551.00|1278.05|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2551.00||||2551.00|895.4|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2551.00||||2551.00|1086.73|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2551.00||||2551.00|1481.98|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2551.00||||2551.00|600.17|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2551.00||||2551.00|660.19|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2551.00||||2551.00|2295.9|2551|135.91 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2551.00||||2551.00||| 32375827|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC SUPERIOR VENOCAVOGRAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2551.00||||2551.00||| 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7175.00||||7175.00|2901.72|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7175.00||||7175.00|6313.87|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7175.00||||7175.00|3085.25|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7175.00||||7175.00|3594.68|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7175.00||||7175.00|2518.43|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7175.00||||7175.00|2769.82|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7175.00||||7175.00|4305|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7175.00||||7175.00|2901.72|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7175.00||||7175.00|2500.44|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|AETNA [1015]|AETNA ACO WILCO [101532]|7175.00||||7175.00|139.58|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MULTIPLAN [1680]|IHC HS [168011]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7175.00||||7175.00|3792.28|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7175.00||||7175.00|2959.9|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MULTIPLAN [1680]|HMA [168003]|7175.00||||7175.00|3956.89|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|HEALTHNET [1495]|HEALTHNET [149500]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7175.00||||7175.00|3085.25|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7175.00||||7175.00|2690.69|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|TRUSTMARK [2030]|STARMARK [203000]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|UMR [2035]|UMR OPTIONS [203501]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7175.00||||7175.00|3851.37|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7175.00||||7175.00|1506.75|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7175.00||||7175.00|2588.88|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7175.00||||7175.00|7175|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7175.00||||7175.00|4663.75|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7175.00||||7175.00|3440.41|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7175.00||||7175.00|3056.55|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|||7175.00||||7175.00|2152.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7175.00||||7175.00|2588.88|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7175.00||||7175.00|2637.93|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7175.00||||7175.00|2381.31|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|CHAMPVA [1240]|CHAMP VA [124000]|7175.00||||7175.00|5381.25|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7175.00||||7175.00|3792.28|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|CORESOURCE [1315]|CORESOURCE [131500]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7175.00||||7175.00|2690.82|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|GEHA [1415]|GEHA [141500]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7175.00||||7175.00|6457.5|7175|139.58 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7175.00||||7175.00||| 32375831|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC VENOGRAM RENAL UNILATERAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7175.00||||7175.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|GEHA [1415]|GEHA [141500]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1719.00||||1719.00|103.16|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|CORESOURCE [1315]|CORESOURCE [131500]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|CHAMPVA [1240]|CHAMP VA [124000]|1719.00||||1719.00|1289.25|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1719.00||||1719.00|91.29|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1719.00||||1719.00|99.25|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|||1719.00||||1719.00|515.7|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1719.00||||1719.00|824.26|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1719.00||||1719.00|1117.35|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1719.00||||1719.00|1719|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1719.00||||1719.00|360.99|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|UMR [2035]|UMR OPTIONS [203501]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1719.00||||1719.00|739.17|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1719.00||||1719.00|113.48|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|FIRST HEALTH [1375]|QUALCHOICE [137513]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MULTIPLAN [1680]|IHC HS [168011]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|HEALTHNET [1495]|HEALTHNET [149500]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|AETNA [1015]|AETNA ACO WILCO [101532]|1719.00||||1719.00|1719|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|TRUSTMARK [2030]|STARMARK [203000]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1719.00||||1719.00|95.86|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1719.00||||1719.00|99.25|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1719.00||||1719.00|1031.4|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1719.00||||1719.00|739.17|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1719.00||||1719.00|861.22|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1719.00||||1719.00|603.37|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1719.00||||1719.00|732.29|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1719.00||||1719.00|1719|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1719.00||||1719.00|1547.1|1719|91.29 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MULTIPLAN [1680]|HMA [168003]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1719.00||||1719.00||| 32375898|EAP|0323 - RADIOLOGY-DIAGNOSTIC-ARTERIOGRAPHY|HC ANGIO EXISTING CATH FOLLOWUP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1719.00||||1719.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|||10.00||||10.00|3|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 325|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALPRAZOLAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|345.24||||345.24|172.97|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|345.24||||345.24|121.18|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|345.24||||345.24|147.07|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|TRUSTMARK [2030]|STARMARK [203000]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|HEALTHNET [1495]|HEALTHNET [149500]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|345.24||||345.24|148.45|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MULTIPLAN [1680]|IHC HS [168011]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|UMR [2035]|UMR OPTIONS [203501]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|345.24||||345.24|72.5|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|345.24||||345.24|207.14|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|345.24||||345.24|148.45|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|345.24||||345.24|224.41|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|345.24||||345.24|165.54|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|||345.24||||345.24|103.57|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|CHAMPVA [1240]|CHAMP VA [124000]|345.24||||345.24|258.93|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|CORESOURCE [1315]|CORESOURCE [131500]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|GEHA [1415]|GEHA [141500]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|345.24||||345.24|310.72|310.72|72.5 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|AETNA [1015]|AETNA ACO WILCO [101532]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MULTIPLAN [1680]|HMA [168003]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|345.24||||345.24||| 32569|ERX|0250 - PHARMACY-GENERAL|STERILE TALC 4 GRAM INTRAPLEURAL AEROSOL POWDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|345.24||||345.24||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.84|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.84|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.84 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 3291|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FUROSEMIDE 10 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|||10.00||||10.00|3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|||10.00||||10.00|3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|||10.00||||10.00|3|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3294|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|||10.00||||10.00|3|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|||10.00||||10.00|3|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3295|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|||10.00||||10.00|3|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FUROSEMIDE 80 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|GEHA [1415]|GEHA [141500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|GEHA [1415]|GEHA [141500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|74.83||||74.83|56.12|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|||74.83||||74.83|22.45|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|||74.83||||74.83|22.45|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74.83||||74.83|35.88|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74.83||||74.83|35.88|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74.83||||74.83|48.64|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74.83||||74.83|48.64|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74.83||||74.83|15.71|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74.83||||74.83|15.71|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74.83||||74.83|32.18|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74.83||||74.83|32.18|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74.83||||74.83|44.9|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74.83||||74.83|44.9|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74.83||||74.83|32.18|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74.83||||74.83|37.49|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|74.83||||74.83|56.12|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74.83||||74.83|26.27|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74.83||||74.83|31.88|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74.83||||74.83|32.18|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74.83||||74.83|37.49|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74.83||||74.83|26.27|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74.83||||74.83|31.88|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74.83||||74.83|67.35|67.35|15.71 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74.83||||74.83||| 33009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VORICONAZOLE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74.83||||74.83||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33083|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MIDODRINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|UMR [2035]|UMR OPTIONS [203501]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|AETNA [1015]|AETNA ACO WILCO [101532]|378.00||||378.00|91.96|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|378.00||||378.00|378|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|378.00||||378.00|226.8|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|378.00||||378.00|68.35|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|378.00||||378.00|67.32|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|378.00||||378.00|181.25|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|TRUSTMARK [2030]|STARMARK [203000]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|378.00||||378.00|79.38|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|||378.00||||378.00|113.4|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|CORESOURCE [1315]|CORESOURCE [131500]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MULTIPLAN [1680]|IHC HS [168011]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|378.00||||378.00|89.33|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|378.00||||378.00|245.7|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|378.00||||378.00|38.79|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|CHAMPVA [1240]|CHAMP VA [124000]|378.00||||378.00|283.5|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|378.00||||378.00|69.97|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|378.00||||378.00|189|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|378.00||||378.00|65.25|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|378.00||||378.00|90.72|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|HEALTHNET [1495]|HEALTHNET [149500]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|378.00||||378.00|63.38|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|378.00||||378.00|71.83|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|378.00||||378.00|71.83|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|378.00||||378.00|161.03|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|378.00||||378.00|65.03|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|GEHA [1415]|GEHA [141500]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|378.00||||378.00|189.38|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|378.00||||378.00|62.14|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|378.00||||378.00|61.93|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|378.00||||378.00|68.35|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|378.00||||378.00|89.33|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|378.00||||378.00|76.97|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|MULTIPLAN [1680]|HMA [168003]|378.00||||378.00|93.21|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|378.00||||378.00|67.32|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|378.00||||378.00|340.2|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|378.00||||378.00|132.68|378|38.79 33180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN SINGLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|378.00||||378.00||| 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|769.00||||769.00|689.3|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|FIRST HEALTH [1375]|QUALCHOICE [137513]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|769.00||||769.00|423.66|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|769.00||||769.00|324.17|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|FMH BENEFIT SERVICES [1390]|FMH [139000]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|769.00||||769.00|300.59|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|769.00||||769.00|99.85|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|TRUSTMARK [2030]|STARMARK [203000]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MULTIPLAN [1680]|HMA [168003]|769.00||||769.00|442.05|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|769.00||||769.00|99.85|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|HEALTHNET [1495]|HEALTHNET [149500]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MULTIPLAN [1680]|IHC HS [168011]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|769.00||||769.00|114.16|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|||769.00||||769.00|230.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|769.00||||769.00|161.49|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|769.00||||769.00|368.74|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|769.00||||769.00|423.66|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|769.00||||769.00|461.4|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|769.00||||769.00|309.44|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|UMR [2035]|UMR OPTIONS [203501]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|CORESOURCE [1315]|CORESOURCE [131500]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|769.00||||769.00|330.67|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|769.00||||769.00|385.27|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|769.00||||769.00|91.84|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|CHAMPVA [1240]|CHAMP VA [124000]|769.00||||769.00|576.75|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|769.00||||769.00|269.92|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|769.00||||769.00|330.67|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|769.00||||769.00|103.78|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|769.00||||769.00|769|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|769.00||||769.00|430.26|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|769.00||||769.00|327.59|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|GEHA [1415]|GEHA [141500]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|769.00||||769.00|499.85|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|769.00||||769.00|294.7|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|769.00||||769.00|96.44|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|769.00||||769.00|324.17|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|769.00||||769.00|692.1|769|91.84 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|769.00||||769.00||| 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|AETNA [1015]|AETNA ACO WILCO [101532]|769.00||||769.00||| 33196420|EAP|0331 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC CHEMO INTRA-ARTERIAL PUSH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|769.00||||769.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|||10.00||||10.00|3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|||10.00||||10.00|3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|||10.00||||10.00|3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|||10.00||||10.00|3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|||10.00||||10.00|3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|||10.00||||10.00|3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|||10.00||||10.00|3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33228|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 875 MG-POTASSIUM CLAVULANATE 125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.76||||61.76|40.14|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.76||||61.76|26.56|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|61.76||||61.76|46.32|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|||61.76||||61.76|18.53|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.76||||61.76|29.61|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.76||||61.76|30.94|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.76||||61.76|26.31|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.76||||61.76|37.06|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|61.76||||61.76|55.58|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.76||||61.76|12.97|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.76||||61.76|26.56|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.76||||61.76|21.68|55.58|12.97 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.76||||61.76||| 33230|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 400 MG-POTASSIUM CLAVULANATE 57 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|61.76||||61.76||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|910.00||||910.00|319.41|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|910.00||||910.00|391.3|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|910.00||||910.00|546|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|910.00||||910.00|387.66|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|910.00||||910.00|455.91|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|HEALTHNET [1495]|HEALTHNET [149500]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|TRUSTMARK [2030]|STARMARK [203000]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|AETNA [1015]|AETNA ACO WILCO [101532]|910.00||||910.00|158.88|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|910.00||||910.00|391.3|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MULTIPLAN [1680]|IHC HS [168011]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|UMR [2035]|UMR OPTIONS [203501]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|910.00||||910.00|591.5|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|910.00||||910.00|910|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|910.00||||910.00|436.35|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|CORESOURCE [1315]|CORESOURCE [131500]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|CHAMPVA [1240]|CHAMP VA [124000]|910.00||||910.00|682.5|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|910.00||||910.00|191.1|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|GEHA [1415]|GEHA [141500]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|||910.00||||910.00|273|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|910.00||||910.00|455|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|910.00||||910.00|819|910|158.88 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MULTIPLAN [1680]|HMA [168003]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|910.00||||910.00||| 33377014|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC GUIDED THERAPY PLACEMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|910.00||||910.00||| 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|GEHA [1415]|GEHA [141500]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1185.00||||1185.00|155.12|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1185.00||||1185.00|568.21|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1185.00||||1185.00|175.93|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1185.00||||1185.00|770.25|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1185.00||||1185.00|1185|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|UMR [2035]|UMR OPTIONS [203501]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1185.00||||1185.00|122.91|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1185.00||||1185.00|509.55|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1185.00||||1185.00|149.24|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|HEALTHNET [1495]|HEALTHNET [149500]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|TRUSTMARK [2030]|STARMARK [203000]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|CHAMPVA [1240]|CHAMP VA [124000]|1185.00||||1185.00|888.75|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1185.00||||1185.00|415.94|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1185.00||||1185.00|149.24|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1185.00||||1185.00|509.55|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1185.00||||1185.00|132.55|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1185.00||||1185.00|711|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|CORESOURCE [1315]|CORESOURCE [131500]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1185.00||||1185.00|248.85|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1185.00||||1185.00|173.23|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1185.00||||1185.00|144.14|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1185.00||||1185.00|593.69|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1185.00||||1185.00|504.81|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1185.00||||1185.00|295.85|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1185.00||||1185.00|132.55|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|AETNA [1015]|AETNA ACO WILCO [101532]|1185.00||||1185.00|57.51|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MULTIPLAN [1680]|IHC HS [168011]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|||1185.00||||1185.00|355.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1185.00||||1185.00|170.62|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1185.00||||1185.00|137.27|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1185.00||||1185.00|1066.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1185.00||||1185.00|126.53|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MULTIPLAN [1680]|HMA [168003]|1185.00||||1185.00|180.75|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1185.00||||1185.00|173.23|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1185.00||||1185.00|120.5|1185|57.51 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1185.00||||1185.00||| 33377300|EAP|0333 - RADIOLOGY-THERAPEUTIC AND/OR CHEMOTHERAPY A|HC DOSIMETRY BASIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1185.00||||1185.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|||10.00||||10.00|3|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|||10.00||||10.00|3|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 33512|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESCITALOPRAM 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|48.65||||48.65|36.49|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.65||||48.65|23.33|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.65||||48.65|10.22|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|GEHA [1415]|GEHA [141500]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.65||||48.65|20.92|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.65||||48.65|17.08|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.65||||48.65|20.92|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.65||||48.65|29.19|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48.65||||48.65|24.37|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48.65||||48.65|20.72|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.65||||48.65|31.62|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|48.65||||48.65|43.79|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|||48.65||||48.65|14.59|43.79|10.22 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.65||||48.65||| 34153|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|EZETIMIBE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.65||||48.65||| 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|305.00||||305.00|350.41|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|CHAMPVA [1240]|CHAMP VA [124000]|305.00||||305.00|228.75|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|CORESOURCE [1315]|CORESOURCE [131500]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|305.00||||305.00|147.78|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|305.00||||305.00|130.79|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|GEHA [1415]|GEHA [141500]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|305.00||||305.00|350.41|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|305.00||||305.00|385.45|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|305.00||||305.00|152.81|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|305.00||||305.00|107.06|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|305.00||||305.00|183|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|305.00||||305.00|350.41|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|305.00||||305.00|137.33|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|305.00||||305.00|385.45|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|305.00||||305.00|131.15|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|TRUSTMARK [2030]|STARMARK [203000]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|AETNA [1015]|AETNA ACO WILCO [101532]|305.00||||305.00|126.96|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|HEALTHNET [1495]|HEALTHNET [149500]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|305.00||||305.00|142.18|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|305.00||||305.00|350.41|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MULTIPLAN [1680]|IHC HS [168011]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|305.00||||305.00|129.93|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MULTIPLAN [1680]|HMA [168003]|305.00||||305.00|525.62|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|305.00||||305.00|350.41|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|305.00||||305.00|350.41|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|305.00||||305.00|162.56|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|305.00||||305.00|131.15|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|305.00||||305.00|357.42|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|UMR [2035]|UMR OPTIONS [203501]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|305.00||||305.00|350.41|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|305.00||||305.00|64.05|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|305.00||||305.00|305|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|305.00||||305.00|274.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|305.00||||305.00|198.25|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|305.00||||305.00|146.25|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|||305.00||||305.00|91.5|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|305.00||||305.00|142.18|525.62|64.05 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|305.00||||305.00||| 34178012|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID UPTAKE SINGLE/MULTIPLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|305.00||||305.00||| 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|401.00||||401.00|194.47|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|401.00||||401.00|401|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|CHAMPVA [1240]|CHAMP VA [124000]|401.00||||401.00|300.75|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|401.00||||401.00|192.28|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|401.00||||401.00|260.65|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|401.00||||401.00|401|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|||401.00||||401.00|120.3|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|401.00||||401.00|84.21|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|401.00||||401.00|401|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|UMR [2035]|UMR OPTIONS [203501]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|401.00||||401.00|172.43|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|CORESOURCE [1315]|CORESOURCE [131500]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|401.00||||401.00|213.91|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|FIRST HEALTH [1375]|QUALCHOICE [137513]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|FMH BENEFIT SERVICES [1390]|FMH [139000]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|401.00||||401.00|357.42|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|401.00||||401.00|401|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MULTIPLAN [1680]|HMA [168003]|401.00||||401.00|525.62|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|401.00||||401.00|172.1|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|AETNA [1015]|AETNA ACO WILCO [101532]|401.00||||401.00|307.49|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|401.00||||401.00|180.71|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|401.00||||401.00|385.45|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|HEALTHNET [1495]|HEALTHNET [149500]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|401.00||||401.00|187.1|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|401.00||||401.00|367.93|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|401.00||||401.00|240.6|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|TRUSTMARK [2030]|STARMARK [203000]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|401.00||||401.00|401|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|401.00||||401.00|172.43|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|GEHA [1415]|GEHA [141500]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|401.00||||401.00|200.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|401.00||||401.00|187.1|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|401.00||||401.00|140.75|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|MULTIPLAN [1680]|IHC HS [168011]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|401.00||||401.00|170.83|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|401.00||||401.00|350.41|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|401.00||||401.00|385.45|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|401.00||||401.00|360.9|525.62|84.21 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|401.00||||401.00||| 34178013|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID IMAGING (W/VASC FLOW WHEN PERFORMED)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|401.00||||401.00||| 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3009.00||||3009.00|494.2|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3009.00||||3009.00|1293.87|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3009.00||||3009.00|1088.8|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3009.00||||3009.00|1281.83|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3009.00||||3009.00|494.2|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|AETNA [1015]|AETNA ACO WILCO [101532]|3009.00||||3009.00|481.3|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|HEALTHNET [1495]|HEALTHNET [149500]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3009.00||||3009.00|382.67|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MULTIPLAN [1680]|IHC HS [168011]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3009.00||||3009.00|645.87|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|FIRST HEALTH [1375]|QUALCHOICE [137513]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3009.00||||3009.00|437.51|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|FMH BENEFIT SERVICES [1390]|FMH [139000]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3009.00||||3009.00|1507.51|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3009.00||||3009.00|1056.16|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MULTIPLAN [1680]|HMA [168003]|3009.00||||3009.00|673.91|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3009.00||||3009.00|458.26|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3009.00||||3009.00|655.94|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3009.00||||3009.00|471.74|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3009.00||||3009.00|369.6|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|TRUSTMARK [2030]|STARMARK [203000]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|||3009.00||||3009.00|902.7|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3009.00||||3009.00|1442.82|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3009.00||||3009.00|382.67|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3009.00||||3009.00|1955.85|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3009.00||||3009.00|449.27|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3009.00||||3009.00|351.99|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3009.00||||3009.00|1805.4|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|CHAMPVA [1240]|CHAMP VA [124000]|3009.00||||3009.00|2256.75|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3009.00||||3009.00|645.87|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|UMR [2035]|UMR OPTIONS [203501]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|CORESOURCE [1315]|CORESOURCE [131500]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3009.00||||3009.00|397.74|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3009.00||||3009.00|1293.87|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|GEHA [1415]|GEHA [141500]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3009.00||||3009.00|631.89|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3009.00||||3009.00|3009|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3009.00||||3009.00|2708.1|3009|351.99 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3009.00||||3009.00||| 34178018|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC THYROID CA METS WHOLE BODY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3009.00||||3009.00||| 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|GEHA [1415]|GEHA [141500]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1477.00||||1477.00|304.04|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1477.00||||1477.00|503.75|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|CORESOURCE [1315]|CORESOURCE [131500]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1477.00||||1477.00|269.07|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1477.00||||1477.00|292.52|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|||1477.00||||1477.00|443.1|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1477.00||||1477.00|960.05|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1477.00||||1477.00|1477|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1477.00||||1477.00|310.17|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|UMR [2035]|UMR OPTIONS [203501]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1477.00||||1477.00|357.42|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1477.00||||1477.00|635.11|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|FIRST HEALTH [1375]|QUALCHOICE [137513]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1477.00||||1477.00|334.44|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|FMH BENEFIT SERVICES [1390]|FMH [139000]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MULTIPLAN [1680]|IHC HS [168011]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1477.00||||1477.00|511.6|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1477.00||||1477.00|708.22|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|AETNA [1015]|AETNA ACO WILCO [101532]|1477.00||||1477.00|459.07|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|TRUSTMARK [2030]|STARMARK [203000]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1477.00||||1477.00|282.53|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1477.00||||1477.00|385.45|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1477.00||||1477.00|292.52|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1477.00||||1477.00|367.93|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|CHAMPVA [1240]|CHAMP VA [124000]|1477.00||||1477.00|1107.75|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1477.00||||1477.00|886.2|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1477.00||||1477.00|844.93|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1477.00||||1477.00|635.11|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1477.00||||1477.00|739.98|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1477.00||||1477.00|518.43|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1477.00||||1477.00|629.2|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1477.00||||1477.00|350.41|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1477.00||||1477.00|503.75|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1477.00||||1477.00|385.45|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|MULTIPLAN [1680]|HMA [168003]|1477.00||||1477.00|525.62|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|HEALTHNET [1495]|HEALTHNET [149500]|1477.00||||1477.00|1329.3|1477|269.07 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1477.00||||1477.00||| 34178070|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PARATHYROID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1477.00||||1477.00||| 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4387.00||||4387.00|494.2|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4387.00||||4387.00|1886.41|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4387.00||||4387.00|1539.84|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4387.00||||4387.00|1868.86|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4387.00||||4387.00|2632.2|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4387.00||||4387.00|494.2|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4387.00||||4387.00|329.32|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|TRUSTMARK [2030]|STARMARK [203000]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|4387.00||||4387.00|526.52|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4387.00||||4387.00|340.96|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|HEALTHNET [1495]|HEALTHNET [149500]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4387.00||||4387.00|645.87|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4387.00||||4387.00|1088.8|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4387.00||||4387.00|2197.89|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|FMH BENEFIT SERVICES [1390]|FMH [139000]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4387.00||||4387.00|471.74|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MULTIPLAN [1680]|HMA [168003]|4387.00||||4387.00|673.91|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MULTIPLAN [1680]|IHC HS [168011]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|FIRST HEALTH [1375]|QUALCHOICE [137513]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4387.00||||4387.00|389.83|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4387.00||||4387.00|458.26|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4387.00||||4387.00|655.94|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4387.00||||4387.00|921.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4387.00||||4387.00|2851.55|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|||4387.00||||4387.00|1316.1|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4387.00||||4387.00|340.96|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4387.00||||4387.00|2103.57|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4387.00||||4387.00|313.63|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|4387.00||||4387.00|3290.25|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4387.00||||4387.00|645.87|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|CORESOURCE [1315]|CORESOURCE [131500]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4387.00||||4387.00|4387|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|UMR [2035]|UMR OPTIONS [203501]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4387.00||||4387.00|354.39|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|GEHA [1415]|GEHA [141500]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4387.00||||4387.00|1886.41|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4387.00||||4387.00|449.27|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4387.00||||4387.00|3948.3|4387|313.63 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4387.00||||4387.00||| 34178195|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LYMPH SYSTEM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4387.00||||4387.00||| 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|GEHA [1415]|GEHA [141500]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1705.00||||1705.00|398.73|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|CORESOURCE [1315]|CORESOURCE [131500]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1705.00||||1705.00|503.75|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|CHAMPVA [1240]|CHAMP VA [124000]|1705.00||||1705.00|1278.75|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1705.00||||1705.00|817.55|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1705.00||||1705.00|1705|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1705.00||||1705.00|358.05|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1705.00||||1705.00|383.62|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|UMR [2035]|UMR OPTIONS [203501]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1705.00||||1705.00|733.15|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1705.00||||1705.00|438.6|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1705.00||||1705.00|352.87|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1705.00||||1705.00|357.42|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1705.00||||1705.00|1108.25|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1705.00||||1705.00|511.6|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MULTIPLAN [1680]|IHC HS [168011]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MULTIPLAN [1680]|HMA [168003]|1705.00||||1705.00|525.62|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|HEALTHNET [1495]|HEALTHNET [149500]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|1705.00||||1705.00|301.37|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1705.00||||1705.00|370.52|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|||1705.00||||1705.00|511.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1705.00||||1705.00|385.45|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1705.00||||1705.00|383.62|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1705.00||||1705.00|367.93|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1705.00||||1705.00|1023|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|TRUSTMARK [2030]|STARMARK [203000]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1705.00||||1705.00|844.93|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1705.00||||1705.00|733.15|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1705.00||||1705.00|854.21|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1705.00||||1705.00|598.46|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1705.00||||1705.00|726.33|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1705.00||||1705.00|503.75|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1705.00||||1705.00|350.41|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1705.00||||1705.00|385.45|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1705.00||||1705.00|1534.5|1705|301.37 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1705.00||||1705.00||| 34178215|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC LIVER & SPLEEN STATIC ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1705.00||||1705.00||| 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MULTIPLAN [1680]|IHC HS [168011]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1657.00||||1657.00|385.45|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1657.00||||1657.00|712.51|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1657.00||||1657.00|830.16|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1657.00||||1657.00|581.61|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1657.00||||1657.00|705.88|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1657.00||||1657.00|844.93|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1657.00||||1657.00|994.2|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1657.00||||1657.00|367.93|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1657.00||||1657.00|385.45|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1657.00||||1657.00|359.87|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|TRUSTMARK [2030]|STARMARK [203000]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|1657.00||||1657.00|519.19|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1657.00||||1657.00|503.75|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MULTIPLAN [1680]|HMA [168003]|1657.00||||1657.00|525.62|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1657.00||||1657.00|425.99|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1657.00||||1657.00|357.42|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1657.00||||1657.00|511.6|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1657.00||||1657.00|1657|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1657.00||||1657.00|372.59|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|||1657.00||||1657.00|497.1|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1657.00||||1657.00|794.53|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1657.00||||1657.00|372.59|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1657.00||||1657.00|1077.05|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1657.00||||1657.00|350.41|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1657.00||||1657.00|347.97|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1657.00||||1657.00|342.72|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|UMR [2035]|UMR OPTIONS [203501]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|1657.00||||1657.00|1242.75|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1657.00||||1657.00|503.75|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1657.00||||1657.00|387.26|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1657.00||||1657.00|712.51|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|GEHA [1415]|GEHA [141500]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1657.00||||1657.00|1491.3|1657|342.72 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1657.00||||1657.00||| 34178226|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBILIARY SYSTEM IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1657.00||||1657.00||| 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1930.00||||1930.00|387.26|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1930.00||||1930.00|342.72|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|||1930.00||||1930.00|579|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1930.00||||1930.00|925.44|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1930.00||||1930.00|405.3|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|UMR [2035]|UMR OPTIONS [203501]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1930.00||||1930.00|829.9|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1930.00||||1930.00|425.99|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|FMH BENEFIT SERVICES [1390]|FMH [139000]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MULTIPLAN [1680]|IHC HS [168011]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MULTIPLAN [1680]|HMA [168003]|1930.00||||1930.00|673.91|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|HEALTHNET [1495]|HEALTHNET [149500]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|AETNA [1015]|AETNA ACO WILCO [101532]|1930.00||||1930.00|710.11|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|TRUSTMARK [2030]|STARMARK [203000]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|FIRST HEALTH [1375]|QUALCHOICE [137513]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1930.00||||1930.00|458.26|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1930.00||||1930.00|359.87|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1930.00||||1930.00|494.2|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1930.00||||1930.00|372.59|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1930.00||||1930.00|1930|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1930.00||||1930.00|471.74|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1930.00||||1930.00|645.87|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1930.00||||1930.00|655.94|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1930.00||||1930.00|1158|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1930.00||||1930.00|1088.8|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1930.00||||1930.00|1254.5|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1930.00||||1930.00|829.9|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1930.00||||1930.00|966.93|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1930.00||||1930.00|677.43|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1930.00||||1930.00|822.18|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1930.00||||1930.00|372.59|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1930.00||||1930.00|494.2|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1930.00||||1930.00|449.27|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|CHAMPVA [1240]|CHAMP VA [124000]|1930.00||||1930.00|1447.5|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1930.00||||1930.00|645.87|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|CORESOURCE [1315]|CORESOURCE [131500]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|GEHA [1415]|GEHA [141500]|1930.00||||1930.00|1737|1930|342.72 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1930.00||||1930.00||| 34178227|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC HEPATOBIL SYST IMAGE W/DRUG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1930.00||||1930.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1277.00||||1277.00|549.11|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1277.00||||1277.00|448.23|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1277.00||||1277.00|766.2|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1277.00||||1277.00|326.37|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|TRUSTMARK [2030]|STARMARK [203000]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|AETNA [1015]|AETNA ACO WILCO [101532]|1277.00||||1277.00|368|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|HEALTHNET [1495]|HEALTHNET [149500]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|FMH BENEFIT SERVICES [1390]|FMH [139000]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1277.00||||1277.00|639.78|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1277.00||||1277.00|844.93|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MULTIPLAN [1680]|IHC HS [168011]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|FIRST HEALTH [1375]|QUALCHOICE [137513]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1277.00||||1277.00|373.15|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1277.00||||1277.00|549.11|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1277.00||||1277.00|268.17|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1277.00||||1277.00|315.22|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1277.00||||1277.00|830.05|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1277.00||||1277.00|326.37|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|CHAMPVA [1240]|CHAMP VA [124000]|1277.00||||1277.00|957.75|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|GEHA [1415]|GEHA [141500]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1277.00||||1277.00|339.22|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|CORESOURCE [1315]|CORESOURCE [131500]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1277.00||||1277.00|300.2|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|||1277.00||||1277.00|383.1|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1277.00||||1277.00|612.32|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1277.00||||1277.00|544|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1277.00||||1277.00|1277|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|UMR [2035]|UMR OPTIONS [203501]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1277.00||||1277.00|1149.3|1277|268.17 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|MULTIPLAN [1680]|HMA [168003]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1277.00||||1277.00||| 34178262|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTROESOPHAGEAL REFLUX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1277.00||||1277.00||| 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1814.00||||1814.00|339.22|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1814.00||||1814.00|503.75|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|CHAMPVA [1240]|CHAMP VA [124000]|1814.00||||1814.00|1360.5|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|||1814.00||||1814.00|544.2|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1814.00||||1814.00|869.81|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1814.00||||1814.00|1814|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1814.00||||1814.00|380.94|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1814.00||||1814.00|511.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1814.00||||1814.00|326.37|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|UMR [2035]|UMR OPTIONS [203501]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1814.00||||1814.00|780.02|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1814.00||||1814.00|373.15|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|FIRST HEALTH [1375]|QUALCHOICE [137513]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|FMH BENEFIT SERVICES [1390]|FMH [139000]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1814.00||||1814.00|357.42|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1814.00||||1814.00|300.2|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|HEALTHNET [1495]|HEALTHNET [149500]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MULTIPLAN [1680]|HMA [168003]|1814.00||||1814.00|525.62|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|AETNA [1015]|AETNA ACO WILCO [101532]|1814.00||||1814.00|523.46|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1814.00||||1814.00|1179.1|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1814.00||||1814.00|315.22|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1814.00||||1814.00|385.45|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1814.00||||1814.00|326.37|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1814.00||||1814.00|367.93|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1814.00||||1814.00|1088.4|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|TRUSTMARK [2030]|STARMARK [203000]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1814.00||||1814.00|844.93|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1814.00||||1814.00|780.02|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|GEHA [1415]|GEHA [141500]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1814.00||||1814.00|908.81|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1814.00||||1814.00|503.75|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1814.00||||1814.00|636.71|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|CORESOURCE [1315]|CORESOURCE [131500]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1814.00||||1814.00|772.76|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1814.00||||1814.00|350.41|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1814.00||||1814.00|385.45|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|MULTIPLAN [1680]|IHC HS [168011]|1814.00||||1814.00|1632.6|1814|300.2 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1814.00||||1814.00||| 34178264|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GASTRIC EMPTYING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1814.00||||1814.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|||1660.00||||1660.00|498|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1660.00||||1660.00|348.6|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1660.00||||1660.00|707.16|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1660.00||||1660.00|713.8|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1660.00||||1660.00|831.66|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1660.00||||1660.00|844.93|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1660.00||||1660.00|996|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1660.00||||1660.00|315.22|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1660.00||||1660.00|582.66|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|AETNA [1015]|AETNA ACO WILCO [101532]|1660.00||||1660.00|530.8|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|HEALTHNET [1495]|HEALTHNET [149500]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|TRUSTMARK [2030]|STARMARK [203000]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MULTIPLAN [1680]|IHC HS [168011]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1660.00||||1660.00|326.37|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1660.00||||1660.00|373.15|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1660.00||||1660.00|713.8|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|UMR [2035]|UMR OPTIONS [203501]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1660.00||||1660.00|1660|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1660.00||||1660.00|1079|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1660.00||||1660.00|795.97|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1660.00||||1660.00|326.37|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1660.00||||1660.00|300.2|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|CHAMPVA [1240]|CHAMP VA [124000]|1660.00||||1660.00|1245|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|CORESOURCE [1315]|CORESOURCE [131500]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1660.00||||1660.00|339.22|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|GEHA [1415]|GEHA [141500]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1660.00||||1660.00|1494|1660|300.2 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MULTIPLAN [1680]|HMA [168003]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1660.00||||1660.00||| 34178278|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC GI BLOOD LOSS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1660.00||||1660.00||| 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1052.00||||1052.00|339.22|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|CORESOURCE [1315]|CORESOURCE [131500]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1052.00||||1052.00|503.75|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|CHAMPVA [1240]|CHAMP VA [124000]|1052.00||||1052.00|789|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1052.00||||1052.00|300.2|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1052.00||||1052.00|326.37|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|||1052.00||||1052.00|315.6|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1052.00||||1052.00|504.43|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1052.00||||1052.00|683.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1052.00||||1052.00|1052|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|GEHA [1415]|GEHA [141500]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1052.00||||1052.00|220.92|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|UMR [2035]|UMR OPTIONS [203501]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1052.00||||1052.00|357.42|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1052.00||||1052.00|452.36|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1052.00||||1052.00|373.15|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MULTIPLAN [1680]|IHC HS [168011]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1052.00||||1052.00|511.6|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|TRUSTMARK [2030]|STARMARK [203000]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1052.00||||1052.00|385.45|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1052.00||||1052.00|326.37|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1052.00||||1052.00|369.25|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1052.00||||1052.00|385.45|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1052.00||||1052.00|527.05|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1052.00||||1052.00|452.36|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1052.00||||1052.00|844.93|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1052.00||||1052.00|448.15|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1052.00||||1052.00|367.93|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1052.00||||1052.00|631.2|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1052.00||||1052.00|315.22|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|AETNA [1015]|AETNA ACO WILCO [101532]|1052.00||||1052.00|525.31|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|HEALTHNET [1495]|HEALTHNET [149500]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MULTIPLAN [1680]|HMA [168003]|1052.00||||1052.00|525.62|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1052.00||||1052.00|946.8|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1052.00||||1052.00|503.75|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1052.00||||1052.00|350.41|1052|220.92 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1052.00||||1052.00||| 34178290|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BOWEL/MECKELS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1052.00||||1052.00||| 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MULTIPLAN [1680]|IHC HS [168011]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1626.00||||1626.00|315.27|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1626.00||||1626.00|692.68|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1626.00||||1626.00|699.18|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1626.00||||1626.00|385.45|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1626.00||||1626.00|814.63|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1626.00||||1626.00|570.73|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1626.00||||1626.00|844.93|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1626.00||||1626.00|975.6|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1626.00||||1626.00|326.43|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1626.00||||1626.00|385.45|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|TRUSTMARK [2030]|STARMARK [203000]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|AETNA [1015]|AETNA ACO WILCO [101532]|1626.00||||1626.00|423.01|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|HEALTHNET [1495]|HEALTHNET [149500]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1626.00||||1626.00|503.75|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MULTIPLAN [1680]|HMA [168003]|1626.00||||1626.00|525.62|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|FMH BENEFIT SERVICES [1390]|FMH [139000]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|FIRST HEALTH [1375]|QUALCHOICE [137513]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1626.00||||1626.00|373.21|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1626.00||||1626.00|357.42|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|UMR [2035]|UMR OPTIONS [203501]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1626.00||||1626.00|1056.9|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1626.00||||1626.00|326.43|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|CHAMPVA [1240]|CHAMP VA [124000]|1626.00||||1626.00|1219.5|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|GEHA [1415]|GEHA [141500]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1626.00||||1626.00|367.93|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1626.00||||1626.00|339.28|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|CORESOURCE [1315]|CORESOURCE [131500]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1626.00||||1626.00|300.25|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1626.00||||1626.00|503.75|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|||1626.00||||1626.00|487.8|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1626.00||||1626.00|1626|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1626.00||||1626.00|341.46|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1626.00||||1626.00|511.6|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1626.00||||1626.00|350.41|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1626.00||||1626.00|699.18|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1626.00||||1626.00|1463.4|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1626.00||||1626.00|779.67|1626|300.25 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1626.00||||1626.00||| 34178305|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE MULTI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1626.00||||1626.00||| 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1988.00||||1988.00|503.75|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|||1988.00||||1988.00|596.4|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1988.00||||1988.00|953.25|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1988.00||||1988.00|1988|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|UMR [2035]|UMR OPTIONS [203501]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1988.00||||1988.00|854.84|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1988.00||||1988.00|503.75|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MULTIPLAN [1680]|IHC HS [168011]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MULTIPLAN [1680]|HMA [168003]|1988.00||||1988.00|525.62|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|HEALTHNET [1495]|HEALTHNET [149500]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|AETNA [1015]|AETNA ACO WILCO [101532]|1988.00||||1988.00|459.68|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|TRUSTMARK [2030]|STARMARK [203000]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1988.00||||1988.00|373.21|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1988.00||||1988.00|357.42|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1988.00||||1988.00|315.27|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1988.00||||1988.00|385.45|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1988.00||||1988.00|511.6|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1988.00||||1988.00|326.43|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1988.00||||1988.00|417.48|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1988.00||||1988.00|367.93|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1988.00||||1988.00|1192.8|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1988.00||||1988.00|844.93|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1988.00||||1988.00|854.84|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1988.00||||1988.00|995.99|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1988.00||||1988.00|326.43|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1988.00||||1988.00|697.79|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1988.00||||1988.00|846.89|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1988.00||||1988.00|350.41|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1988.00||||1988.00|385.45|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1988.00||||1988.00|300.25|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|CHAMPVA [1240]|CHAMP VA [124000]|1988.00||||1988.00|1491|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|CORESOURCE [1315]|CORESOURCE [131500]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1988.00||||1988.00|339.28|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1988.00||||1988.00|1292.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|GEHA [1415]|GEHA [141500]|1988.00||||1988.00|1789.2|1988|300.25 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1988.00||||1988.00||| 34178306|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE WHOLE BODY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1988.00||||1988.00||| 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2187.00||||2187.00|385.45|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2187.00||||2187.00|940.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2187.00||||2187.00|1095.69|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2187.00||||2187.00|844.93|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2187.00||||2187.00|1312.2|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2187.00||||2187.00|315.27|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|AETNA [1015]|AETNA ACO WILCO [101532]|2187.00||||2187.00|524.07|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|HEALTHNET [1495]|HEALTHNET [149500]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MULTIPLAN [1680]|IHC HS [168011]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2187.00||||2187.00|503.75|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MULTIPLAN [1680]|HMA [168003]|2187.00||||2187.00|525.62|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2187.00||||2187.00|931.66|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2187.00||||2187.00|373.21|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2187.00||||2187.00|511.6|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2187.00||||2187.00|300.25|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2187.00||||2187.00|503.75|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|CORESOURCE [1315]|CORESOURCE [131500]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2187.00||||2187.00|767.64|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|TRUSTMARK [2030]|STARMARK [203000]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2187.00||||2187.00|326.43|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2187.00||||2187.00|385.45|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|GEHA [1415]|GEHA [141500]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|CHAMPVA [1240]|CHAMP VA [124000]|2187.00||||2187.00|1640.25|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2187.00||||2187.00|367.93|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2187.00||||2187.00|350.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|||2187.00||||2187.00|656.1|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2187.00||||2187.00|326.43|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2187.00||||2187.00|1048.67|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2187.00||||2187.00|1421.55|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2187.00||||2187.00|339.28|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2187.00||||2187.00|2187|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|UMR [2035]|UMR OPTIONS [203501]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2187.00||||2187.00|357.42|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2187.00||||2187.00|459.27|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2187.00||||2187.00|940.41|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2187.00||||2187.00|1968.3|2187|300.25 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2187.00||||2187.00||| 34178315|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BONE 3 PHASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2187.00||||2187.00||| 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5900.00||||5900.00|1740.89|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MULTIPLAN [1680]|HMA [168003]|5900.00||||5900.00|1816.46|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|HEALTHNET [1495]|HEALTHNET [149500]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|AETNA [1015]|AETNA ACO WILCO [101532]|5900.00||||5900.00|695.65|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|TRUSTMARK [2030]|STARMARK [203000]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5900.00||||5900.00|987.62|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5900.00||||5900.00|1332.07|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5900.00||||5900.00|1022.55|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MULTIPLAN [1680]|IHC HS [168011]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5900.00||||5900.00|1271.52|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5900.00||||5900.00|3540|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5900.00||||5900.00|2938.52|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5900.00||||5900.00|2537|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5900.00||||5900.00|2955.9|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5900.00||||5900.00|2070.9|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5900.00||||5900.00|1332.07|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5900.00||||5900.00|2513.4|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|GEHA [1415]|GEHA [141500]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5900.00||||5900.00|1062.81|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5900.00||||5900.00|1740.89|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|CHAMPVA [1240]|CHAMP VA [124000]|5900.00||||5900.00|4425|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5900.00||||5900.00|1022.55|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|||5900.00||||5900.00|1770|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5900.00||||5900.00|2829.05|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5900.00||||5900.00|3835|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5900.00||||5900.00|940.56|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5900.00||||5900.00|5900|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|CORESOURCE [1315]|CORESOURCE [131500]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5900.00||||5900.00|1239|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5900.00||||5900.00|1768.02|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|UMR [2035]|UMR OPTIONS [203501]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5900.00||||5900.00|1235.19|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5900.00||||5900.00|2537|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5900.00||||5900.00|1169.1|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|FIRST HEALTH [1375]|QUALCHOICE [137513]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5900.00||||5900.00|1210.97|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|FMH BENEFIT SERVICES [1390]|FMH [139000]|5900.00||||5900.00|5310|5900|695.65 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5900.00||||5900.00||| 34178452|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MYOCARD PERFIMAGTOMO(SPECT)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5900.00||||5900.00||| 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1552.00||||1552.00|385.45|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1552.00||||1552.00|667.36|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1552.00||||1552.00|777.55|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1552.00||||1552.00|544.75|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1552.00||||1552.00|844.93|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1552.00||||1552.00|931.2|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1552.00||||1552.00|403.42|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1552.00||||1552.00|385.45|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|TRUSTMARK [2030]|STARMARK [203000]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|AETNA [1015]|AETNA ACO WILCO [101532]|1552.00||||1552.00|319.71|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|HEALTHNET [1495]|HEALTHNET [149500]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MULTIPLAN [1680]|IHC HS [168011]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1552.00||||1552.00|503.75|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1552.00||||1552.00|461.23|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1552.00||||1552.00|667.36|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1552.00||||1552.00|357.42|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MULTIPLAN [1680]|HMA [168003]|1552.00||||1552.00|525.62|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|UMR [2035]|UMR OPTIONS [203501]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1552.00||||1552.00|511.6|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1552.00||||1552.00|325.92|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1552.00||||1552.00|389.64|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1552.00||||1552.00|367.93|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1552.00||||1552.00|1552|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1552.00||||1552.00|1008.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1552.00||||1552.00|661.15|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1552.00||||1552.00|744.18|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|||1552.00||||1552.00|465.6|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1552.00||||1552.00|403.42|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1552.00||||1552.00|350.41|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1552.00||||1552.00|371.08|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|CHAMPVA [1240]|CHAMP VA [124000]|1552.00||||1552.00|1164|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1552.00||||1552.00|503.75|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|CORESOURCE [1315]|CORESOURCE [131500]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1552.00||||1552.00|419.3|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|GEHA [1415]|GEHA [141500]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1552.00||||1552.00|1396.8|1552|319.71 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1552.00||||1552.00||| 34178472|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC MUGA CARDIAC BLOOD POOL SINGLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1552.00||||1552.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1359.00||||1359.00|267.21|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|CORESOURCE [1315]|CORESOURCE [131500]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|CHAMPVA [1240]|CHAMP VA [124000]|1359.00||||1359.00|1019.25|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1359.00||||1359.00|236.47|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|||1359.00||||1359.00|407.7|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1359.00||||1359.00|651.64|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1359.00||||1359.00|1359|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1359.00||||1359.00|285.39|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|UMR [2035]|UMR OPTIONS [203501]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1359.00||||1359.00|584.37|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1359.00||||1359.00|293.94|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MULTIPLAN [1680]|IHC HS [168011]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1359.00||||1359.00|883.35|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|HEALTHNET [1495]|HEALTHNET [149500]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1359.00||||1359.00|257.09|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|AETNA [1015]|AETNA ACO WILCO [101532]|1359.00||||1359.00|286.49|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|TRUSTMARK [2030]|STARMARK [203000]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1359.00||||1359.00|248.3|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1359.00||||1359.00|257.09|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|GEHA [1415]|GEHA [141500]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1359.00||||1359.00|815.4|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1359.00||||1359.00|844.93|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1359.00||||1359.00|584.37|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1359.00||||1359.00|680.86|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1359.00||||1359.00|477.01|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1359.00||||1359.00|578.93|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1359.00||||1359.00|1223.1|1359|236.47 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MULTIPLAN [1680]|HMA [168003]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1359.00||||1359.00||| 34178579|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT IMAGING AEROSOL/GAS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1359.00||||1359.00||| 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2824.00||||2824.00|494.2|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2824.00||||2824.00|1214.32|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2824.00||||2824.00|991.22|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2824.00||||2824.00|1203.02|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2824.00||||2824.00|1088.8|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2824.00||||2824.00|1694.4|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2824.00||||2824.00|471.74|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2824.00||||2824.00|494.2|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2824.00||||2824.00|388.06|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|AETNA [1015]|AETNA ACO WILCO [101532]|2824.00||||2824.00|498.41|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|HEALTHNET [1495]|HEALTHNET [149500]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MULTIPLAN [1680]|HMA [168003]|2824.00||||2824.00|673.91|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MULTIPLAN [1680]|IHC HS [168011]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2824.00||||2824.00|645.87|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2824.00||||2824.00|459.36|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2824.00||||2824.00|1214.32|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2824.00||||2824.00|458.26|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|UMR [2035]|UMR OPTIONS [203501]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2824.00||||2824.00|655.94|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|TRUSTMARK [2030]|STARMARK [203000]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2824.00||||2824.00|593.04|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2824.00||||2824.00|401.78|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2824.00||||2824.00|2824|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2824.00||||2824.00|1835.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2824.00||||2824.00|1354.11|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2824.00||||2824.00|1414.82|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|||2824.00||||2824.00|847.2|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2824.00||||2824.00|401.78|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2824.00||||2824.00|449.27|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2824.00||||2824.00|369.57|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|CHAMPVA [1240]|CHAMP VA [124000]|2824.00||||2824.00|2118|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2824.00||||2824.00|645.87|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|CORESOURCE [1315]|CORESOURCE [131500]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2824.00||||2824.00|417.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|GEHA [1415]|GEHA [141500]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2824.00||||2824.00|2541.6|2824|369.57 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2824.00||||2824.00||| 34178582|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM VENT&PERF AEROSOL OR GAS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2824.00||||2824.00||| 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|GEHA [1415]|GEHA [141500]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|995.00||||995.00|267.21|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|995.00||||995.00|503.75|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|995.00||||995.00|746.25|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|995.00||||995.00|257.09|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|||995.00||||995.00|298.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|995.00||||995.00|477.1|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|995.00||||995.00|646.75|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|995.00||||995.00|995|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|995.00||||995.00|208.95|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|UMR [2035]|UMR OPTIONS [203501]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|995.00||||995.00|357.42|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|995.00||||995.00|427.85|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|995.00||||995.00|293.94|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MULTIPLAN [1680]|IHC HS [168011]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|995.00||||995.00|511.6|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|995.00||||995.00|503.75|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MULTIPLAN [1680]|HMA [168003]|995.00||||995.00|525.62|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|995.00||||995.00|292.6|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|TRUSTMARK [2030]|STARMARK [203000]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|995.00||||995.00|236.47|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|995.00||||995.00|248.3|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|995.00||||995.00|385.45|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|995.00||||995.00|257.09|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|995.00||||995.00|367.93|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|995.00||||995.00|597|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|995.00||||995.00|844.93|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|995.00||||995.00|427.85|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|995.00||||995.00|498.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|995.00||||995.00|349.25|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|995.00||||995.00|423.87|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|995.00||||995.00|350.41|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|995.00||||995.00|385.45|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|995.00||||995.00|895.5|995|208.95 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|995.00||||995.00||| 34178597|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|995.00||||995.00||| 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2181.00||||2181.00|494.2|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2181.00||||2181.00|937.83|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2181.00||||2181.00|1092.68|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2181.00||||2181.00|765.53|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2181.00||||2181.00|1088.8|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2181.00||||2181.00|1308.6|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2181.00||||2181.00|401.78|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2181.00||||2181.00|494.2|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2181.00||||2181.00|388.06|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|TRUSTMARK [2030]|STARMARK [203000]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|2181.00||||2181.00|467.23|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MULTIPLAN [1680]|IHC HS [168011]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2181.00||||2181.00|645.87|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MULTIPLAN [1680]|HMA [168003]|2181.00||||2181.00|673.91|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2181.00||||2181.00|459.36|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2181.00||||2181.00|937.83|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2181.00||||2181.00|458.26|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|UMR [2035]|UMR OPTIONS [203501]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2181.00||||2181.00|655.94|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2181.00||||2181.00|458.01|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2181.00||||2181.00|2181|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2181.00||||2181.00|1417.65|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2181.00||||2181.00|471.74|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2181.00||||2181.00|929.11|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2181.00||||2181.00|1045.79|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|||2181.00||||2181.00|654.3|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2181.00||||2181.00|401.78|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2181.00||||2181.00|449.27|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2181.00||||2181.00|369.57|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|2181.00||||2181.00|1635.75|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2181.00||||2181.00|645.87|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2181.00||||2181.00|417.6|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|GEHA [1415]|GEHA [141500]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2181.00||||2181.00|1962.9|2181|369.57 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2181.00||||2181.00||| 34178598|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC PULM PERF&VENT DIFF W/ OR W/O IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2181.00||||2181.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|GEHA [1415]|GEHA [141500]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|717.00||||717.00|269.72|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|CORESOURCE [1315]|CORESOURCE [131500]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|717.00||||717.00|238.69|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|||717.00||||717.00|215.1|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|717.00||||717.00|343.8|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|717.00||||717.00|466.05|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|717.00||||717.00|717|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|717.00||||717.00|150.57|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|UMR [2035]|UMR OPTIONS [203501]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|717.00||||717.00|308.31|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|717.00||||717.00|296.69|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MULTIPLAN [1680]|IHC HS [168011]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|HEALTHNET [1495]|HEALTHNET [149500]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|717.00||||717.00|259.5|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|717.00||||717.00|282.43|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|TRUSTMARK [2030]|STARMARK [203000]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|717.00||||717.00|250.63|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|CHAMPVA [1240]|CHAMP VA [124000]|717.00||||717.00|537.75|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|717.00||||717.00|259.5|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|717.00||||717.00|430.2|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|717.00||||717.00|717|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|717.00||||717.00|308.31|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|717.00||||717.00|359.22|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|717.00||||717.00|251.67|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|717.00||||717.00|305.44|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|717.00||||717.00|645.3|717|150.57 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MULTIPLAN [1680]|HMA [168003]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|717.00||||717.00||| 34178610|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC BRAIN FLOW ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|717.00||||717.00||| 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1593.00||||1593.00|494.2|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1593.00||||1593.00|684.99|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1593.00||||1593.00|798.09|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1593.00||||1593.00|559.14|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1593.00||||1593.00|678.62|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1593.00||||1593.00|1088.8|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1593.00||||1593.00|955.8|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1593.00||||1593.00|471.74|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1593.00||||1593.00|494.2|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1593.00||||1593.00|737.32|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|TRUSTMARK [2030]|STARMARK [203000]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|AETNA [1015]|AETNA ACO WILCO [101532]|1593.00||||1593.00|537.53|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|HEALTHNET [1495]|HEALTHNET [149500]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MULTIPLAN [1680]|IHC HS [168011]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1593.00||||1593.00|645.87|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MULTIPLAN [1680]|HMA [168003]|1593.00||||1593.00|673.91|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1593.00||||1593.00|872.79|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1593.00||||1593.00|684.99|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1593.00||||1593.00|458.26|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|UMR [2035]|UMR OPTIONS [203501]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1593.00||||1593.00|655.94|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1593.00||||1593.00|334.53|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1593.00||||1593.00|1593|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1593.00||||1593.00|763.39|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1593.00||||1593.00|1035.45|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1593.00||||1593.00|763.84|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|||1593.00||||1593.00|477.9|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1593.00||||1593.00|763.39|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1593.00||||1593.00|449.27|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1593.00||||1593.00|702.19|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|CHAMPVA [1240]|CHAMP VA [124000]|1593.00||||1593.00|1194.75|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1593.00||||1593.00|645.87|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|CORESOURCE [1315]|CORESOURCE [131500]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1593.00||||1593.00|793.45|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|GEHA [1415]|GEHA [141500]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1593.00||||1593.00|1433.7|1593|334.53 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1593.00||||1593.00||| 34178630|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC CISTERNOGRAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1593.00||||1593.00||| 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|GEHA [1415]|GEHA [141500]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2052.00||||2052.00|445.69|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2052.00||||2052.00|645.87|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|CHAMPVA [1240]|CHAMP VA [124000]|2052.00||||2052.00|1539|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2052.00||||2052.00|394.43|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2052.00||||2052.00|428.81|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|||2052.00||||2052.00|615.6|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2052.00||||2052.00|983.93|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2052.00||||2052.00|1333.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2052.00||||2052.00|2052|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2052.00||||2052.00|430.92|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2052.00||||2052.00|655.94|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|UMR [2035]|UMR OPTIONS [203501]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2052.00||||2052.00|458.26|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2052.00||||2052.00|882.36|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2052.00||||2052.00|490.26|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|FIRST HEALTH [1375]|QUALCHOICE [137513]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|FMH BENEFIT SERVICES [1390]|FMH [139000]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2052.00||||2052.00|645.87|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MULTIPLAN [1680]|IHC HS [168011]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MULTIPLAN [1680]|HMA [168003]|2052.00||||2052.00|673.91|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|HEALTHNET [1495]|HEALTHNET [149500]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|AETNA [1015]|AETNA ACO WILCO [101532]|2052.00||||2052.00|328.87|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|TRUSTMARK [2030]|STARMARK [203000]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2052.00||||2052.00|414.16|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2052.00||||2052.00|494.2|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2052.00||||2052.00|428.81|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2052.00||||2052.00|471.74|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2052.00||||2052.00|1231.2|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|CORESOURCE [1315]|CORESOURCE [131500]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2052.00||||2052.00|1088.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2052.00||||2052.00|882.36|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2052.00||||2052.00|1028.05|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2052.00||||2052.00|720.25|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2052.00||||2052.00|874.15|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2052.00||||2052.00|449.27|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2052.00||||2052.00|494.2|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2052.00||||2052.00|1846.8|2052|328.87 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2052.00||||2052.00||| 34178707|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC KIDNEY VSC FLW/FNC SGL W/O RX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2052.00||||2052.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2084.00||||2084.00|896.12|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2084.00||||2084.00|1044.08|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2084.00||||2084.00|731.48|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2084.00||||2084.00|2084|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2084.00||||2084.00|1250.4|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2084.00||||2084.00|673.37|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|TRUSTMARK [2030]|STARMARK [203000]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|2084.00||||2084.00|496.57|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MULTIPLAN [1680]|IHC HS [168011]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2084.00||||2084.00|769.88|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2084.00||||2084.00|896.12|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|UMR [2035]|UMR OPTIONS [203501]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2084.00||||2084.00|437.64|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2084.00||||2084.00|650.37|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2084.00||||2084.00|2084|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2084.00||||2084.00|1354.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2084.00||||2084.00|887.78|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2084.00||||2084.00|999.28|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|||2084.00||||2084.00|625.2|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2084.00||||2084.00|673.37|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2084.00||||2084.00|619.38|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|2084.00||||2084.00|1563|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2084.00||||2084.00|699.88|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|GEHA [1415]|GEHA [141500]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2084.00||||2084.00|1875.6|2084|437.64 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|MULTIPLAN [1680]|HMA [168003]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2084.00||||2084.00||| 34178802|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCLZJ PLNR WHOLE BODY SINGLE DAY IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2084.00||||2084.00||| 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3147.00||||3147.00|699.88|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3147.00||||3147.00|1740.89|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3147.00||||3147.00|619.38|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3147.00||||3147.00|673.37|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|||3147.00||||3147.00|944.1|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3147.00||||3147.00|1508.99|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3147.00||||3147.00|3147|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3147.00||||3147.00|660.87|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3147.00||||3147.00|1768.02|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|UMR [2035]|UMR OPTIONS [203501]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3147.00||||3147.00|1235.19|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3147.00||||3147.00|1353.21|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3147.00||||3147.00|769.88|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MULTIPLAN [1680]|IHC HS [168011]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3147.00||||3147.00|1740.89|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MULTIPLAN [1680]|HMA [168003]|3147.00||||3147.00|1816.46|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3147.00||||3147.00|2045.55|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|3147.00||||3147.00|510.02|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|TRUSTMARK [2030]|STARMARK [203000]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3147.00||||3147.00|650.37|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|3147.00||||3147.00|2360.25|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3147.00||||3147.00|1332.07|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3147.00||||3147.00|673.37|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3147.00||||3147.00|1271.52|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|GEHA [1415]|GEHA [141500]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3147.00||||3147.00|1888.2|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3147.00||||3147.00|1088.8|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3147.00||||3147.00|1353.21|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3147.00||||3147.00|1576.65|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3147.00||||3147.00|1104.6|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3147.00||||3147.00|1340.62|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3147.00||||3147.00|1210.97|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3147.00||||3147.00|1332.07|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3147.00||||3147.00|2832.3|3147|510.02 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3147.00||||3147.00||| 34178803|EAP|0341 - NUCLEAR MEDICINE-DIAGNOSTIC|HC RP LOCALIZE SPECT 1 AREA 1 DAY IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3147.00||||3147.00||| 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1763.00||||1763.00|68.35|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1763.00||||1763.00|881.5|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1763.00||||1763.00|71.83|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1763.00||||1763.00|883.26|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1763.00||||1763.00|618.81|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1763.00||||1763.00|1057.8|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1763.00||||1763.00|65.25|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1763.00||||1763.00|67.32|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1763.00||||1763.00|65.03|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1763.00||||1763.00|38.79|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|AETNA [1015]|AETNA ACO WILCO [101532]|1763.00||||1763.00|91.96|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MULTIPLAN [1680]|IHC HS [168011]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1763.00||||1763.00|89.33|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MULTIPLAN [1680]|HMA [168003]|1763.00||||1763.00|93.21|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1763.00||||1763.00|71.83|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|HEALTHNET [1495]|HEALTHNET [149500]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1763.00||||1763.00|63.38|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1763.00||||1763.00|76.97|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|TRUSTMARK [2030]|STARMARK [203000]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|UMR [2035]|UMR OPTIONS [203501]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1763.00||||1763.00|90.72|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1763.00||||1763.00|370.23|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1763.00||||1763.00|68.35|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1763.00||||1763.00|1763|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1763.00||||1763.00|1145.95|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1763.00||||1763.00|845.36|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1763.00||||1763.00|751.04|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|||1763.00||||1763.00|528.9|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1763.00||||1763.00|67.32|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1763.00||||1763.00|62.14|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1763.00||||1763.00|61.93|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|CHAMPVA [1240]|CHAMP VA [124000]|1763.00||||1763.00|1322.25|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1763.00||||1763.00|89.33|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|CORESOURCE [1315]|CORESOURCE [131500]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1763.00||||1763.00|69.97|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|GEHA [1415]|GEHA [141500]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1763.00||||1763.00|1586.7|1763|38.79 34180307|EAP|0301 - LABORATORY-CHEMISTRY|HC DRUG SCREEN PRESUMP PER DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1763.00||||1763.00||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|127.57||||127.57|95.68|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|||127.57||||127.57|38.27|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127.57||||127.57|82.92|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127.57||||127.57|26.79|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127.57||||127.57|54.86|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127.57||||127.57|61.17|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.57||||127.57|76.54|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127.57||||127.57|54.86|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127.57||||127.57|63.91|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127.57||||127.57|44.78|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127.57||||127.57|54.34|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127.57||||127.57|114.81|114.81|26.79 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127.57||||127.57||| 3423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127.57||||127.57||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216.44||||216.44|75.97|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|216.44||||216.44|108.44|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|216.44||||216.44|92.2|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|216.44||||216.44|108.44|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|216.44||||216.44|92.2|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|216.44||||216.44|108.44|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216.44||||216.44|75.97|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|216.44||||216.44|108.44|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216.44||||216.44|75.97|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216.44||||216.44|129.86|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216.44||||216.44|129.86|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216.44||||216.44|129.86|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|216.44||||216.44|93.07|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216.44||||216.44|45.45|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216.44||||216.44|45.45|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216.44||||216.44|45.45|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|216.44||||216.44|45.45|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216.44||||216.44|140.69|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216.44||||216.44|140.69|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216.44||||216.44|140.69|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|216.44||||216.44|140.69|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216.44||||216.44|103.78|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216.44||||216.44|103.78|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216.44||||216.44|103.78|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|216.44||||216.44|103.78|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|||216.44||||216.44|64.93|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|||216.44||||216.44|64.93|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|||216.44||||216.44|64.93|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|||216.44||||216.44|64.93|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|216.44||||216.44|129.86|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|216.44||||216.44|92.2|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|216.44||||216.44|92.2|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|216.44||||216.44|75.97|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|216.44||||216.44|162.33|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|216.44||||216.44|162.33|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|216.44||||216.44|162.33|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|216.44||||216.44|162.33|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|216.44||||216.44|194.8|194.8|45.45 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|216.44||||216.44||| 3424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.1 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|216.44||||216.44||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|GEHA [1415]|GEHA [141500]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|91.58||||91.58|68.69|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|||91.58||||91.58|27.47|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91.58||||91.58|43.91|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91.58||||91.58|59.53|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91.58||||91.58|19.23|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|UMR [2035]|UMR OPTIONS [203501]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91.58||||91.58|39.38|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91.58||||91.58|54.95|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91.58||||91.58|39.38|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|91.58||||91.58|45.88|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91.58||||91.58|32.14|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|91.58||||91.58|39.01|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91.58||||91.58|82.42|82.42|19.23 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MULTIPLAN [1680]|HMA [168003]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91.58||||91.58||| 3427|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % (3 MG/GRAM) EYE OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91.58||||91.58||| 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3290.00||||3290.00|1414.7|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3290.00||||3290.00|1648.29|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3290.00||||3290.00|1154.79|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3290.00||||3290.00|1401.54|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3290.00||||3290.00|551.87|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3290.00||||3290.00|237.28|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3290.00||||3290.00|287.74|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3290.00||||3290.00|277.9|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|TRUSTMARK [2030]|STARMARK [203000]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|AETNA [1015]|AETNA ACO WILCO [101532]|3290.00||||3290.00|86.62|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MULTIPLAN [1680]|HMA [168003]|3290.00||||3290.00|338.97|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MULTIPLAN [1680]|IHC HS [168011]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3290.00||||3290.00|324.87|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|FMH BENEFIT SERVICES [1390]|FMH [139000]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|FIRST HEALTH [1375]|QUALCHOICE [137513]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|HEALTHNET [1495]|HEALTHNET [149500]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3290.00||||3290.00|1414.7|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3290.00||||3290.00|328.97|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3290.00||||3290.00|230.5|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|UMR [2035]|UMR OPTIONS [203501]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3290.00||||3290.00|329.93|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3290.00||||3290.00|690.9|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3290.00||||3290.00|248.58|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3290.00||||3290.00|3290|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3290.00||||3290.00|1974|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3290.00||||3290.00|2138.5|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3290.00||||3290.00|1577.56|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|||3290.00||||3290.00|987|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3290.00||||3290.00|287.74|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3290.00||||3290.00|248.58|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3290.00||||3290.00|225.98|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3290.00||||3290.00|264.66|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|CHAMPVA [1240]|CHAMP VA [124000]|3290.00||||3290.00|2467.5|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3290.00||||3290.00|324.87|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3290.00||||3290.00|299.07|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|CORESOURCE [1315]|CORESOURCE [131500]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|GEHA [1415]|GEHA [141500]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3290.00||||3290.00|2961|3290|86.62 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3290.00||||3290.00||| 34279005|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC ORAL RADIOPHARM RX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3290.00||||3290.00||| 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|GEHA [1415]|GEHA [141500]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|CORESOURCE [1315]|CORESOURCE [131500]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1425.00||||1425.00|299.07|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|CHAMPVA [1240]|CHAMP VA [124000]|1425.00||||1425.00|1068.75|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1425.00||||1425.00|264.66|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1425.00||||1425.00|287.74|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|||1425.00||||1425.00|427.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1425.00||||1425.00|926.25|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1425.00||||1425.00|1425|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1425.00||||1425.00|299.25|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1425.00||||1425.00|329.93|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|UMR [2035]|UMR OPTIONS [203501]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1425.00||||1425.00|230.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1425.00||||1425.00|328.97|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1425.00||||1425.00|612.75|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1425.00||||1425.00|324.87|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MULTIPLAN [1680]|IHC HS [168011]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MULTIPLAN [1680]|HMA [168003]|1425.00||||1425.00|338.97|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|HEALTHNET [1495]|HEALTHNET [149500]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1425.00||||1425.00|683.29|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|AETNA [1015]|AETNA ACO WILCO [101532]|1425.00||||1425.00|85.78|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|TRUSTMARK [2030]|STARMARK [203000]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1425.00||||1425.00|324.87|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1425.00||||1425.00|277.9|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1425.00||||1425.00|248.58|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1425.00||||1425.00|287.74|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1425.00||||1425.00|237.28|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1425.00||||1425.00|855|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1425.00||||1425.00|551.87|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1425.00||||1425.00|612.75|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1425.00||||1425.00|713.93|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1425.00||||1425.00|500.18|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1425.00||||1425.00|607.05|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1425.00||||1425.00|225.98|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1425.00||||1425.00|248.58|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1425.00||||1425.00|1282.5|1425|85.78 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1425.00||||1425.00||| 34279101|EAP|0342 - NUCLEAR MEDICINE-THERAPEUTIC|HC RADIOPH RX BY IV ADMIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1425.00||||1425.00||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.59||||49.59|17.41|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.59||||49.59|21.32|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.59||||49.59|24.84|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.59||||49.59|21.32|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.59||||49.59|24.84|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.59||||49.59|17.41|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.59||||49.59|21.32|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.59||||49.59|24.84|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.59||||49.59|17.41|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.59||||49.59|29.75|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.59||||49.59|29.75|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.59||||49.59|29.75|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.59||||49.59|21.32|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.59||||49.59|21.32|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.59||||49.59|21.32|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.59||||49.59|10.41|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.59||||49.59|10.41|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.59||||49.59|10.41|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.59||||49.59|32.23|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.59||||49.59|32.23|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.59||||49.59|32.23|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.59||||49.59|23.78|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.59||||49.59|23.78|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.59||||49.59|23.78|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|||49.59||||49.59|14.88|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|||49.59||||49.59|14.88|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|||49.59||||49.59|14.88|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.59||||49.59|21.13|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.59||||49.59|21.13|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.59||||49.59|21.13|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|49.59||||49.59|37.19|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|49.59||||49.59|37.19|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|49.59||||49.59|37.19|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.59||||49.59|44.63|44.63|10.41 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.59||||49.59||| 3428|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GENTAMICIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.59||||49.59||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34418|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34505|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|||10.00||||10.00|3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|||10.00||||10.00|3|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|||10.00||||10.00|3|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 34711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3489|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLYBURIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|||0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901001|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVICORE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|||0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901002|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|||0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901003|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM MEDICALIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|||0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901004|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NDSC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|||0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901005|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM NIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|||0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901006|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|||0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901007|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AIM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|||0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901008|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CRANBERRY PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|||0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901009|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SAGE HEALTH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|||0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901010|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM STANSON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|||0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901011|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM QUALIFIED NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|||0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901012|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|||0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901013|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EVIDENCECARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|||0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901014|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INVENIQA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|||0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901015|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM RELIANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|||0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901016|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|||0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901017|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM HEALTHHELP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|||0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901018|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INFINX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|||0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901019|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM LOGICNETS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|||0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901020|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|||0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901021|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM EHEALTHLINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|||0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901022|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM INTERMOUNTAIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|||0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 34901023|EAP|0349 - NUCLEAR MEDICINE-OTHER|HC CDSM PERSIVIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1159.00||||1159.00|753.35|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1159.00||||1159.00|243.39|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1159.00||||1159.00|253.24|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|UMR [2035]|UMR OPTIONS [203501]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1159.00||||1159.00|176.92|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1159.00||||1159.00|448.02|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1159.00||||1159.00|498.37|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MULTIPLAN [1680]|HMA [168003]|1159.00||||1159.00|260.18|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MULTIPLAN [1680]|IHC HS [168011]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1159.00||||1159.00|249.35|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|HEALTHNET [1495]|HEALTHNET [149500]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|TRUSTMARK [2030]|STARMARK [203000]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1159.00||||1159.00|378.48|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1159.00||||1159.00|190.8|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|AETNA [1015]|AETNA ACO WILCO [101532]|1159.00||||1159.00|415.32|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1159.00||||1159.00|391.86|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1159.00||||1159.00|1159|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1159.00||||1159.00|182.12|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1159.00||||1159.00|695.4|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1159.00||||1159.00|482.2|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1159.00||||1159.00|406.81|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1159.00||||1159.00|493.73|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1159.00||||1159.00|555.74|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1159.00||||1159.00|190.8|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1159.00||||1159.00|580.66|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1159.00||||1159.00|498.37|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|GEHA [1415]|GEHA [141500]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|CORESOURCE [1315]|CORESOURCE [131500]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1159.00||||1159.00|407.29|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1159.00||||1159.00|249.35|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|CHAMPVA [1240]|CHAMP VA [124000]|1159.00||||1159.00|869.25|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1159.00||||1159.00|360.44|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1159.00||||1159.00|1043.1|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1159.00||||1159.00|173.45|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1159.00||||1159.00|391.86|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|||1159.00||||1159.00|347.7|1159|173.45 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1159.00||||1159.00||| 35074262|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY DIAGNOSTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1159.00||||1159.00|580.66|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1159.00||||1159.00|406.81|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1159.00||||1159.00|493.73|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1159.00||||1159.00|695.4|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|TRUSTMARK [2030]|STARMARK [203000]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1159.00||||1159.00|301.34|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MULTIPLAN [1680]|IHC HS [168011]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1159.00||||1159.00|718.58|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1159.00||||1159.00|498.37|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|1159.00||||1159.00|1159|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|UMR [2035]|UMR OPTIONS [203501]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1159.00||||1159.00|719.74|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1159.00||||1159.00|243.39|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1159.00||||1159.00|1159|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1159.00||||1159.00|753.35|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1159.00||||1159.00|555.74|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1159.00||||1159.00|579.5|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|||1159.00||||1159.00|347.7|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1159.00||||1159.00|498.37|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1159.00||||1159.00|301.34|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|1159.00||||1159.00|869.25|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1159.00||||1159.00|718.58|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|GEHA [1415]|GEHA [141500]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1159.00||||1159.00|1043.1|1159|243.39 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|MULTIPLAN [1680]|HMA [168003]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1159.00||||1159.00||| 35074263|EAP|0350 - CT SCAN-GENERAL|HC COLONOGRAPHY SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1159.00||||1159.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|GEHA [1415]|GEHA [141500]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|CORESOURCE [1315]|CORESOURCE [131500]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|CHAMPVA [1240]|CHAMP VA [124000]|940.00||||940.00|705|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|940.00||||940.00|450.73|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|940.00||||940.00|611|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|940.00||||940.00|940|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|940.00||||940.00|404.2|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|FIRST HEALTH [1375]|QUALCHOICE [137513]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|UMR [2035]|UMR OPTIONS [203501]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|FMH BENEFIT SERVICES [1390]|FMH [139000]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|940.00||||940.00|197.4|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MULTIPLAN [1680]|IHC HS [168011]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|HEALTHNET [1495]|HEALTHNET [149500]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|AETNA [1015]|AETNA ACO WILCO [101532]|940.00||||940.00|27.68|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|||940.00||||940.00|282|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|TRUSTMARK [2030]|STARMARK [203000]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|940.00||||940.00|404.2|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|940.00||||940.00|470.94|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|940.00||||940.00|329.94|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|940.00||||940.00|400.44|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|940.00||||940.00|564|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|940.00||||940.00|470|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|940.00||||940.00|846|940|27.68 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MULTIPLAN [1680]|HMA [168003]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|940.00||||940.00||| 35076376|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER NOT REQ POSTPROC ON INDEP WS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|940.00||||940.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|937.00||||937.00|468.5|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|937.00||||937.00|562.2|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|937.00||||937.00|402.91|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|937.00||||937.00|469.44|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|937.00||||937.00|399.16|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|TRUSTMARK [2030]|STARMARK [203000]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|AETNA [1015]|AETNA ACO WILCO [101532]|937.00||||937.00|65.48|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MULTIPLAN [1680]|IHC HS [168011]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|FMH BENEFIT SERVICES [1390]|FMH [139000]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|FIRST HEALTH [1375]|QUALCHOICE [137513]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|HEALTHNET [1495]|HEALTHNET [149500]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|937.00||||937.00|402.91|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|UMR [2035]|UMR OPTIONS [203501]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|937.00||||937.00|196.77|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|937.00||||937.00|937|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|937.00||||937.00|328.89|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|937.00||||937.00|609.05|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|937.00||||937.00|449.29|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|||937.00||||937.00|281.1|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|CHAMPVA [1240]|CHAMP VA [124000]|937.00||||937.00|702.75|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|CORESOURCE [1315]|CORESOURCE [131500]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|GEHA [1415]|GEHA [141500]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|937.00||||937.00|843.3|937|65.48 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MULTIPLAN [1680]|HMA [168003]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|937.00||||937.00||| 35076377|EAP|0350 - CT SCAN-GENERAL|HC 3D RENDER W POST PROCESS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|937.00||||937.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|GEHA [1415]|GEHA [141500]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|CORESOURCE [1315]|CORESOURCE [131500]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|CHAMPVA [1240]|CHAMP VA [124000]|3032.00||||3032.00|2274|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|||3032.00||||3032.00|909.6|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3032.00||||3032.00|1970.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3032.00||||3032.00|3032|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3032.00||||3032.00|636.72|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|UMR [2035]|UMR OPTIONS [203501]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3032.00||||3032.00|1303.76|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MULTIPLAN [1680]|IHC HS [168011]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|HEALTHNET [1495]|HEALTHNET [149500]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3032.00||||3032.00|1453.84|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|AETNA [1015]|AETNA ACO WILCO [101532]|3032.00||||3032.00|161.1|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|TRUSTMARK [2030]|STARMARK [203000]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3032.00||||3032.00|1819.2|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3032.00||||3032.00|1303.76|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3032.00||||3032.00|1519.03|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3032.00||||3032.00|1064.23|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3032.00||||3032.00|1291.63|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3032.00||||3032.00|1516|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3032.00||||3032.00|2728.8|3032|161.1 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MULTIPLAN [1680]|HMA [168003]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3032.00||||3032.00||| 35077012|EAP|0350 - CT SCAN-GENERAL|HC GUIDED NEEDLE BIOPSY/ASPIRATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3032.00||||3032.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2539.00||||2539.00|1091.77|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2539.00||||2539.00|1272.04|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2539.00||||2539.00|1081.61|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2539.00||||2539.00|1523.4|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|TRUSTMARK [2030]|STARMARK [203000]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|HEALTHNET [1495]|HEALTHNET [149500]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MULTIPLAN [1680]|IHC HS [168011]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2539.00||||2539.00|1091.77|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|AETNA [1015]|AETNA ACO WILCO [101532]|2539.00||||2539.00|732.54|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|UMR [2035]|UMR OPTIONS [203501]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2539.00||||2539.00|533.19|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2539.00||||2539.00|2539|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2539.00||||2539.00|1650.35|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2539.00||||2539.00|1217.45|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2539.00||||2539.00|891.19|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|||2539.00||||2539.00|761.7|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2539.00||||2539.00|1269.5|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|CHAMPVA [1240]|CHAMP VA [124000]|2539.00||||2539.00|1904.25|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|CORESOURCE [1315]|CORESOURCE [131500]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|GEHA [1415]|GEHA [141500]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2539.00||||2539.00|2285.1|2539|533.19 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|MULTIPLAN [1680]|HMA [168003]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2539.00||||2539.00||| 35077013|EAP|0350 - CT SCAN-GENERAL|HC GUIDANCE &MONITORING VISC TISS ABLATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2539.00||||2539.00||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|36.79||||36.79|27.59|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|||36.79||||36.79|11.04|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|||36.79||||36.79|11.04|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.79||||36.79|17.64|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36.79||||36.79|17.64|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.79||||36.79|23.91|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36.79||||36.79|23.91|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.79||||36.79|7.73|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36.79||||36.79|7.73|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.79||||36.79|15.82|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36.79||||36.79|15.82|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.79||||36.79|15.82|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36.79||||36.79|18.43|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.79||||36.79|12.91|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36.79||||36.79|15.67|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36.79||||36.79|15.82|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|36.79||||36.79|27.59|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|GEHA [1415]|GEHA [141500]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36.79||||36.79|18.43|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36.79||||36.79|12.91|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36.79||||36.79|15.67|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.79||||36.79|22.07|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36.79||||36.79|22.07|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36.79||||36.79|33.11|33.11|7.73 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.79||||36.79||| 35134|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36.79||||36.79||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|||10.00||||10.00|3|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35135|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2454.00||||2454.00|267.48|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2454.00||||2454.00|153.38|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2454.00||||2454.00|236.72|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2454.00||||2454.00|257.35|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|||2454.00||||2454.00|736.2|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2454.00||||2454.00|1176.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2454.00||||2454.00|2454|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2454.00||||2454.00|155.77|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2454.00||||2454.00|108.82|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2454.00||||2454.00|294.24|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2454.00||||2454.00|1055.22|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2454.00||||2454.00|160.04|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2454.00||||2454.00|153.38|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2454.00||||2454.00|515.34|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2454.00||||2454.00|1595.1|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2454.00||||2454.00|152.21|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2454.00||||2454.00|248.57|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2454.00||||2454.00|1840.5|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2454.00||||2454.00|117.36|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2454.00||||2454.00|257.35|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2454.00||||2454.00|1472.4|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|GEHA [1415]|GEHA [141500]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2454.00||||2454.00|112.03|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2454.00||||2454.00|1055.22|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2454.00||||2454.00|1229.45|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2454.00||||2454.00|861.35|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2454.00||||2454.00|1045.4|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2454.00||||2454.00|268.93|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2454.00||||2454.00|106.69|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2454.00||||2454.00|117.36|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2454.00||||2454.00|2208.6|2454|106.69 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2454.00||||2454.00||| 35170450|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2454.00||||2454.00||| 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2992.00||||2992.00|190.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2992.00||||2992.00|482.2|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2992.00||||2992.00|1286.56|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2992.00||||2992.00|1498.99|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2992.00||||2992.00|1050.19|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2992.00||||2992.00|182.12|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2992.00||||2992.00|1795.2|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2992.00||||2992.00|391.86|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2992.00||||2992.00|190.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2992.00||||2992.00|378.48|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2992.00||||2992.00|221.88|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2992.00||||2992.00|249.35|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2992.00||||2992.00|1286.56|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|2992.00||||2992.00|260.18|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2992.00||||2992.00|448.02|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2992.00||||2992.00|176.92|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2992.00||||2992.00|253.24|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2992.00||||2992.00|628.32|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2992.00||||2992.00|2992|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2992.00||||2992.00|1944.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2992.00||||2992.00|1434.66|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2992.00||||2992.00|1274.59|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|||2992.00||||2992.00|897.6|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2992.00||||2992.00|391.86|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2992.00||||2992.00|173.45|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2992.00||||2992.00|360.44|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2992.00||||2992.00|2244|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2992.00||||2992.00|249.35|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2992.00||||2992.00|407.29|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|GEHA [1415]|GEHA [141500]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2992.00||||2992.00|2692.8|2992|173.45 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2992.00||||2992.00||| 35170460|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2992.00||||2992.00||| 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3605.00||||3605.00|457.34|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3605.00||||3605.00|249.35|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3605.00||||3605.00|2703.75|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3605.00||||3605.00|404.73|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3605.00||||3605.00|440.01|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|||3605.00||||3605.00|1081.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3605.00||||3605.00|1728.6|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3605.00||||3605.00|2343.25|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3605.00||||3605.00|3605|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3605.00||||3605.00|757.05|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3605.00||||3605.00|176.92|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3605.00||||3605.00|503.07|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3605.00||||3605.00|1550.15|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3605.00||||3605.00|260.18|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3605.00||||3605.00|253.24|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3605.00||||3605.00|249.35|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3605.00||||3605.00|265.61|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3605.00||||3605.00|424.98|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3605.00||||3605.00|190.8|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3605.00||||3605.00|440.01|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3605.00||||3605.00|2163|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3605.00||||3605.00|177.22|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3605.00||||3605.00|1550.15|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3605.00||||3605.00|1806.11|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3605.00||||3605.00|1265.36|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3605.00||||3605.00|1535.73|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3605.00||||3605.00|482.2|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3605.00||||3605.00|173.45|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3605.00||||3605.00|190.8|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3605.00||||3605.00|3244.5|3605|173.45 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3605.00||||3605.00||| 35170470|EAP|0351 - CT SCAN-HEAD SCAN|HC HEAD/BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3605.00||||3605.00||| 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2404.00||||2404.00|114.2|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2404.00||||2404.00|268.93|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2404.00||||2404.00|1033.72|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2404.00||||2404.00|1204.4|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2404.00||||2404.00|843.8|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2404.00||||2404.00|1024.1|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2404.00||||2404.00|109.01|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2404.00||||2404.00|257.35|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2404.00||||2404.00|114.2|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2404.00||||2404.00|232.25|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2404.00||||2404.00|149.25|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2404.00||||2404.00|155.73|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2404.00||||2404.00|1033.72|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2404.00||||2404.00|294.24|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2404.00||||2404.00|105.9|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2404.00||||2404.00|155.77|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2404.00||||2404.00|248.57|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2404.00||||2404.00|504.84|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2404.00||||2404.00|1442.4|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2404.00||||2404.00|2404|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2404.00||||2404.00|1562.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2404.00||||2404.00|1152.72|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|||2404.00||||2404.00|721.2|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2404.00||||2404.00|257.35|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2404.00||||2404.00|103.82|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2404.00||||2404.00|236.72|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2404.00||||2404.00|1803|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2404.00||||2404.00|149.25|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2404.00||||2404.00|267.48|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|GEHA [1415]|GEHA [141500]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2404.00||||2404.00|2163.6|2404|103.82 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2404.00||||2404.00||| 35170480|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2404.00||||2404.00||| 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3150.00||||3150.00|407.29|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3150.00||||3150.00|242.64|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3150.00||||3150.00|360.44|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|||3150.00||||3150.00|945|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3150.00||||3150.00|1510.43|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3150.00||||3150.00|3150|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3150.00||||3150.00|246.42|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3150.00||||3150.00|173.45|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3150.00||||3150.00|448.02|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3150.00||||3150.00|1354.5|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3150.00||||3150.00|172.16|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3150.00||||3150.00|253.18|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3150.00||||3150.00|661.5|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3150.00||||3150.00|242.64|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3150.00||||3150.00|2047.5|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3150.00||||3150.00|391.86|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3150.00||||3150.00|415.32|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3150.00||||3150.00|378.48|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3150.00||||3150.00|2362.5|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3150.00||||3150.00|185.66|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|GEHA [1415]|GEHA [141500]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3150.00||||3150.00|391.86|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3150.00||||3150.00|1890|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3150.00||||3150.00|177.22|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3150.00||||3150.00|1354.5|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3150.00||||3150.00|1578.15|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3150.00||||3150.00|1105.65|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3150.00||||3150.00|1341.9|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3150.00||||3150.00|482.2|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3150.00||||3150.00|168.78|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3150.00||||3150.00|185.66|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3150.00||||3150.00|2835|3150|168.78 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3150.00||||3150.00||| 35170481|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3150.00||||3150.00||| 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3268.00||||3268.00|185.66|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3268.00||||3268.00|482.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3268.00||||3268.00|1405.24|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3268.00||||3268.00|1637.27|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3268.00||||3268.00|1147.07|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3268.00||||3268.00|177.22|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3268.00||||3268.00|1960.8|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3268.00||||3268.00|440.01|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3268.00||||3268.00|185.66|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3268.00||||3268.00|424.98|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|AETNA [1015]|AETNA ACO WILCO [101532]|3268.00||||3268.00|415.58|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MULTIPLAN [1680]|IHC HS [168011]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3268.00||||3268.00|242.64|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MULTIPLAN [1680]|HMA [168003]|3268.00||||3268.00|253.18|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|FMH BENEFIT SERVICES [1390]|FMH [139000]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|FIRST HEALTH [1375]|QUALCHOICE [137513]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3268.00||||3268.00|1405.24|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|HEALTHNET [1495]|HEALTHNET [149500]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3268.00||||3268.00|503.07|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3268.00||||3268.00|172.16|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|TRUSTMARK [2030]|STARMARK [203000]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|UMR [2035]|UMR OPTIONS [203501]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3268.00||||3268.00|246.42|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3268.00||||3268.00|686.28|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3268.00||||3268.00|3268|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3268.00||||3268.00|2124.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3268.00||||3268.00|1392.17|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3268.00||||3268.00|1567.01|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|||3268.00||||3268.00|980.4|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3268.00||||3268.00|440.01|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3268.00||||3268.00|168.78|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3268.00||||3268.00|404.73|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|CHAMPVA [1240]|CHAMP VA [124000]|3268.00||||3268.00|2451|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3268.00||||3268.00|242.64|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|CORESOURCE [1315]|CORESOURCE [131500]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3268.00||||3268.00|457.34|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|GEHA [1415]|GEHA [141500]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3268.00||||3268.00|2941.2|3268|168.78 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3268.00||||3268.00||| 35170482|EAP|0351 - CT SCAN-HEAD SCAN|HC ORBIT/SELLA/FOSSA/EAR W&WO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3268.00||||3268.00||| 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|GEHA [1415]|GEHA [141500]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2444.00||||2444.00|267.48|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2444.00||||2444.00|149.25|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2444.00||||2444.00|1833|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2444.00||||2444.00|236.72|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2444.00||||2444.00|106.69|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2444.00||||2444.00|257.35|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|||2444.00||||2444.00|733.2|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2444.00||||2444.00|1171.9|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2444.00||||2444.00|1588.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2444.00||||2444.00|2444|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2444.00||||2444.00|513.24|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2444.00||||2444.00|105.9|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2444.00||||2444.00|294.24|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2444.00||||2444.00|1050.92|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2444.00||||2444.00|106.69|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2444.00||||2444.00|155.77|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2444.00||||2444.00|149.25|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2444.00||||2444.00|155.73|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2444.00||||2444.00|200.38|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2444.00||||2444.00|248.57|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2444.00||||2444.00|114.2|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2444.00||||2444.00|257.35|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2444.00||||2444.00|1466.4|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2444.00||||2444.00|109.01|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2444.00||||2444.00|1050.92|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2444.00||||2444.00|1224.44|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2444.00||||2444.00|857.84|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2444.00||||2444.00|1041.14|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2444.00||||2444.00|268.93|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2444.00||||2444.00|103.82|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2444.00||||2444.00|114.2|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2444.00||||2444.00|2199.6|2444|103.82 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2444.00||||2444.00||| 35170486|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2444.00||||2444.00||| 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3846.00||||3846.00|190.8|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3846.00||||3846.00|482.2|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3846.00||||3846.00|1653.78|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3846.00||||3846.00|1349.95|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3846.00||||3846.00|1638.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3846.00||||3846.00|182.12|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3846.00||||3846.00|391.86|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3846.00||||3846.00|190.8|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3846.00||||3846.00|230.77|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3846.00||||3846.00|260.18|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3846.00||||3846.00|1653.78|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3846.00||||3846.00|448.02|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3846.00||||3846.00|176.92|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3846.00||||3846.00|249.35|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3846.00||||3846.00|253.24|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3846.00||||3846.00|807.66|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3846.00||||3846.00|378.48|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3846.00||||3846.00|2307.6|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3846.00||||3846.00|3846|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3846.00||||3846.00|2499.9|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3846.00||||3846.00|1926.85|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3846.00||||3846.00|1844.16|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|||3846.00||||3846.00|1153.8|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3846.00||||3846.00|391.86|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3846.00||||3846.00|173.45|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3846.00||||3846.00|360.44|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3846.00||||3846.00|2884.5|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3846.00||||3846.00|249.35|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3846.00||||3846.00|407.29|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|GEHA [1415]|GEHA [141500]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3846.00||||3846.00|3461.4|3846|173.45 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3846.00||||3846.00||| 35170487|EAP|0351 - CT SCAN-HEAD SCAN|HC FACIAL/SINUS W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3846.00||||3846.00||| 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|GEHA [1415]|GEHA [141500]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2560.00||||2560.00|267.48|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2560.00||||2560.00|153.38|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2560.00||||2560.00|1920|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2560.00||||2560.00|236.72|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|||2560.00||||2560.00|768|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2560.00||||2560.00|1227.52|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2560.00||||2560.00|2560|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2560.00||||2560.00|537.6|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2560.00||||2560.00|155.77|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2560.00||||2560.00|294.24|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2560.00||||2560.00|1100.8|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2560.00||||2560.00|108.82|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2560.00||||2560.00|160.04|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2560.00||||2560.00|153.38|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2560.00||||2560.00|1664|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2560.00||||2560.00|257.35|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2560.00||||2560.00|208.54|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2560.00||||2560.00|103.82|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2560.00||||2560.00|248.57|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2560.00||||2560.00|117.36|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2560.00||||2560.00|257.35|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2560.00||||2560.00|1536|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2560.00||||2560.00|112.03|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2560.00||||2560.00|1100.8|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2560.00||||2560.00|1282.56|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2560.00||||2560.00|898.56|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2560.00||||2560.00|1090.56|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2560.00||||2560.00|268.93|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2560.00||||2560.00|106.69|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2560.00||||2560.00|117.36|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2560.00||||2560.00|2304|2560|103.82 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2560.00||||2560.00||| 35170490|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2560.00||||2560.00||| 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2974.00||||2974.00|190.8|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2974.00||||2974.00|482.2|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2974.00||||2974.00|1278.82|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2974.00||||2974.00|1489.97|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2974.00||||2974.00|1043.87|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2974.00||||2974.00|1266.92|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2974.00||||2974.00|182.12|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2974.00||||2974.00|1784.4|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2974.00||||2974.00|391.86|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2974.00||||2974.00|190.8|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2974.00||||2974.00|378.48|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2974.00||||2974.00|277.46|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2974.00||||2974.00|249.35|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MULTIPLAN [1680]|HMA [168003]|2974.00||||2974.00|260.18|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2974.00||||2974.00|1278.82|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2974.00||||2974.00|448.02|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2974.00||||2974.00|176.92|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2974.00||||2974.00|253.24|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2974.00||||2974.00|624.54|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2974.00||||2974.00|2974|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2974.00||||2974.00|1933.1|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2974.00||||2974.00|1426.03|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|||2974.00||||2974.00|892.2|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2974.00||||2974.00|391.86|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2974.00||||2974.00|173.45|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2974.00||||2974.00|360.44|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2974.00||||2974.00|2230.5|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2974.00||||2974.00|249.35|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2974.00||||2974.00|407.29|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|GEHA [1415]|GEHA [141500]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2974.00||||2974.00|2676.6|2974|173.45 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2974.00||||2974.00||| 35170491|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2974.00||||2974.00||| 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3547.00||||3547.00|457.34|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3547.00||||3547.00|242.64|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3547.00||||3547.00|2660.25|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3547.00||||3547.00|404.73|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3547.00||||3547.00|440.01|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|||3547.00||||3547.00|1064.1|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3547.00||||3547.00|1700.79|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3547.00||||3547.00|2305.55|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3547.00||||3547.00|3547|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3547.00||||3547.00|744.87|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3547.00||||3547.00|172.16|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3547.00||||3547.00|503.07|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3547.00||||3547.00|1525.21|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3547.00||||3547.00|253.18|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3547.00||||3547.00|246.42|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3547.00||||3547.00|242.64|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3547.00||||3547.00|339.72|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3547.00||||3547.00|424.98|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3547.00||||3547.00|185.66|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3547.00||||3547.00|440.01|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3547.00||||3547.00|2128.2|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3547.00||||3547.00|177.22|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3547.00||||3547.00|1525.21|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3547.00||||3547.00|1777.05|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3547.00||||3547.00|1245|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3547.00||||3547.00|1511.02|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3547.00||||3547.00|482.2|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3547.00||||3547.00|168.78|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3547.00||||3547.00|185.66|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3547.00||||3547.00|3192.3|3547|168.78 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3547.00||||3547.00||| 35170492|EAP|0351 - CT SCAN-HEAD SCAN|HC NECK SOFT TISSUE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3547.00||||3547.00||| 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4182.00||||4182.00|190.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4182.00||||4182.00|482.2|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4182.00||||4182.00|1798.26|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4182.00||||4182.00|1467.88|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4182.00||||4182.00|1781.53|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4182.00||||4182.00|182.12|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4182.00||||4182.00|449.17|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4182.00||||4182.00|190.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4182.00||||4182.00|433.82|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|4182.00||||4182.00|415.58|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4182.00||||4182.00|249.35|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|4182.00||||4182.00|260.18|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4182.00||||4182.00|1798.26|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4182.00||||4182.00|513.54|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4182.00||||4182.00|176.92|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4182.00||||4182.00|253.24|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4182.00||||4182.00|878.22|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4182.00||||4182.00|4182|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4182.00||||4182.00|2718.3|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4182.00||||4182.00|2509.2|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4182.00||||4182.00|2095.18|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4182.00||||4182.00|2005.27|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|||4182.00||||4182.00|1254.6|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4182.00||||4182.00|449.17|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4182.00||||4182.00|173.45|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4182.00||||4182.00|413.15|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|4182.00||||4182.00|3136.5|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4182.00||||4182.00|249.35|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4182.00||||4182.00|466.86|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|GEHA [1415]|GEHA [141500]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4182.00||||4182.00|3763.8|4182|173.45 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4182.00||||4182.00||| 35170496|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA HEAD W & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4182.00||||4182.00||| 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3848.00||||3848.00|466.86|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3848.00||||3848.00|249.35|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3848.00||||3848.00|413.15|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3848.00||||3848.00|449.17|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|||3848.00||||3848.00|1154.4|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3848.00||||3848.00|1845.12|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3848.00||||3848.00|2501.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3848.00||||3848.00|3848|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3848.00||||3848.00|253.24|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3848.00||||3848.00|513.54|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3848.00||||3848.00|176.92|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3848.00||||3848.00|1654.64|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3848.00||||3848.00|808.08|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3848.00||||3848.00|260.18|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3848.00||||3848.00|249.35|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3848.00||||3848.00|415.58|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3848.00||||3848.00|433.82|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3848.00||||3848.00|2886|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3848.00||||3848.00|190.8|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3848.00||||3848.00|449.17|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3848.00||||3848.00|2308.8|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3848.00||||3848.00|182.12|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3848.00||||3848.00|1654.64|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3848.00||||3848.00|1927.85|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3848.00||||3848.00|1350.65|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3848.00||||3848.00|1639.25|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3848.00||||3848.00|482.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3848.00||||3848.00|173.45|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3848.00||||3848.00|190.8|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3848.00||||3848.00|3463.2|3848|173.45 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3848.00||||3848.00||| 35170498|EAP|0351 - CT SCAN-HEAD SCAN|HC CTA NECK W & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3848.00||||3848.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35184|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOBENZAPRINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1294.00||||1294.00|154.25|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1294.00||||1294.00|109.21|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1294.00||||1294.00|136.51|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1294.00||||1294.00|75.97|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1294.00||||1294.00|148.41|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|||1294.00||||1294.00|388.2|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1294.00||||1294.00|841.1|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1294.00||||1294.00|620.47|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1294.00||||1294.00|1294|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1294.00||||1294.00|110.91|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|UMR [2035]|UMR OPTIONS [203501]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1294.00||||1294.00|75.4|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1294.00||||1294.00|75.97|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1294.00||||1294.00|169.68|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1294.00||||1294.00|556.42|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MULTIPLAN [1680]|IHC HS [168011]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1294.00||||1294.00|106.27|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MULTIPLAN [1680]|HMA [168003]|1294.00||||1294.00|110.88|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1294.00||||1294.00|271.74|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|TRUSTMARK [2030]|STARMARK [203000]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1294.00||||1294.00|143.34|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1294.00||||1294.00|81.31|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|1294.00||||1294.00|970.5|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1294.00||||1294.00|75.97|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1294.00||||1294.00|148.41|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1294.00||||1294.00|776.4|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|GEHA [1415]|GEHA [141500]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1294.00||||1294.00|77.62|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1294.00||||1294.00|556.42|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1294.00||||1294.00|648.29|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1294.00||||1294.00|551.24|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1294.00||||1294.00|454.19|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1294.00||||1294.00|148.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1294.00||||1294.00|73.92|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1294.00||||1294.00|81.31|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1294.00||||1294.00|1164.6|1294|73.92 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1294.00||||1294.00||| 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|1294.00||||1294.00||| 35200297|EAP|0352 - CT SCAN-BODY SCAN|HC LDCT FOR LUNG CA SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1294.00||||1294.00||| 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2713.00||||2713.00|117.36|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2713.00||||2713.00|268.93|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2713.00||||2713.00|1166.59|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2713.00||||2713.00|1359.21|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2713.00||||2713.00|952.26|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2713.00||||2713.00|112.03|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2713.00||||2713.00|1627.8|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2713.00||||2713.00|257.35|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2713.00||||2713.00|117.36|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2713.00||||2713.00|248.57|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|AETNA [1015]|AETNA ACO WILCO [101532]|2713.00||||2713.00|208.54|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MULTIPLAN [1680]|IHC HS [168011]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2713.00||||2713.00|153.38|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|FMH BENEFIT SERVICES [1390]|FMH [139000]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|FIRST HEALTH [1375]|QUALCHOICE [137513]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2713.00||||2713.00|1166.59|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MULTIPLAN [1680]|HMA [168003]|2713.00||||2713.00|160.04|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|HEALTHNET [1495]|HEALTHNET [149500]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2713.00||||2713.00|294.24|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2713.00||||2713.00|108.82|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|TRUSTMARK [2030]|STARMARK [203000]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|UMR [2035]|UMR OPTIONS [203501]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2713.00||||2713.00|155.77|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2713.00||||2713.00|569.73|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2713.00||||2713.00|2713|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2713.00||||2713.00|1763.45|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2713.00||||2713.00|1300.88|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2713.00||||2713.00|1155.74|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|||2713.00||||2713.00|813.9|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2713.00||||2713.00|257.35|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2713.00||||2713.00|106.69|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2713.00||||2713.00|236.72|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|CHAMPVA [1240]|CHAMP VA [124000]|2713.00||||2713.00|2034.75|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2713.00||||2713.00|153.38|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|CORESOURCE [1315]|CORESOURCE [131500]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2713.00||||2713.00|267.48|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|GEHA [1415]|GEHA [141500]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2713.00||||2713.00|2441.7|2713|106.69 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2713.00||||2713.00||| 35271250|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/O CON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2713.00||||2713.00||| 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|GEHA [1415]|GEHA [141500]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3219.00||||3219.00|407.29|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3219.00||||3219.00|249.35|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3219.00||||3219.00|2414.25|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3219.00||||3219.00|360.44|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3219.00||||3219.00|391.86|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|||3219.00||||3219.00|965.7|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3219.00||||3219.00|1543.51|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3219.00||||3219.00|2092.35|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3219.00||||3219.00|3219|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3219.00||||3219.00|675.99|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3219.00||||3219.00|176.92|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3219.00||||3219.00|448.02|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3219.00||||3219.00|1384.17|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3219.00||||3219.00|253.24|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3219.00||||3219.00|249.35|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MULTIPLAN [1680]|HMA [168003]|3219.00||||3219.00|260.18|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3219.00||||3219.00|278.95|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3219.00||||3219.00|378.48|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3219.00||||3219.00|190.8|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3219.00||||3219.00|391.86|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3219.00||||3219.00|1931.4|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3219.00||||3219.00|177.22|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3219.00||||3219.00|1384.17|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3219.00||||3219.00|1612.72|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3219.00||||3219.00|1129.87|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3219.00||||3219.00|1371.29|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3219.00||||3219.00|482.2|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3219.00||||3219.00|173.45|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3219.00||||3219.00|190.8|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3219.00||||3219.00|2897.1|3219|173.45 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3219.00||||3219.00||| 35271260|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W/ CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3219.00||||3219.00||| 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3714.00||||3714.00|1597.02|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3714.00||||3714.00|503.07|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3714.00||||3714.00|176.92|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3714.00||||3714.00|253.24|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3714.00||||3714.00|779.94|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3714.00||||3714.00|3714|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3714.00||||3714.00|2414.1|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3714.00||||3714.00|1780.86|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|||3714.00||||3714.00|1114.2|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3714.00||||3714.00|440.01|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3714.00||||3714.00|404.73|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3714.00||||3714.00|2785.5|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3714.00||||3714.00|249.35|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3714.00||||3714.00|457.34|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|GEHA [1415]|GEHA [141500]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3714.00||||3714.00|190.8|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3714.00||||3714.00|190.8|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3714.00||||3714.00|1582.16|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3714.00||||3714.00|340.46|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MULTIPLAN [1680]|HMA [168003]|3714.00||||3714.00|260.18|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3714.00||||3714.00|482.2|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3714.00||||3714.00|182.12|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3714.00||||3714.00|1597.02|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3714.00||||3714.00|424.98|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3714.00||||3714.00|249.35|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3714.00||||3714.00|1303.61|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3714.00||||3714.00|1860.71|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3714.00||||3714.00|173.45|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3714.00||||3714.00|440.01|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3714.00||||3714.00|3342.6|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3714.00||||3714.00|2228.4|3714|173.45 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3714.00||||3714.00||| 35271270|EAP|0352 - CT SCAN-BODY SCAN|HC CHEST/THORAX W & WO CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3714.00||||3714.00||| 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3703.00||||3703.00|1855.2|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3703.00||||3703.00|1775.59|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3703.00||||3703.00|449.17|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3703.00||||3703.00|260.18|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3703.00||||3703.00|433.82|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3703.00||||3703.00|449.17|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3703.00||||3703.00|2221.8|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3703.00||||3703.00|3703|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3703.00||||3703.00|1577.48|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3703.00||||3703.00|176.92|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3703.00||||3703.00|415.58|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3703.00||||3703.00|413.15|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3703.00||||3703.00|190.8|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3703.00||||3703.00|182.12|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3703.00||||3703.00|1299.75|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3703.00||||3703.00|466.86|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3703.00||||3703.00|2777.25|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3703.00||||3703.00|1592.29|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3703.00||||3703.00|482.2|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3703.00||||3703.00|513.54|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3703.00||||3703.00|190.8|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3703.00||||3703.00|253.24|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|||3703.00||||3703.00|1110.9|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3703.00||||3703.00|249.35|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3703.00||||3703.00|249.35|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3703.00||||3703.00|2406.95|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3703.00||||3703.00|1592.29|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3703.00||||3703.00|777.63|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3703.00||||3703.00|3332.7|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3703.00||||3703.00|173.45|3703|173.45 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3703.00||||3703.00||| 35271275|EAP|0352 - CT SCAN-BODY SCAN|HC CTA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3703.00||||3703.00||| 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2994.00||||2994.00|2994|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2994.00||||2994.00|236.72|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2994.00||||2994.00|257.35|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2994.00||||2994.00|1435.62|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|||2994.00||||2994.00|898.2|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2994.00||||2994.00|2245.5|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2994.00||||2994.00|1946.1|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2994.00||||2994.00|628.74|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2994.00||||2994.00|155.77|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2994.00||||2994.00|248.57|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2994.00||||2994.00|1287.42|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2994.00||||2994.00|117.36|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2994.00||||2994.00|268.93|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2994.00||||2994.00|153.38|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2994.00||||2994.00|1796.4|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2994.00||||2994.00|257.35|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|GEHA [1415]|GEHA [141500]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2994.00||||2994.00|267.48|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2994.00||||2994.00|153.38|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2994.00||||2994.00|109.01|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2994.00||||2994.00|160.04|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2994.00||||2994.00|231.51|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2994.00||||2994.00|108.82|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2994.00||||2994.00|294.24|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2994.00||||2994.00|1275.44|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2994.00||||2994.00|117.36|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2994.00||||2994.00|1499.99|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2994.00||||2994.00|1287.42|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2994.00||||2994.00|1050.89|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2994.00||||2994.00|2694.6|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2994.00||||2994.00|106.69|2994|106.69 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2994.00||||2994.00||| 35272125|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2994.00||||2994.00||| 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3497.00||||3497.00|1503.71|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3497.00||||3497.00|734.37|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|GEHA [1415]|GEHA [141500]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3497.00||||3497.00|522.53|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3497.00||||3497.00|360.44|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3497.00||||3497.00|407.29|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3497.00||||3497.00|370.75|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3497.00||||3497.00|922.36|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3497.00||||3497.00|378.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3497.00||||3497.00|1676.81|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3497.00||||3497.00|448.02|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3497.00||||3497.00|545.22|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3497.00||||3497.00|3497|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3497.00||||3497.00|522.53|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3497.00||||3497.00|399.82|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3497.00||||3497.00|530.68|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3497.00||||3497.00|1503.71|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3497.00||||3497.00|2622.75|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3497.00||||3497.00|1227.45|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3497.00||||3497.00|2098.2|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3497.00||||3497.00|1752|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3497.00||||3497.00|2273.05|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3497.00||||3497.00|391.86|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3497.00||||3497.00|391.86|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|||3497.00||||3497.00|1049.1|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3497.00||||3497.00|345.65|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3497.00||||3497.00|363.48|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3497.00||||3497.00|399.82|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3497.00||||3497.00|1489.72|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3497.00||||3497.00|381.65|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3497.00||||3497.00|3147.3|3497|345.65 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3497.00||||3497.00||| 35272126|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3497.00||||3497.00||| 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|||4686.00||||4686.00|1405.8|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4686.00||||4686.00|249.35|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|4686.00||||4686.00|3514.5|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4686.00||||4686.00|440.01|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4686.00||||4686.00|3045.9|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4686.00||||4686.00|4686|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4686.00||||4686.00|2246.94|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4686.00||||4686.00|404.73|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4686.00||||4686.00|457.34|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|4686.00||||4686.00|415.32|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|4686.00||||4686.00|260.18|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4686.00||||4686.00|2347.69|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4686.00||||4686.00|190.8|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4686.00||||4686.00|2014.98|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4686.00||||4686.00|182.12|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4686.00||||4686.00|2811.6|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4686.00||||4686.00|440.01|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4686.00||||4686.00|253.24|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4686.00||||4686.00|2014.98|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4686.00||||4686.00|984.06|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4686.00||||4686.00|503.07|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4686.00||||4686.00|1996.24|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4686.00||||4686.00|176.92|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4686.00||||4686.00|424.98|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4686.00||||4686.00|173.45|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4686.00||||4686.00|249.35|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4686.00||||4686.00|4217.4|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4686.00||||4686.00|190.8|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4686.00||||4686.00|1644.79|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4686.00||||4686.00|482.2|4686|173.45 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4686.00||||4686.00||| 35272127|EAP|0352 - CT SCAN-BODY SCAN|HC C-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4686.00||||4686.00||| 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2862.00||||2862.00|2862|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2862.00||||2862.00|108.82|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2862.00||||2862.00|2146.5|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2862.00||||2862.00|601.02|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2862.00||||2862.00|153.38|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2862.00||||2862.00|267.48|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2862.00||||2862.00|117.36|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2862.00||||2862.00|155.77|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2862.00||||2862.00|1860.3|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2862.00||||2862.00|257.35|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|GEHA [1415]|GEHA [141500]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2862.00||||2862.00|1372.33|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2862.00||||2862.00|1230.66|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2862.00||||2862.00|231.51|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2862.00||||2862.00|153.38|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2862.00||||2862.00|160.04|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2862.00||||2862.00|294.24|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2862.00||||2862.00|1219.21|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2862.00||||2862.00|1230.66|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2862.00||||2862.00|268.93|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2862.00||||2862.00|106.69|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|||2862.00||||2862.00|858.6|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2862.00||||2862.00|236.72|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2862.00||||2862.00|1717.2|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2862.00||||2862.00|257.35|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2862.00||||2862.00|112.03|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2862.00||||2862.00|248.57|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2862.00||||2862.00|2575.8|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2862.00||||2862.00|1004.56|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2862.00||||2862.00|117.36|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2862.00||||2862.00|1433.86|2862|106.69 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2862.00||||2862.00||| 35272128|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2862.00||||2862.00||| 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3662.00||||3662.00|190.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3662.00||||3662.00|482.2|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3662.00||||3662.00|391.86|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3662.00||||3662.00|1834.66|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3662.00||||3662.00|260.18|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3662.00||||3662.00|249.35|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3662.00||||3662.00|378.48|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3662.00||||3662.00|1560.01|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3662.00||||3662.00|769.02|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3662.00||||3662.00|448.02|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3662.00||||3662.00|1574.66|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3662.00||||3662.00|176.92|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3662.00||||3662.00|360.44|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3662.00||||3662.00|1574.66|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3662.00||||3662.00|253.24|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3662.00||||3662.00|2746.5|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3662.00||||3662.00|1755.93|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3662.00||||3662.00|3662|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3662.00||||3662.00|348.61|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3662.00||||3662.00|391.86|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3662.00||||3662.00|2197.2|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3662.00||||3662.00|1285.36|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3662.00||||3662.00|407.29|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|GEHA [1415]|GEHA [141500]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3662.00||||3662.00|173.45|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3662.00||||3662.00|190.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3662.00||||3662.00|249.35|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|||3662.00||||3662.00|1098.6|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3662.00||||3662.00|182.12|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3662.00||||3662.00|3295.8|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3662.00||||3662.00|2380.3|3662|173.45 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3662.00||||3662.00||| 35272129|EAP|0352 - CT SCAN-BODY SCAN|HC T-SPINE W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3662.00||||3662.00||| 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2870.00||||2870.00|236.72|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2870.00||||2870.00|2152.5|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2870.00||||2870.00|155.77|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2870.00||||2870.00|257.35|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|GEHA [1415]|GEHA [141500]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2870.00||||2870.00|1376.17|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2870.00||||2870.00|294.24|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2870.00||||2870.00|1234.1|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2870.00||||2870.00|602.7|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2870.00||||2870.00|160.04|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2870.00||||2870.00|1007.37|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2870.00||||2870.00|153.38|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2870.00||||2870.00|1222.62|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2870.00||||2870.00|1722|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2870.00||||2870.00|231.51|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2870.00||||2870.00|117.36|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2870.00||||2870.00|103.82|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2870.00||||2870.00|2870|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2870.00||||2870.00|1234.1|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|||2870.00||||2870.00|861|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2870.00||||2870.00|248.57|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2870.00||||2870.00|1865.5|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2870.00||||2870.00|267.48|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2870.00||||2870.00|257.35|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2870.00||||2870.00|117.36|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2870.00||||2870.00|268.93|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2870.00||||2870.00|112.03|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2870.00||||2870.00|106.69|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2870.00||||2870.00|108.82|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2870.00||||2870.00|1437.87|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2870.00||||2870.00|153.38|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2870.00||||2870.00|2583|2870|103.82 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2870.00||||2870.00||| 35272131|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2870.00||||2870.00||| 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3319.00||||3319.00|407.29|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|GEHA [1415]|GEHA [141500]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3319.00||||3319.00|522.53|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3319.00||||3319.00|360.44|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3319.00||||3319.00|2489.25|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3319.00||||3319.00|346.39|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3319.00||||3319.00|378.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3319.00||||3319.00|391.86|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3319.00||||3319.00|399.82|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3319.00||||3319.00|1662.82|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3319.00||||3319.00|1164.97|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3319.00||||3319.00|1413.89|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3319.00||||3319.00|1991.4|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3319.00||||3319.00|399.82|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3319.00||||3319.00|696.99|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3319.00||||3319.00|370.75|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3319.00||||3319.00|1427.17|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3319.00||||3319.00|448.02|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3319.00||||3319.00|545.22|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3319.00||||3319.00|381.65|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3319.00||||3319.00|530.68|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3319.00||||3319.00|1591.46|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3319.00||||3319.00|1427.17|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3319.00||||3319.00|922.36|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3319.00||||3319.00|391.86|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3319.00||||3319.00|3319|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3319.00||||3319.00|2157.35|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|||3319.00||||3319.00|995.7|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3319.00||||3319.00|363.48|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3319.00||||3319.00|522.53|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3319.00||||3319.00|2987.1|3319|346.39 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3319.00||||3319.00||| 35272132|EAP|0352 - CT SCAN-BODY SCAN|HC L-SPINE W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3319.00||||3319.00||| 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3999.00||||3999.00|260.18|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3999.00||||3999.00|2999.25|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3999.00||||3999.00|249.35|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3999.00||||3999.00|503.07|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3999.00||||3999.00|440.01|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|||3999.00||||3999.00|1199.7|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3999.00||||3999.00|1917.52|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3999.00||||3999.00|3999|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3999.00||||3999.00|839.79|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3999.00||||3999.00|176.92|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3999.00||||3999.00|1719.57|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3999.00||||3999.00|253.24|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3999.00||||3999.00|249.35|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3999.00||||3999.00|415.32|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3999.00||||3999.00|2399.4|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3999.00||||3999.00|190.8|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3999.00||||3999.00|1719.57|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3999.00||||3999.00|1703.57|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3999.00||||3999.00|482.2|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3999.00||||3999.00|190.8|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3999.00||||3999.00|1403.65|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3999.00||||3999.00|457.34|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3999.00||||3999.00|182.12|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3999.00||||3999.00|440.01|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3999.00||||3999.00|424.98|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3999.00||||3999.00|2003.5|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3999.00||||3999.00|2599.35|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3999.00||||3999.00|173.45|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3999.00||||3999.00|404.73|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3999.00||||3999.00|3599.1|3999|173.45 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3999.00||||3999.00||| 35272133|EAP|0352 - CT SCAN-BODY SCAN|HC LUMBAR SPINE W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3999.00||||3999.00||| 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA ACO WILCO [101532]|3906.00||||3906.00|415.58|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3906.00||||3906.00|433.82|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3906.00||||3906.00|449.17|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3906.00||||3906.00|2343.6|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3906.00||||3906.00|1663.96|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3906.00||||3906.00|190.8|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3906.00||||3906.00|182.12|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3906.00||||3906.00|1956.91|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3906.00||||3906.00|1679.58|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3906.00||||3906.00|482.2|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3906.00||||3906.00|1371.01|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3906.00||||3906.00|190.8|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3906.00||||3906.00|820.26|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|HEALTHNET [1495]|HEALTHNET [149500]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|IHC HS [168011]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3906.00||||3906.00|513.54|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3906.00||||3906.00|2538.9|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3906.00||||3906.00|1679.58|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|UMR [2035]|UMR OPTIONS [203501]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3906.00||||3906.00|253.24|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3906.00||||3906.00|449.17|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|HMA [168003]|3906.00||||3906.00|260.18|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3906.00||||3906.00|3906|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3906.00||||3906.00|1872.93|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3906.00||||3906.00|413.15|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|CHAMPVA [1240]|CHAMP VA [124000]|3906.00||||3906.00|2929.5|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3906.00||||3906.00|249.35|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3906.00||||3906.00|466.86|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|GEHA [1415]|GEHA [141500]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3906.00||||3906.00|176.92|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3906.00||||3906.00|249.35|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|||3906.00||||3906.00|1171.8|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|TRUSTMARK [2030]|STARMARK [203000]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3906.00||||3906.00|173.45|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|CORESOURCE [1315]|CORESOURCE [131500]|3906.00||||3906.00|3515.4|3906|173.45 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3906.00||||3906.00||| 35272191|EAP|0352 - CT SCAN-BODY SCAN|HC CTA PELVIS W/CONT+NONCONTRAST IMG IF DONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3906.00||||3906.00||| 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2873.00||||2873.00|603.33|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|||2873.00||||2873.00|861.9|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2873.00||||2873.00|236.72|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2873.00||||2873.00|2154.75|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2873.00||||2873.00|153.38|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2873.00||||2873.00|267.48|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|GEHA [1415]|GEHA [141500]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2873.00||||2873.00|2873|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2873.00||||2873.00|257.35|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2873.00||||2873.00|1377.6|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2873.00||||2873.00|140.85|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2873.00||||2873.00|155.77|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2873.00||||2873.00|294.24|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2873.00||||2873.00|1235.39|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2873.00||||2873.00|160.04|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2873.00||||2873.00|153.38|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2873.00||||2873.00|117.36|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2873.00||||2873.00|112.03|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2873.00||||2873.00|1235.39|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2873.00||||2873.00|268.93|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2873.00||||2873.00|1439.37|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2873.00||||2873.00|1008.42|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2873.00||||2873.00|117.36|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2873.00||||2873.00|1223.9|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2873.00||||2873.00|108.82|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2873.00||||2873.00|1723.8|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2873.00||||2873.00|189.27|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2873.00||||2873.00|248.57|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2873.00||||2873.00|257.35|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2873.00||||2873.00|1867.45|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2873.00||||2873.00|106.69|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2873.00||||2873.00|2585.7|2873|106.69 35272192|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2873.00||||2873.00||| 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3355.00||||3355.00|182.12|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3355.00||||3355.00|190.8|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3355.00||||3355.00|482.2|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3355.00||||3355.00|1442.65|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3355.00||||3355.00|1680.86|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3355.00||||3355.00|1429.23|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3355.00||||3355.00|365.66|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3355.00||||3355.00|2013|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3355.00||||3355.00|190.8|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3355.00||||3355.00|378.48|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3355.00||||3355.00|260.18|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3355.00||||3355.00|249.35|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3355.00||||3355.00|391.86|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3355.00||||3355.00|1442.65|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3355.00||||3355.00|448.02|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3355.00||||3355.00|176.92|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3355.00||||3355.00|253.24|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3355.00||||3355.00|3355|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3355.00||||3355.00|704.55|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3355.00||||3355.00|391.86|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3355.00||||3355.00|2180.75|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3355.00||||3355.00|216.1|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3355.00||||3355.00|360.44|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3355.00||||3355.00|1608.72|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|||3355.00||||3355.00|1006.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3355.00||||3355.00|1177.61|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3355.00||||3355.00|249.35|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3355.00||||3355.00|2516.25|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3355.00||||3355.00|173.45|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|GEHA [1415]|GEHA [141500]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3355.00||||3355.00|407.29|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3355.00||||3355.00|3019.5|3355|173.45 35272193|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3355.00||||3355.00||| 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4097.00||||4097.00|440.01|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4097.00||||4097.00|2663.05|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4097.00||||4097.00|249.35|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4097.00||||4097.00|404.73|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4097.00||||4097.00|457.34|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|4097.00||||4097.00|3072.75|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|||4097.00||||4097.00|1229.1|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4097.00||||4097.00|1964.51|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4097.00||||4097.00|4097|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4097.00||||4097.00|176.92|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|4097.00||||4097.00|260.18|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4097.00||||4097.00|503.07|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4097.00||||4097.00|1761.71|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4097.00||||4097.00|249.35|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4097.00||||4097.00|253.24|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4097.00||||4097.00|860.37|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4097.00||||4097.00|424.98|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4097.00||||4097.00|2458.2|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4097.00||||4097.00|182.12|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|4097.00||||4097.00|415.32|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4097.00||||4097.00|1761.71|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4097.00||||4097.00|190.8|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4097.00||||4097.00|482.2|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4097.00||||4097.00|2052.6|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4097.00||||4097.00|1438.05|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4097.00||||4097.00|440.01|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4097.00||||4097.00|190.8|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4097.00||||4097.00|3687.3|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4097.00||||4097.00|173.45|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4097.00||||4097.00|1745.32|4097|173.45 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4097.00||||4097.00||| 35272194|EAP|0352 - CT SCAN-BODY SCAN|HC PELVIS W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4097.00||||4097.00||| 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2400.00||||2400.00|1032|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2400.00||||2400.00|106.69|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2400.00||||2400.00|268.93|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2400.00||||2400.00|1202.4|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2400.00||||2400.00|842.4|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2400.00||||2400.00|1022.4|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2400.00||||2400.00|345.43|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2400.00||||2400.00|1440|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2400.00||||2400.00|257.35|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2400.00||||2400.00|109.01|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2400.00||||2400.00|106.69|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2400.00||||2400.00|155.73|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2400.00||||2400.00|105.9|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2400.00||||2400.00|1032|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2400.00||||2400.00|294.24|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2400.00||||2400.00|114.2|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2400.00||||2400.00|155.77|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2400.00||||2400.00|504|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2400.00||||2400.00|2400|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2400.00||||2400.00|257.35|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2400.00||||2400.00|1560|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2400.00||||2400.00|248.57|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2400.00||||2400.00|106.69|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2400.00||||2400.00|236.72|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|GEHA [1415]|GEHA [141500]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2400.00||||2400.00|267.48|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2400.00||||2400.00|149.25|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2400.00||||2400.00|153.38|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2400.00||||2400.00|1800|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2400.00||||2400.00|114.2|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2400.00||||2400.00|1150.8|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|||2400.00||||2400.00|720|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2400.00||||2400.00|2160|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2400.00||||2400.00|103.82|2400|103.82 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2400.00||||2400.00||| 35273200|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2400.00||||2400.00||| 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3211.00||||3211.00|2087.15|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3211.00||||3211.00|516.39|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3211.00||||3211.00|530.54|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3211.00||||3211.00|1380.73|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3211.00||||3211.00|360.77|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3211.00||||3211.00|508.47|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3211.00||||3211.00|448.02|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3211.00||||3211.00|371.38|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3211.00||||3211.00|1926.6|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3211.00||||3211.00|378.48|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3211.00||||3211.00|391.86|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3211.00||||3211.00|1608.71|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3211.00||||3211.00|1127.06|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3211.00||||3211.00|922.36|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3211.00||||3211.00|389.06|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3211.00||||3211.00|1367.89|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3211.00||||3211.00|1380.73|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3211.00||||3211.00|674.31|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3211.00||||3211.00|1539.67|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3211.00||||3211.00|3211|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3211.00||||3211.00|342.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3211.00||||3211.00|389.06|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|GEHA [1415]|GEHA [141500]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3211.00||||3211.00|407.29|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3211.00||||3211.00|508.47|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3211.00||||3211.00|2408.25|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3211.00||||3211.00|360.44|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3211.00||||3211.00|2889.9|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3211.00||||3211.00|353.69|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3211.00||||3211.00|391.86|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|||3211.00||||3211.00|963.3|3211|342.69 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3211.00||||3211.00||| 35273201|EAP|0352 - CT SCAN-BODY SCAN|HC UPPER EXT W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3211.00||||3211.00||| 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3016.00||||3016.00|482.2|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3016.00||||3016.00|190.8|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3016.00||||3016.00|1296.88|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3016.00||||3016.00|1511.02|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3016.00||||3016.00|1284.82|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3016.00||||3016.00|182.12|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3016.00||||3016.00|1809.6|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3016.00||||3016.00|190.8|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3016.00||||3016.00|433.82|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|TRUSTMARK [2030]|STARMARK [203000]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3016.00||||3016.00|249.35|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MULTIPLAN [1680]|IHC HS [168011]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|FIRST HEALTH [1375]|QUALCHOICE [137513]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3016.00||||3016.00|1296.88|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3016.00||||3016.00|513.54|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3016.00||||3016.00|176.92|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MULTIPLAN [1680]|HMA [168003]|3016.00||||3016.00|260.18|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|HEALTHNET [1495]|HEALTHNET [149500]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|UMR [2035]|UMR OPTIONS [203501]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|FMH BENEFIT SERVICES [1390]|FMH [139000]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|AETNA [1015]|AETNA ACO WILCO [101532]|3016.00||||3016.00|415.58|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3016.00||||3016.00|253.24|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3016.00||||3016.00|633.36|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3016.00||||3016.00|3016|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3016.00||||3016.00|1960.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3016.00||||3016.00|1446.17|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3016.00||||3016.00|449.17|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3016.00||||3016.00|1058.62|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3016.00||||3016.00|249.35|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|GEHA [1415]|GEHA [141500]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3016.00||||3016.00|466.86|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|CORESOURCE [1315]|CORESOURCE [131500]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|CHAMPVA [1240]|CHAMP VA [124000]|3016.00||||3016.00|2262|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3016.00||||3016.00|413.15|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3016.00||||3016.00|173.45|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3016.00||||3016.00|449.17|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3016.00||||3016.00|2714.4|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|||3016.00||||3016.00|904.8|3016|173.45 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3016.00||||3016.00||| 35273206|EAP|0352 - CT SCAN-BODY SCAN|HC CTA UPPER EXT W & W/O CONT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3016.00||||3016.00||| 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|GEHA [1415]|GEHA [141500]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2613.00||||2613.00|267.48|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2613.00||||2613.00|153.38|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2613.00||||2613.00|1959.75|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2613.00||||2613.00|1252.93|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2613.00||||2613.00|257.35|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|||2613.00||||2613.00|783.9|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2613.00||||2613.00|1698.45|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2613.00||||2613.00|2613|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2613.00||||2613.00|548.73|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2613.00||||2613.00|108.82|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2613.00||||2613.00|1123.59|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2613.00||||2613.00|160.04|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2613.00||||2613.00|153.38|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2613.00||||2613.00|294.24|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2613.00||||2613.00|231.51|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2613.00||||2613.00|155.77|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2613.00||||2613.00|248.57|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2613.00||||2613.00|117.36|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2613.00||||2613.00|257.35|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2613.00||||2613.00|1567.8|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2613.00||||2613.00|112.03|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2613.00||||2613.00|1123.59|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2613.00||||2613.00|1309.11|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2613.00||||2613.00|917.16|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2613.00||||2613.00|1113.14|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2613.00||||2613.00|268.93|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2613.00||||2613.00|236.72|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2613.00||||2613.00|117.36|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2613.00||||2613.00|2351.7|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2613.00||||2613.00|106.69|2613|106.69 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2613.00||||2613.00||| 35273700|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2613.00||||2613.00||| 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3211.00||||3211.00|1380.73|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3211.00||||3211.00|177.22|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3211.00||||3211.00|190.8|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3211.00||||3211.00|1380.73|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3211.00||||3211.00|1608.71|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3211.00||||3211.00|1127.06|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3211.00||||3211.00|1367.89|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3211.00||||3211.00|1926.6|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3211.00||||3211.00|391.86|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3211.00||||3211.00|378.48|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3211.00||||3211.00|348.61|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3211.00||||3211.00|249.35|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3211.00||||3211.00|260.18|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3211.00||||3211.00|448.02|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3211.00||||3211.00|176.92|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3211.00||||3211.00|253.24|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3211.00||||3211.00|190.8|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3211.00||||3211.00|674.31|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3211.00||||3211.00|3211|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3211.00||||3211.00|2087.15|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3211.00||||3211.00|1539.67|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|||3211.00||||3211.00|963.3|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3211.00||||3211.00|360.44|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3211.00||||3211.00|407.29|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3211.00||||3211.00|482.2|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|GEHA [1415]|GEHA [141500]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3211.00||||3211.00|249.35|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3211.00||||3211.00|2408.25|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3211.00||||3211.00|2889.9|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3211.00||||3211.00|391.86|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3211.00||||3211.00|173.45|3211|173.45 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3211.00||||3211.00||| 35273701|EAP|0352 - CT SCAN-BODY SCAN|HC LOWER EXT W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3211.00||||3211.00||| 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|GEHA [1415]|GEHA [141500]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3317.00||||3317.00|466.86|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|CORESOURCE [1315]|CORESOURCE [131500]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|CHAMPVA [1240]|CHAMP VA [124000]|3317.00||||3317.00|2487.75|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3317.00||||3317.00|413.15|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3317.00||||3317.00|449.17|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|||3317.00||||3317.00|995.1|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3317.00||||3317.00|1590.5|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3317.00||||3317.00|2156.05|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3317.00||||3317.00|253.24|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|UMR [2035]|UMR OPTIONS [203501]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3317.00||||3317.00|1426.31|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|IHC HS [168011]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|HEALTHNET [1495]|HEALTHNET [149500]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3317.00||||3317.00|449.17|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3317.00||||3317.00|1426.31|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3317.00||||3317.00|1661.82|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3317.00||||3317.00|482.2|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3317.00||||3317.00|190.8|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3317.00||||3317.00|1413.04|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3317.00||||3317.00|1164.27|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3317.00||||3317.00|182.12|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3317.00||||3317.00|1990.2|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3317.00||||3317.00|433.82|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3317.00||||3317.00|190.8|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|TRUSTMARK [2030]|STARMARK [203000]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3317.00||||3317.00|249.35|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|HMA [168003]|3317.00||||3317.00|260.18|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3317.00||||3317.00|249.35|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3317.00||||3317.00|173.45|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3317.00||||3317.00|513.54|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3317.00||||3317.00|176.92|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3317.00||||3317.00|696.57|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3317.00||||3317.00|3317|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3317.00||||3317.00|2985.3|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA ACO WILCO [101532]|3317.00||||3317.00|414.85|3317|173.45 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3317.00||||3317.00||| 35273706|EAP|0352 - CT SCAN-BODY SCAN|HC CTA LOWER EXT W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3317.00||||3317.00||| 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2894.00||||2894.00|1015.79|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2894.00||||2894.00|117.36|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2894.00||||2894.00|1244.42|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2894.00||||2894.00|1449.89|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2894.00||||2894.00|1232.84|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2894.00||||2894.00|112.03|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2894.00||||2894.00|1736.4|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2894.00||||2894.00|257.35|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2894.00||||2894.00|117.36|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2894.00||||2894.00|248.57|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2894.00||||2894.00|153.38|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2894.00||||2894.00|160.04|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2894.00||||2894.00|294.24|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2894.00||||2894.00|607.74|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2894.00||||2894.00|2894|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2894.00||||2894.00|1387.67|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|||2894.00||||2894.00|868.2|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2894.00||||2894.00|1881.1|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2894.00||||2894.00|257.35|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2894.00||||2894.00|236.72|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2894.00||||2894.00|155.77|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2894.00||||2894.00|2170.5|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2894.00||||2894.00|153.38|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2894.00||||2894.00|108.82|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2894.00||||2894.00|267.48|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|GEHA [1415]|GEHA [141500]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2894.00||||2894.00|1244.42|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2894.00||||2894.00|268.93|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2894.00||||2894.00|106.69|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2894.00||||2894.00|187.04|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2894.00||||2894.00|2604.6|2894|106.69 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2894.00||||2894.00||| 35274150|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2894.00||||2894.00||| 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3349.00||||3349.00|1440.07|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|GEHA [1415]|GEHA [141500]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3349.00||||3349.00|407.29|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3349.00||||3349.00|360.44|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3349.00||||3349.00|2511.75|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3349.00||||3349.00|391.86|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3349.00||||3349.00|1605.85|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3349.00||||3349.00|2176.85|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3349.00||||3349.00|3349|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3349.00||||3349.00|703.29|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3349.00||||3349.00|253.24|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3349.00||||3349.00|176.92|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3349.00||||3349.00|448.02|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3349.00||||3349.00|1440.07|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|||3349.00||||3349.00|1004.7|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3349.00||||3349.00|249.35|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MULTIPLAN [1680]|HMA [168003]|3349.00||||3349.00|260.18|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3349.00||||3349.00|249.35|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3349.00||||3349.00|364.18|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3349.00||||3349.00|378.48|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3349.00||||3349.00|190.8|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3349.00||||3349.00|391.86|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3349.00||||3349.00|2009.4|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3349.00||||3349.00|182.12|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3349.00||||3349.00|1677.85|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3349.00||||3349.00|1175.5|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3349.00||||3349.00|1426.67|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3349.00||||3349.00|482.2|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3349.00||||3349.00|173.45|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3349.00||||3349.00|190.8|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3349.00||||3349.00|3014.1|3349|173.45 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3349.00||||3349.00||| 35274160|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3349.00||||3349.00||| 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4051.00||||4051.00|2029.55|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4051.00||||4051.00|190.8|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4051.00||||4051.00|482.2|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4051.00||||4051.00|168.78|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4051.00||||4051.00|1741.93|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4051.00||||4051.00|1421.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4051.00||||4051.00|1725.73|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4051.00||||4051.00|2430.6|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4051.00||||4051.00|440.01|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4051.00||||4051.00|424.98|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|4051.00||||4051.00|260.18|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4051.00||||4051.00|1741.93|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4051.00||||4051.00|503.07|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|||4051.00||||4051.00|1215.3|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4051.00||||4051.00|404.73|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4051.00||||4051.00|457.34|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4051.00||||4051.00|249.35|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|4051.00||||4051.00|3038.25|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4051.00||||4051.00|440.01|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4051.00||||4051.00|1942.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4051.00||||4051.00|4051|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4051.00||||4051.00|190.8|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4051.00||||4051.00|2633.15|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4051.00||||4051.00|850.71|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4051.00||||4051.00|182.12|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4051.00||||4051.00|253.24|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4051.00||||4051.00|176.92|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4051.00||||4051.00|249.35|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|4051.00||||4051.00|415.32|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4051.00||||4051.00|173.45|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4051.00||||4051.00|3645.9|4051|168.78 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4051.00||||4051.00||| 35274170|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4051.00||||4051.00||| 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|GEHA [1415]|GEHA [141500]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5125.00||||5125.00|766.37|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|CORESOURCE [1315]|CORESOURCE [131500]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5125.00||||5125.00|522.53|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|CHAMPVA [1240]|CHAMP VA [124000]|5125.00||||5125.00|3843.75|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5125.00||||5125.00|678.22|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5125.00||||5125.00|737.34|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|||5125.00||||5125.00|1537.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5125.00||||5125.00|3331.25|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5125.00||||5125.00|5125|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5125.00||||5125.00|530.68|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5125.00||||5125.00|2203.75|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5125.00||||5125.00|1076.25|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|IHC HS [168011]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5125.00||||5125.00|843.01|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5125.00||||5125.00|522.53|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|HMA [168003]|5125.00||||5125.00|545.22|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|HEALTHNET [1495]|HEALTHNET [149500]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA ACO WILCO [101532]|5125.00||||5125.00|597.91|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5125.00||||5125.00|2457.44|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|UMR [2035]|UMR OPTIONS [203501]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|TRUSTMARK [2030]|STARMARK [203000]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5125.00||||5125.00|353.69|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5125.00||||5125.00|737.34|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5125.00||||5125.00|2567.63|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5125.00||||5125.00|922.36|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5125.00||||5125.00|399.82|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5125.00||||5125.00|1798.88|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5125.00||||5125.00|2203.75|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5125.00||||5125.00|381.65|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5125.00||||5125.00|3075|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5125.00||||5125.00|2183.25|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5125.00||||5125.00|399.82|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5125.00||||5125.00|712.15|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5125.00||||5125.00|370.75|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5125.00||||5125.00|4612.5|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5125.00||||5125.00|363.48|5125|353.69 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5125.00||||5125.00||| 35274174|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD/PELV W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5125.00||||5125.00||| 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3865.00||||3865.00|190.8|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3865.00||||3865.00|482.2|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3865.00||||3865.00|1661.95|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3865.00||||3865.00|1936.37|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3865.00||||3865.00|1356.62|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3865.00||||3865.00|1646.49|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3865.00||||3865.00|182.12|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3865.00||||3865.00|2319|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3865.00||||3865.00|190.8|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3865.00||||3865.00|433.82|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|TRUSTMARK [2030]|STARMARK [203000]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3865.00||||3865.00|249.35|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|IHC HS [168011]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3865.00||||3865.00|1661.95|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3865.00||||3865.00|513.54|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3865.00||||3865.00|176.92|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MULTIPLAN [1680]|HMA [168003]|3865.00||||3865.00|260.18|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|UMR [2035]|UMR OPTIONS [203501]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3865.00||||3865.00|253.24|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3865.00||||3865.00|811.65|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3865.00||||3865.00|3865|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3865.00||||3865.00|449.17|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3865.00||||3865.00|2512.25|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3865.00||||3865.00|1853.27|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3865.00||||3865.00|173.45|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3865.00||||3865.00|249.35|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|GEHA [1415]|GEHA [141500]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3865.00||||3865.00|466.86|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|CORESOURCE [1315]|CORESOURCE [131500]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|CHAMPVA [1240]|CHAMP VA [124000]|3865.00||||3865.00|2898.75|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3865.00||||3865.00|413.15|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|AETNA [1015]|AETNA ACO WILCO [101532]|3865.00||||3865.00|415.58|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3865.00||||3865.00|449.17|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|||3865.00||||3865.00|1159.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|HEALTHNET [1495]|HEALTHNET [149500]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3865.00||||3865.00|3478.5|3865|173.45 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3865.00||||3865.00||| 35274175|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABDOMEN W/CONT+NONCONTRAST IMG IF DONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3865.00||||3865.00||| 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5766.00||||5766.00|230.21|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|GEHA [1415]|GEHA [141500]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5766.00||||5766.00|318.9|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|5766.00||||5766.00|4324.5|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5766.00||||5766.00|250.28|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5766.00||||5766.00|2764.8|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5766.00||||5766.00|3747.9|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5766.00||||5766.00|1210.86|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5766.00||||5766.00|323.87|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5766.00||||5766.00|226.26|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5766.00||||5766.00|2479.38|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5766.00||||5766.00|286.15|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5766.00||||5766.00|318.9|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|5766.00||||5766.00|332.74|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|5766.00||||5766.00|235.22|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|||5766.00||||5766.00|1729.8|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5766.00||||5766.00|244.01|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5766.00||||5766.00|232.92|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5766.00||||5766.00|2023.87|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5766.00||||5766.00|2456.32|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5766.00||||5766.00|244.01|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5766.00||||5766.00|260.13|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5766.00||||5766.00|2888.77|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5766.00||||5766.00|551.1|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5766.00||||5766.00|2479.38|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5766.00||||5766.00|3459.6|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5766.00||||5766.00|250.28|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5766.00||||5766.00|241.72|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5766.00||||5766.00|221.83|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5766.00||||5766.00|5766|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5766.00||||5766.00|5189.4|5766|221.83 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5766.00||||5766.00||| 35274176|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5766.00||||5766.00||| 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6704.00||||6704.00|389.06|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6704.00||||6704.00|922.36|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6704.00||||6704.00|3358.7|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6704.00||||6704.00|2353.1|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6704.00||||6704.00|2855.9|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6704.00||||6704.00|4022.4|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6704.00||||6704.00|387.09|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6704.00||||6704.00|399.82|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6704.00||||6704.00|373.87|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MULTIPLAN [1680]|HMA [168003]|6704.00||||6704.00|545.22|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6704.00||||6704.00|522.53|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6704.00||||6704.00|2882.72|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6704.00||||6704.00|442.57|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6704.00||||6704.00|370.75|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|UMR [2035]|UMR OPTIONS [203501]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|6704.00||||6704.00|473.87|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6704.00||||6704.00|530.68|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6704.00||||6704.00|1407.84|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6704.00||||6704.00|6704|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6704.00||||6704.00|381.65|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6704.00||||6704.00|4357.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6704.00||||6704.00|3214.57|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|||6704.00||||6704.00|2011.2|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6704.00||||6704.00|356.06|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6704.00||||6704.00|402.33|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6704.00||||6704.00|2882.72|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|GEHA [1415]|GEHA [141500]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6704.00||||6704.00|522.53|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|6704.00||||6704.00|5028|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6704.00||||6704.00|363.48|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6704.00||||6704.00|387.09|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6704.00||||6704.00|6033.6|6704|356.06 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6704.00||||6704.00||| 35274177|EAP|0350 - CT SCAN-GENERAL|HC ABDOM/PELVIS W/ CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6704.00||||6704.00||| 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|8149.00||||8149.00|522.53|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|GEHA [1415]|GEHA [141500]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|8149.00||||8149.00|448.53|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|8149.00||||8149.00|6111.75|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8149.00||||8149.00|396.95|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8149.00||||8149.00|431.54|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|||8149.00||||8149.00|2444.7|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8149.00||||8149.00|3907.45|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8149.00||||8149.00|5296.85|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8149.00||||8149.00|1711.29|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8149.00||||8149.00|530.68|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|8149.00||||8149.00|493.38|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8149.00||||8149.00|363.48|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8149.00||||8149.00|3504.07|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8149.00||||8149.00|370.75|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|UMR [2035]|UMR OPTIONS [203501]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MULTIPLAN [1680]|HMA [168003]|8149.00||||8149.00|530.54|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|8149.00||||8149.00|508.47|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|8149.00||||8149.00|541.59|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8149.00||||8149.00|8149|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8149.00||||8149.00|363.48|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|8149.00||||8149.00|363.48|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8149.00||||8149.00|431.54|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|8149.00||||8149.00|4082.65|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8149.00||||8149.00|922.36|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8149.00||||8149.00|389.06|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8149.00||||8149.00|353.69|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|8149.00||||8149.00|3471.47|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8149.00||||8149.00|2860.3|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8149.00||||8149.00|3504.07|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8149.00||||8149.00|381.65|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8149.00||||8149.00|7334.1|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8149.00||||8149.00|389.06|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8149.00||||8149.00|4889.4|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8149.00||||8149.00|416.81|8149|353.69 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|8149.00||||8149.00||| 35274178|EAP|0352 - CT SCAN-BODY SCAN|HC ABDOM/PELVIS W/WO CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8149.00||||8149.00||| 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|514.00||||514.00|81.31|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|514.00||||514.00|148.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|514.00||||514.00|221.02|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|514.00||||514.00|257.51|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|514.00||||514.00|218.96|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|514.00||||514.00|77.62|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|514.00||||514.00|308.4|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|514.00||||514.00|81.31|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|514.00||||514.00|37.37|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|TRUSTMARK [2030]|STARMARK [203000]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|514.00||||514.00|106.27|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|FMH BENEFIT SERVICES [1390]|FMH [139000]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|FIRST HEALTH [1375]|QUALCHOICE [137513]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|514.00||||514.00|221.02|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|514.00||||514.00|44.24|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|514.00||||514.00|75.4|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MULTIPLAN [1680]|HMA [168003]|514.00||||514.00|110.88|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|HEALTHNET [1495]|HEALTHNET [149500]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|UMR [2035]|UMR OPTIONS [203501]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|AETNA [1015]|AETNA ACO WILCO [101532]|514.00||||514.00|128.48|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|514.00||||514.00|107.93|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MULTIPLAN [1680]|IHC HS [168011]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|514.00||||514.00|107.94|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|514.00||||514.00|514|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|514.00||||514.00|75.97|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|514.00||||514.00|38.69|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|514.00||||514.00|334.1|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|514.00||||514.00|246.46|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|||514.00||||514.00|154.2|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|514.00||||514.00|38.69|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|514.00||||514.00|75.97|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|514.00||||514.00|180.41|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|514.00||||514.00|109.21|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|GEHA [1415]|GEHA [141500]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|514.00||||514.00|40.21|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|CHAMPVA [1240]|CHAMP VA [124000]|514.00||||514.00|385.5|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|514.00||||514.00|35.59|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|514.00||||514.00|73.92|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|CORESOURCE [1315]|CORESOURCE [131500]|514.00||||514.00|462.6|514|35.59 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|514.00||||514.00||| 35275571|EAP|0352 - CT SCAN-BODY SCAN|HC HEART W/O DYE W/CALCIUM SCORE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|514.00||||514.00||| 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|645.00||||645.00|369.06|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|GEHA [1415]|GEHA [141500]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|CORESOURCE [1315]|CORESOURCE [131500]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|645.00||||645.00|249.35|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|CHAMPVA [1240]|CHAMP VA [124000]|645.00||||645.00|483.75|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|645.00||||645.00|326.61|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|645.00||||645.00|355.08|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|645.00||||645.00|309.28|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|645.00||||645.00|419.25|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|645.00||||645.00|135.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|UMR [2035]|UMR OPTIONS [203501]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|645.00||||645.00|176.92|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|645.00||||645.00|277.35|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|FIRST HEALTH [1375]|QUALCHOICE [137513]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|FMH BENEFIT SERVICES [1390]|FMH [139000]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|645.00||||645.00|405.97|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MULTIPLAN [1680]|HMA [168003]|645.00||||645.00|260.18|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MULTIPLAN [1680]|IHC HS [168011]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|645.00||||645.00|249.35|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|HEALTHNET [1495]|HEALTHNET [149500]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|645.00||||645.00|253.24|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|645.00||||645.00|645|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|AETNA [1015]|AETNA ACO WILCO [101532]|645.00||||645.00|374.83|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|||645.00||||645.00|193.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|TRUSTMARK [2030]|STARMARK [203000]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|645.00||||645.00|190.8|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|645.00||||645.00|355.08|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|645.00||||645.00|387|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|645.00||||645.00|182.12|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|645.00||||645.00|274.77|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|645.00||||645.00|190.8|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|645.00||||645.00|482.2|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|645.00||||645.00|226.4|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|645.00||||645.00|323.15|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|645.00||||645.00|580.5|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|645.00||||645.00|277.35|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|645.00||||645.00|342.95|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|645.00||||645.00|173.45|645|135.45 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|645.00||||645.00||| 35275572|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART STRUC & MORPH W CON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|645.00||||645.00|482.2|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|645.00||||645.00|323.15|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|645.00||||645.00|226.4|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|645.00||||645.00|274.77|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|645.00||||645.00|387|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|645.00||||645.00|355.08|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|645.00||||645.00|342.95|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|TRUSTMARK [2030]|STARMARK [203000]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|AETNA [1015]|AETNA ACO WILCO [101532]|645.00||||645.00|415.58|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|HEALTHNET [1495]|HEALTHNET [149500]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|FMH BENEFIT SERVICES [1390]|FMH [139000]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|645.00||||645.00|277.35|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|645.00||||645.00|405.97|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|FIRST HEALTH [1375]|QUALCHOICE [137513]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|UMR [2035]|UMR OPTIONS [203501]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|AETNA [1015]|COVENTRY HEALTHCARE [101502]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|645.00||||645.00|135.45|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MULTIPLAN [1680]|IHC HS [168011]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|645.00||||645.00|645|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|645.00||||645.00|419.25|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|645.00||||645.00|309.28|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|||645.00||||645.00|193.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|645.00||||645.00|326.61|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|645.00||||645.00|277.35|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|645.00||||645.00|369.06|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|CORESOURCE [1315]|CORESOURCE [131500]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|CHAMPVA [1240]|CHAMP VA [124000]|645.00||||645.00|483.75|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|GEHA [1415]|GEHA [141500]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|645.00||||645.00|355.08|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|645.00||||645.00|580.5|645|135.45 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MULTIPLAN [1680]|HMA [168003]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|645.00||||645.00||| 35275573|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA-HEART (CHD) STRUC & MOR W|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|645.00||||645.00||| 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4577.00||||4577.00|190.8|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|GEHA [1415]|GEHA [141500]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4577.00||||4577.00|369.06|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|CORESOURCE [1315]|CORESOURCE [131500]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|CHAMPVA [1240]|CHAMP VA [124000]|4577.00||||4577.00|3432.75|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4577.00||||4577.00|326.61|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4577.00||||4577.00|355.08|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|||4577.00||||4577.00|1373.1|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4577.00||||4577.00|2975.05|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4577.00||||4577.00|961.17|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4577.00||||4577.00|253.24|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|UMR [2035]|UMR OPTIONS [203501]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4577.00||||4577.00|176.92|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4577.00||||4577.00|405.97|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4577.00||||4577.00|1968.11|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|FIRST HEALTH [1375]|QUALCHOICE [137513]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|FMH BENEFIT SERVICES [1390]|FMH [139000]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4577.00||||4577.00|4577|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MULTIPLAN [1680]|IHC HS [168011]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4577.00||||4577.00|249.35|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4577.00||||4577.00|2194.67|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MULTIPLAN [1680]|HMA [168003]|4577.00||||4577.00|260.18|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|HEALTHNET [1495]|HEALTHNET [149500]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|AETNA [1015]|AETNA ACO WILCO [101532]|4577.00||||4577.00|415.58|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|TRUSTMARK [2030]|STARMARK [203000]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4577.00||||4577.00|249.35|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4577.00||||4577.00|342.95|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4577.00||||4577.00|190.8|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4577.00||||4577.00|4119.3|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4577.00||||4577.00|355.08|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4577.00||||4577.00|2746.2|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4577.00||||4577.00|182.12|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4577.00||||4577.00|1968.11|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4577.00||||4577.00|2293.08|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4577.00||||4577.00|1606.53|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4577.00||||4577.00|1949.8|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4577.00||||4577.00|173.45|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4577.00||||4577.00|482.2|4577|173.45 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4577.00||||4577.00||| 35275574|EAP|0352 - CT SCAN-BODY SCAN|HC CCTA W/DYE CORARTERIES/BPGRFTS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4577.00||||4577.00||| 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3927.00||||3927.00|190.8|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3927.00||||3927.00|1688.61|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3927.00||||3927.00|1967.43|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3927.00||||3927.00|1672.9|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3927.00||||3927.00|182.12|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3927.00||||3927.00|2356.2|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3927.00||||3927.00|190.8|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3927.00||||3927.00|433.82|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|TRUSTMARK [2030]|STARMARK [203000]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|HEALTHNET [1495]|HEALTHNET [149500]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MULTIPLAN [1680]|IHC HS [168011]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MULTIPLAN [1680]|HMA [168003]|3927.00||||3927.00|260.18|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3927.00||||3927.00|249.35|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3927.00||||3927.00|1688.61|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3927.00||||3927.00|513.54|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|AETNA [1015]|AETNA ACO WILCO [101532]|3927.00||||3927.00|415.58|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3927.00||||3927.00|176.92|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|UMR [2035]|UMR OPTIONS [203501]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3927.00||||3927.00|253.24|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3927.00||||3927.00|824.67|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3927.00||||3927.00|3927|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3927.00||||3927.00|449.17|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3927.00||||3927.00|2552.55|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3927.00||||3927.00|1883|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3927.00||||3927.00|1378.38|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|||3927.00||||3927.00|1178.1|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3927.00||||3927.00|482.2|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3927.00||||3927.00|449.17|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3927.00||||3927.00|173.45|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3927.00||||3927.00|413.15|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|CHAMPVA [1240]|CHAMP VA [124000]|3927.00||||3927.00|2945.25|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3927.00||||3927.00|249.35|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|CORESOURCE [1315]|CORESOURCE [131500]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3927.00||||3927.00|466.86|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|GEHA [1415]|GEHA [141500]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3927.00||||3927.00|3534.3|3927|173.45 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3927.00||||3927.00||| 35275635|EAP|0352 - CT SCAN-BODY SCAN|HC CTA ABD AORTA&BI ILIOFEM W/CONT+NONCONT IF DONE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3927.00||||3927.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|||10.00||||10.00|3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|||10.00||||10.00|3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|||10.00||||10.00|3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|||10.00||||10.00|3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|||10.00||||10.00|3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|||10.00||||10.00|3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3579|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|||10.00||||10.00|3|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|||10.00||||10.00|3|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HALOPERIDOL 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.96|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.96|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.96|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.96|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.96 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 3584|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|||0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901001|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVICORE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|||0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901002|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDCURRENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|||0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901003|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM MEDICALIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|||0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901004|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NDSC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|||0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901005|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM NIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|||0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901006|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM TEST APPROP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|||0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901007|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AIM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|||0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901008|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CRANBERRY PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|||0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901009|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SAGE HEALTH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|||0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901010|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM STANSON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|||0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901011|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM QUALIFIED NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|||0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901012|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM AGILEMD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|||0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901013|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EVIDENCECARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|||0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901014|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INVENIQA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|||0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901015|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM RELIANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|||0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901016|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM SPEED OF CARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|||0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901017|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM HEALTHHELP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|||0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901018|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INFINX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|||0.01||||0.01||| 35901019|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM LOGICNETS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|||0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901020|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM CURBSIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|||0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901021|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM EHEALTHLINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|||0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901022|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|||0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 35901023|EAP|0359 - CT SCAN-OTHER CT SCANS|HC CDSM PERSIVIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|||10.00||||10.00|3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|||10.00||||10.00|3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|||10.00||||10.00|3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|||10.00||||10.00|3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|||10.00||||10.00|3|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 35943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED RELEASE(PART/CRYST)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|CHAMPVA [1240]|CHAMP VA [124000]|2901.00||||2901.00|2175.75|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2901.00||||2901.00|665.5|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|GEHA [1415]|GEHA [141500]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2901.00||||2901.00|849.02|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|CORESOURCE [1315]|CORESOURCE [131500]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2901.00||||2901.00|588.94|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2901.00||||2901.00|732.05|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2901.00||||2901.00|1885.65|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2901.00||||2901.00|1391.03|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2901.00||||2901.00|609.21|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|||2901.00||||2901.00|870.3|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2901.00||||2901.00|602.39|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2901.00||||2901.00|1247.43|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2901.00||||2901.00|849.02|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|FIRST HEALTH [1375]|QUALCHOICE [137513]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2901.00||||2901.00|640.29|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2901.00||||2901.00|862.25|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MULTIPLAN [1680]|IHC HS [168011]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|UMR [2035]|UMR OPTIONS [203501]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2901.00||||2901.00|2901|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MULTIPLAN [1680]|HMA [168003]|2901.00||||2901.00|885.87|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|HEALTHNET [1495]|HEALTHNET [149500]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|FMH BENEFIT SERVICES [1390]|FMH [139000]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2901.00||||2901.00|620.11|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2901.00||||2901.00|618.38|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2901.00||||2901.00|640.29|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2901.00||||2901.00|1740.6|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2901.00||||2901.00|1247.43|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2901.00||||2901.00|1453.4|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2901.00||||2901.00|1018.25|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2901.00||||2901.00|1235.83|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2901.00||||2901.00|1431.31|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2901.00||||2901.00|649.64|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|TRUSTMARK [2030]|STARMARK [203000]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2901.00||||2901.00|2610.9|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2901.00||||2901.00|649.64|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2901.00||||2901.00|590.58|2901|588.94 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2901.00||||2901.00||| 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|AETNA [1015]|AETNA ACO WILCO [101532]|2901.00||||2901.00||| 36000260|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SI JT ANES/STER INJ W/WO ARTHR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2901.00||||2901.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2311.00||||2311.00|1157.81|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2311.00||||2311.00|984.49|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2311.00||||2311.00|1155.5|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2311.00||||2311.00|993.73|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2311.00||||2311.00|811.16|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|TRUSTMARK [2030]|STARMARK [203000]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2311.00||||2311.00|993.73|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MULTIPLAN [1680]|IHC HS [168011]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2311.00||||2311.00|1386.6|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|UMR [2035]|UMR OPTIONS [203501]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2311.00||||2311.00|1502.15|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|HEALTHNET [1495]|HEALTHNET [149500]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2311.00||||2311.00|1108.12|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|CHAMPVA [1240]|CHAMP VA [124000]|2311.00||||2311.00|1733.25|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|||2311.00||||2311.00|693.3|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|CORESOURCE [1315]|CORESOURCE [131500]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2311.00||||2311.00|2311|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2311.00||||2311.00|485.31|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|GEHA [1415]|GEHA [141500]|2311.00||||2311.00|2079.9|2311|485.31 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|AETNA [1015]|AETNA ACO WILCO [101532]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MULTIPLAN [1680]|HMA [168003]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2311.00||||2311.00||| 36000269|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLCMT ART/VEN OCCLUSIVE DEVICE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2311.00||||2311.00||| 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|GEHA [1415]|GEHA [141500]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7983.00||||7983.00|2936.6|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7983.00||||7983.00|7983|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7983.00||||7983.00|2598.76|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|||7983.00||||7983.00|2394.9|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7983.00||||7983.00|7983|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7983.00||||7983.00|5188.95|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7983.00||||7983.00|1676.43|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7983.00||||7983.00|3827.85|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7983.00||||7983.00|7983|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|UMR [2035]|UMR OPTIONS [203501]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7983.00||||7983.00|5807.98|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7983.00||||7983.00|3432.69|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7983.00||||7983.00|3230.26|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7983.00||||7983.00|7983|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MULTIPLAN [1680]|IHC HS [168011]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MULTIPLAN [1680]|HMA [168003]|7983.00||||7983.00|8541.14|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7983.00||||7983.00|3999.48|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7983.00||||7983.00|6263.5|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7983.00||||7983.00|4789.8|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7983.00||||7983.00|5978.8|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7983.00||||7983.00|2728.69|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7983.00||||7983.00|3400.76|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7983.00||||7983.00|2825.35|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7983.00||||7983.00|2802.03|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|7983.00||||7983.00|5987.25|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7983.00||||7983.00|3432.69|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7983.00||||7983.00|2825.35|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|TRUSTMARK [2030]|STARMARK [203000]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7983.00||||7983.00|6263.5|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7983.00||||7983.00|5694.09|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7983.00||||7983.00|7983|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7983.00||||7983.00|7184.7|8541.14|1676.43 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7983.00||||7983.00||| 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7983.00||||7983.00||| 36002010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC SACROPLASTY BIL INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|7983.00||||7983.00||| 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|GEHA [1415]|GEHA [141500]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3808.00||||3808.00|794.39|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3808.00||||3808.00|638.72|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3808.00||||3808.00|1384.76|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3808.00||||3808.00|1637.44|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3808.00||||3808.00|1907.81|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3808.00||||3808.00|1336.61|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3808.00||||3808.00|1622.21|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3808.00||||3808.00|764.3|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3808.00||||3808.00|565.03|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|TRUSTMARK [2030]|STARMARK [203000]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MULTIPLAN [1680]|IHC HS [168011]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MULTIPLAN [1680]|HMA [168003]|3808.00||||3808.00|870.99|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|HEALTHNET [1495]|HEALTHNET [149500]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|FMH BENEFIT SERVICES [1390]|FMH [139000]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3808.00||||3808.00|638.72|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|FIRST HEALTH [1375]|QUALCHOICE [137513]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3808.00||||3808.00|834.75|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3808.00||||3808.00|2284.8|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3808.00||||3808.00|1637.44|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3808.00||||3808.00|592.27|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3808.00||||3808.00|873.83|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3808.00||||3808.00|593.28|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|UMR [2035]|UMR OPTIONS [203501]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3808.00||||3808.00|847.76|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3808.00||||3808.00|1825.94|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3808.00||||3808.00|2475.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|||3808.00||||3808.00|1142.4|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3808.00||||3808.00|3808|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3808.00||||3808.00|764.3|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3808.00||||3808.00|799.68|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|CHAMPVA [1240]|CHAMP VA [124000]|3808.00||||3808.00|2856|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3808.00||||3808.00|580.66|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3808.00||||3808.00|834.75|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|CORESOURCE [1315]|CORESOURCE [131500]|3808.00||||3808.00|3427.2|3808|565.03 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3808.00||||3808.00||| 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3808.00||||3808.00||| 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|AETNA [1015]|AETNA ACO WILCO [101532]|3808.00||||3808.00||| 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3808.00||||3808.00||| 36010005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3808.00||||3808.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|GEHA [1415]|GEHA [141500]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|CHAMPVA [1240]|CHAMP VA [124000]|2591.00||||2591.00|1943.25|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|||2591.00||||2591.00|777.3|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2591.00||||2591.00|2591|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2591.00||||2591.00|544.11|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|UMR [2035]|UMR OPTIONS [203501]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|FIRST HEALTH [1375]|QUALCHOICE [137513]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|FMH BENEFIT SERVICES [1390]|FMH [139000]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2591.00||||2591.00|1114.13|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2591.00||||2591.00|1242.38|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2591.00||||2591.00|1684.15|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|HEALTHNET [1495]|HEALTHNET [149500]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MULTIPLAN [1680]|IHC HS [168011]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|TRUSTMARK [2030]|STARMARK [203000]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2591.00||||2591.00|1114.13|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2591.00||||2591.00|1298.09|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2591.00||||2591.00|909.44|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|CORESOURCE [1315]|CORESOURCE [131500]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2591.00||||2591.00|1103.77|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2591.00||||2591.00|1554.6|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2591.00||||2591.00|2331.9|2591|544.11 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MULTIPLAN [1680]|HMA [168003]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2591.00||||2591.00||| 36010006|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FINE NDL ASPIRATION BX W/US GDN EA ADDL LESION|AETNA [1015]|AETNA ACO WILCO [101532]|2591.00||||2591.00||| 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3560.00||||3560.00|638.72|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3560.00||||3560.00|1530.8|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3560.00||||3560.00|1783.56|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3560.00||||3560.00|1249.56|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3560.00||||3560.00|609.69|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3560.00||||3560.00|2136|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|TRUSTMARK [2030]|STARMARK [203000]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|HEALTHNET [1495]|HEALTHNET [149500]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3560.00||||3560.00|834.75|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MULTIPLAN [1680]|HMA [168003]|3560.00||||3560.00|870.99|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|FMH BENEFIT SERVICES [1390]|FMH [139000]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|FIRST HEALTH [1375]|QUALCHOICE [137513]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3560.00||||3560.00|195.37|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3560.00||||3560.00|638.72|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3560.00||||3560.00|223.37|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3560.00||||3560.00|1530.8|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MULTIPLAN [1680]|IHC HS [168011]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3560.00||||3560.00|592.27|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|UMR [2035]|UMR OPTIONS [203501]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3560.00||||3560.00|747.6|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3560.00||||3560.00|188.68|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|||3560.00||||3560.00|1068|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3560.00||||3560.00|195.37|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3560.00||||3560.00|1516.56|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3560.00||||3560.00|580.66|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3560.00||||3560.00|179.7|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|CHAMPVA [1240]|CHAMP VA [124000]|3560.00||||3560.00|2670|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3560.00||||3560.00|834.75|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3560.00||||3560.00|2314|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|CORESOURCE [1315]|CORESOURCE [131500]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3560.00||||3560.00|1707.02|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3560.00||||3560.00|203.06|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|GEHA [1415]|GEHA [141500]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3560.00||||3560.00|1384.76|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3560.00||||3560.00|3560|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3560.00||||3560.00|847.76|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3560.00||||3560.00|3204|3560|179.7 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|AETNA [1015]|AETNA ACO WILCO [101532]|3560.00||||3560.00||| 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3560.00||||3560.00||| 36010030|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAINAGE SOFT TISSUE PERC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3560.00||||3560.00||| 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7830.00||||7830.00|1166.59|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|GEHA [1415]|GEHA [141500]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|CORESOURCE [1315]|CORESOURCE [131500]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7830.00||||7830.00|1878.3|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|CHAMPVA [1240]|CHAMP VA [124000]|7830.00||||7830.00|5872.5|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7830.00||||7830.00|1032.39|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7830.00||||7830.00|1122.4|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7830.00||||7830.00|5089.5|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7830.00||||7830.00|3754.49|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7830.00||||7830.00|7830|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7830.00||||7830.00|1644.3|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7830.00||||7830.00|1907.56|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7830.00||||7830.00|3366.9|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7830.00||||7830.00|1283.25|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|||7830.00||||7830.00|2349|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7830.00||||7830.00|1332.68|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|UMR [2035]|UMR OPTIONS [203501]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MULTIPLAN [1680]|IHC HS [168011]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7830.00||||7830.00|1878.3|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MULTIPLAN [1680]|HMA [168003]|7830.00||||7830.00|1959.83|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|AETNA [1015]|AETNA ACO WILCO [101532]|7830.00||||7830.00|1933|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|TRUSTMARK [2030]|STARMARK [203000]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7830.00||||7830.00|1084|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7830.00||||7830.00|4698|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7830.00||||7830.00|1371.88|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7830.00||||7830.00|3287.78|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7830.00||||7830.00|1122.4|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7830.00||||7830.00|3366.9|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7830.00||||7830.00|3922.83|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7830.00||||7830.00|2748.33|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7830.00||||7830.00|1437.21|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7830.00||||7830.00|3335.58|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7830.00||||7830.00|1437.21|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7830.00||||7830.00|1306.55|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|HEALTHNET [1495]|HEALTHNET [149500]|7830.00||||7830.00|7047|7830|1032.39 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7830.00||||7830.00||| 36010140|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC I&D HEMATOMA/SEROMA/FLUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7830.00||||7830.00||| 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|853.00||||853.00|334.55|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|853.00||||853.00|366.79|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|853.00||||853.00|299.4|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|853.00||||853.00|363.38|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|853.00||||853.00|750.73|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|853.00||||853.00|319.34|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|853.00||||853.00|511.8|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|853.00||||853.00|129.45|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|HEALTHNET [1495]|HEALTHNET [149500]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MULTIPLAN [1680]|IHC HS [168011]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|853.00||||853.00|437.23|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|FIRST HEALTH [1375]|QUALCHOICE [137513]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|853.00||||853.00|334.55|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|FMH BENEFIT SERVICES [1390]|FMH [139000]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|853.00||||853.00|125.02|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|853.00||||853.00|148.01|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MULTIPLAN [1680]|HMA [168003]|853.00||||853.00|456.21|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|853.00||||853.00|366.79|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|853.00||||853.00|310.22|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|UMR [2035]|UMR OPTIONS [203501]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|853.00||||853.00|444.04|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|||853.00||||853.00|255.9|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|853.00||||853.00|304.14|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|853.00||||853.00|427.35|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|853.00||||853.00|119.07|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|853.00||||853.00|129.45|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|CHAMPVA [1240]|CHAMP VA [124000]|853.00||||853.00|639.75|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|853.00||||853.00|409.01|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|853.00||||853.00|437.23|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|CORESOURCE [1315]|CORESOURCE [131500]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|GEHA [1415]|GEHA [141500]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|853.00||||853.00|554.45|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|853.00||||853.00|853|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|853.00||||853.00|179.13|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|853.00||||853.00|134.55|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|TRUSTMARK [2030]|STARMARK [203000]|853.00||||853.00|767.7|853|119.07 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|853.00||||853.00||| 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|AETNA [1015]|AETNA ACO WILCO [101532]|853.00||||853.00||| 36010160|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP ABSCSS/HEMATOMA/BULLA/CYST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|853.00||||853.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|GEHA [1415]|GEHA [141500]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|CHAMPVA [1240]|CHAMP VA [124000]|4981.00||||4981.00|3735.75|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4981.00||||4981.00|4981|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4981.00||||4981.00|1046.01|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4981.00||||4981.00|2388.39|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4981.00||||4981.00|2141.83|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|FIRST HEALTH [1375]|QUALCHOICE [137513]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|FMH BENEFIT SERVICES [1390]|FMH [139000]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4981.00||||4981.00|3237.65|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|UMR [2035]|UMR OPTIONS [203501]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|||4981.00||||4981.00|1494.3|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MULTIPLAN [1680]|IHC HS [168011]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|TRUSTMARK [2030]|STARMARK [203000]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4981.00||||4981.00|2988.6|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4981.00||||4981.00|1154.23|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4981.00||||4981.00|2141.83|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|CORESOURCE [1315]|CORESOURCE [131500]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4981.00||||4981.00|2495.48|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4981.00||||4981.00|1748.33|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4981.00||||4981.00|2121.91|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|HEALTHNET [1495]|HEALTHNET [149500]|4981.00||||4981.00|4482.9|4981|1046.01 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MULTIPLAN [1680]|HMA [168003]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|AETNA [1015]|AETNA ACO WILCO [101532]|4981.00||||4981.00||| 36012020|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPERFICIAL WND DEHISCENCE SIMPLE CLSR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4981.00||||4981.00||| 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2291.00||||2291.00|1437.21|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2291.00||||2291.00|985.13|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2291.00||||2291.00|1147.79|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2291.00||||2291.00|804.14|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2291.00||||2291.00|2291|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2291.00||||2291.00|1371.88|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2291.00||||2291.00|1374.6|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2291.00||||2291.00|1437.21|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|TRUSTMARK [2030]|STARMARK [203000]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|HEALTHNET [1495]|HEALTHNET [149500]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MULTIPLAN [1680]|HMA [168003]|2291.00||||2291.00|1959.83|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2291.00||||2291.00|671.13|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2291.00||||2291.00|1878.3|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2291.00||||2291.00|794.5|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MULTIPLAN [1680]|IHC HS [168011]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2291.00||||2291.00|985.13|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2291.00||||2291.00|1332.68|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2291.00||||2291.00|694.91|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|UMR [2035]|UMR OPTIONS [203501]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2291.00||||2291.00|481.11|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2291.00||||2291.00|1489.15|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2291.00||||2291.00|1098.53|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2291.00||||2291.00|694.91|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2291.00||||2291.00|975.97|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2291.00||||2291.00|639.18|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|CHAMPVA [1240]|CHAMP VA [124000]|2291.00||||2291.00|1718.25|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2291.00||||2291.00|1878.3|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|||2291.00||||2291.00|687.3|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2291.00||||2291.00|722.27|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|CORESOURCE [1315]|CORESOURCE [131500]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|GEHA [1415]|GEHA [141500]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2291.00||||2291.00|2291|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2291.00||||2291.00|1306.55|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2291.00||||2291.00|1907.56|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2291.00||||2291.00|2061.9|2291|481.11 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2291.00||||2291.00||| 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|AETNA [1015]|AETNA ACO WILCO [101532]|2291.00||||2291.00||| 36020206|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC NEEDLE BIOPSY MUSCLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2291.00||||2291.00||| 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|GEHA [1415]|GEHA [141500]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|CORESOURCE [1315]|CORESOURCE [131500]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1725.00||||1725.00|758.17|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1725.00||||1725.00|1725|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1725.00||||1725.00|670.95|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1725.00||||1725.00|729.45|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1725.00||||1725.00|827.14|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1725.00||||1725.00|1121.25|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1725.00||||1725.00|1725|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1725.00||||1725.00|741.75|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1725.00||||1725.00|833.99|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|||1725.00||||1725.00|517.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1725.00||||1725.00|1332.68|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1725.00||||1725.00|362.25|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|UMR [2035]|UMR OPTIONS [203501]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1725.00||||1725.00|1725|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1725.00||||1725.00|1725|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MULTIPLAN [1680]|IHC HS [168011]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MULTIPLAN [1680]|HMA [168003]|1725.00||||1725.00|1959.83|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|TRUSTMARK [2030]|STARMARK [203000]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1725.00||||1725.00|704.49|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1725.00||||1725.00|1035|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1725.00||||1725.00|1371.88|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1725.00||||1725.00|1725|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1725.00||||1725.00|729.45|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1725.00||||1725.00|741.75|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|CHAMPVA [1240]|CHAMP VA [124000]|1725.00||||1725.00|1293.75|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1725.00||||1725.00|864.23|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1725.00||||1725.00|605.48|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1725.00||||1725.00|734.85|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1725.00||||1725.00|1437.21|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|HEALTHNET [1495]|HEALTHNET [149500]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1725.00||||1725.00|1437.21|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1725.00||||1725.00|1306.55|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1725.00||||1725.00|1552.5|1959.83|362.25 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1725.00||||1725.00||| 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1725.00||||1725.00||| 36020220|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE SUPERFICIAL|AETNA [1015]|AETNA ACO WILCO [101532]|1725.00||||1725.00||| 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5123.00||||5123.00|2202.89|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5123.00||||5123.00|2566.62|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5123.00||||5123.00|1798.17|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5123.00||||5123.00|2182.4|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5123.00||||5123.00|3287.78|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5123.00||||5123.00|1437.21|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5123.00||||5123.00|1502.77|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|HEALTHNET [1495]|HEALTHNET [149500]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MULTIPLAN [1680]|HMA [168003]|5123.00||||5123.00|1959.83|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MULTIPLAN [1680]|IHC HS [168011]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|FMH BENEFIT SERVICES [1390]|FMH [139000]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5123.00||||5123.00|1556|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|FIRST HEALTH [1375]|QUALCHOICE [137513]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5123.00||||5123.00|1878.3|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|TRUSTMARK [2030]|STARMARK [203000]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5123.00||||5123.00|3073.8|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5123.00||||5123.00|1779|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5123.00||||5123.00|2202.89|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5123.00||||5123.00|1332.68|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5123.00||||5123.00|1371.88|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|UMR [2035]|UMR OPTIONS [203501]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5123.00||||5123.00|1907.56|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5123.00||||5123.00|3329.95|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|||5123.00||||5123.00|1536.9|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5123.00||||5123.00|1556|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5123.00||||5123.00|1306.55|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5123.00||||5123.00|1431.21|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|CHAMPVA [1240]|CHAMP VA [124000]|5123.00||||5123.00|3842.25|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5123.00||||5123.00|1878.3|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5123.00||||5123.00|1617.27|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5123.00||||5123.00|1437.21|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|CORESOURCE [1315]|CORESOURCE [131500]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|GEHA [1415]|GEHA [141500]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5123.00||||5123.00|5123|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5123.00||||5123.00|1075.83|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5123.00||||5123.00|2456.48|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5123.00||||5123.00|4610.7|5123|1075.83 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5123.00||||5123.00||| 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|AETNA [1015]|AETNA ACO WILCO [101532]|5123.00||||5123.00||| 36020225|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BX BONE TROCAR/NEEDLE DEEP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5123.00||||5123.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|GEHA [1415]|GEHA [141500]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|CORESOURCE [1315]|CORESOURCE [131500]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|CHAMPVA [1240]|CHAMP VA [124000]|900.00||||900.00|675|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|900.00||||900.00|900|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|UMR [2035]|UMR OPTIONS [203501]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|900.00||||900.00|387|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|900.00||||900.00|431.55|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|900.00||||900.00|585|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|||900.00||||900.00|270|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MULTIPLAN [1680]|IHC HS [168011]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|900.00||||900.00|189|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|TRUSTMARK [2030]|STARMARK [203000]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|900.00||||900.00|450|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|900.00||||900.00|387|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|900.00||||900.00|450.9|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|900.00||||900.00|315.9|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|900.00||||900.00|383.4|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|900.00||||900.00|540|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|HEALTHNET [1495]|HEALTHNET [149500]|900.00||||900.00|810|900|189 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MULTIPLAN [1680]|HMA [168003]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|900.00||||900.00||| 36020501|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINUS TRACT/DX SINOGRAM|AETNA [1015]|AETNA ACO WILCO [101532]|900.00||||900.00||| 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|743.00||||743.00|272.07|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|743.00||||743.00|591.53|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|743.00||||743.00|319.49|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|743.00||||743.00|372.24|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|743.00||||743.00|260.79|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|743.00||||743.00|445.8|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|743.00||||743.00|272.07|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|TRUSTMARK [2030]|STARMARK [203000]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MULTIPLAN [1680]|IHC HS [168011]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|743.00||||743.00|355.57|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MULTIPLAN [1680]|HMA [168003]|743.00||||743.00|371|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|HEALTHNET [1495]|HEALTHNET [149500]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|FMH BENEFIT SERVICES [1390]|FMH [139000]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|FIRST HEALTH [1375]|QUALCHOICE [137513]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|743.00||||743.00|227.28|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|743.00||||743.00|219.5|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|743.00||||743.00|259.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|743.00||||743.00|259.85|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|743.00||||743.00|316.52|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|743.00||||743.00|319.49|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|743.00||||743.00|252.28|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|UMR [2035]|UMR OPTIONS [203501]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|743.00||||743.00|156.03|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|743.00||||743.00|482.95|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|743.00||||743.00|356.27|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|743.00||||743.00|227.28|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|743.00||||743.00|209.05|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|CHAMPVA [1240]|CHAMP VA [124000]|743.00||||743.00|557.25|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|743.00||||743.00|247.34|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|743.00||||743.00|355.57|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|||743.00||||743.00|222.9|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|CORESOURCE [1315]|CORESOURCE [131500]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|743.00||||743.00|236.23|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|GEHA [1415]|GEHA [141500]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|743.00||||743.00|743|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|743.00||||743.00|361.11|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|743.00||||743.00|668.7|743|156.03 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|743.00||||743.00||| 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|AETNA [1015]|AETNA ACO WILCO [101532]|743.00||||743.00||| 36020526|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TX CARPAL TUNNEL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|743.00||||743.00||| 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1073.00||||1073.00|236.23|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|CORESOURCE [1315]|CORESOURCE [131500]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1073.00||||1073.00|355.57|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1073.00||||1073.00|209.05|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1073.00||||1073.00|227.28|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1073.00||||1073.00|514.5|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1073.00||||1073.00|1073|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1073.00||||1073.00|225.33|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1073.00||||1073.00|252.28|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1073.00||||1073.00|697.45|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1073.00||||1073.00|461.39|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1073.00||||1073.00|361.11|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1073.00||||1073.00|259.85|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|UMR [2035]|UMR OPTIONS [203501]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|HEALTHNET [1495]|HEALTHNET [149500]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MULTIPLAN [1680]|IHC HS [168011]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1073.00||||1073.00|355.57|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1073.00||||1073.00|219.5|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1073.00||||1073.00|643.8|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1073.00||||1073.00|259.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1073.00||||1073.00|376.62|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1073.00||||1073.00|227.28|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1073.00||||1073.00|461.39|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1073.00||||1073.00|537.57|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1073.00||||1073.00|457.1|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|CHAMPVA [1240]|CHAMP VA [124000]|1073.00||||1073.00|804.75|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1073.00||||1073.00|591.53|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|TRUSTMARK [2030]|STARMARK [203000]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1073.00||||1073.00|272.07|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|GEHA [1415]|GEHA [141500]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1073.00||||1073.00|272.07|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1073.00||||1073.00|247.34|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1073.00||||1073.00|965.7|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|MULTIPLAN [1680]|HMA [168003]|1073.00||||1073.00|371|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|||1073.00||||1073.00|321.9|1073|209.05 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|AETNA [1015]|AETNA ACO WILCO [101532]|1073.00||||1073.00||| 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1073.00||||1073.00||| 36020550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ TENDON SHEATH/LIGAMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1073.00||||1073.00||| 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|842.00||||842.00|272.07|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|842.00||||842.00|362.06|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|842.00||||842.00|421.84|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|842.00||||842.00|295.54|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|842.00||||842.00|358.69|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|842.00||||842.00|227.28|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MULTIPLAN [1680]|IHC HS [168011]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|TRUSTMARK [2030]|STARMARK [203000]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|842.00||||842.00|355.57|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MULTIPLAN [1680]|HMA [168003]|842.00||||842.00|371|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|842.00||||842.00|272.07|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|842.00||||842.00|219.5|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|842.00||||842.00|259.85|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|HEALTHNET [1495]|HEALTHNET [149500]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|842.00||||842.00|362.06|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|842.00||||842.00|252.28|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|842.00||||842.00|259.7|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|UMR [2035]|UMR OPTIONS [203501]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|842.00||||842.00|361.11|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|842.00||||842.00|403.74|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|||842.00||||842.00|252.6|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|842.00||||842.00|247.34|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|842.00||||842.00|591.53|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|842.00||||842.00|209.05|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|842.00||||842.00|227.28|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|CHAMPVA [1240]|CHAMP VA [124000]|842.00||||842.00|631.5|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|842.00||||842.00|505.2|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|842.00||||842.00|355.57|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|CORESOURCE [1315]|CORESOURCE [131500]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|842.00||||842.00|236.23|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|GEHA [1415]|GEHA [141500]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|842.00||||842.00|547.3|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|842.00||||842.00|757.8|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|842.00||||842.00|176.82|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|842.00||||842.00|842|842|176.82 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|842.00||||842.00||| 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|AETNA [1015]|AETNA ACO WILCO [101532]|842.00||||842.00||| 36020551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SINGLE TENDON ORIGIN/INSERTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|842.00||||842.00||| 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|GEHA [1415]|GEHA [141500]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1372.00||||1372.00|236.23|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|CORESOURCE [1315]|CORESOURCE [131500]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1372.00||||1372.00|355.57|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|CHAMPVA [1240]|CHAMP VA [124000]|1372.00||||1372.00|1029|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1372.00||||1372.00|209.05|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1372.00||||1372.00|657.87|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1372.00||||1372.00|227.28|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1372.00||||1372.00|288.12|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|UMR [2035]|UMR OPTIONS [203501]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1372.00||||1372.00|1372|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1372.00||||1372.00|891.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1372.00||||1372.00|589.96|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1372.00||||1372.00|259.85|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1372.00||||1372.00|252.28|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|FIRST HEALTH [1375]|QUALCHOICE [137513]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|||1372.00||||1372.00|411.6|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|FMH BENEFIT SERVICES [1390]|FMH [139000]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|HEALTHNET [1495]|HEALTHNET [149500]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1372.00||||1372.00|361.11|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MULTIPLAN [1680]|IHC HS [168011]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1372.00||||1372.00|355.57|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|TRUSTMARK [2030]|STARMARK [203000]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1372.00||||1372.00|272.07|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1372.00||||1372.00|227.28|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1372.00||||1372.00|823.2|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1372.00||||1372.00|259.7|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1372.00||||1372.00|589.96|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1372.00||||1372.00|687.37|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1372.00||||1372.00|481.57|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1372.00||||1372.00|584.47|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1372.00||||1372.00|219.5|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1372.00||||1372.00|591.53|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1372.00||||1372.00|272.07|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|AETNA [1015]|AETNA ACO WILCO [101532]|1372.00||||1372.00|1372|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1372.00||||1372.00|247.34|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|MULTIPLAN [1680]|HMA [168003]|1372.00||||1372.00|371|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1372.00||||1372.00|1234.8|1372|209.05 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1372.00||||1372.00||| 36020552|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 1 OR 2 MUSCLE(S)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1372.00||||1372.00||| 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1372.00||||1372.00|272.07|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1372.00||||1372.00|591.53|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1372.00||||1372.00|589.96|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1372.00||||1372.00|687.37|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1372.00||||1372.00|481.57|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1372.00||||1372.00|584.47|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1372.00||||1372.00|259.7|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1372.00||||1372.00|823.2|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1372.00||||1372.00|272.07|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|TRUSTMARK [2030]|STARMARK [203000]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MULTIPLAN [1680]|IHC HS [168011]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MULTIPLAN [1680]|HMA [168003]|1372.00||||1372.00|371|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|FMH BENEFIT SERVICES [1390]|FMH [139000]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|FIRST HEALTH [1375]|QUALCHOICE [137513]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1372.00||||1372.00|219.5|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|HEALTHNET [1495]|HEALTHNET [149500]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1372.00||||1372.00|355.57|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1372.00||||1372.00|259.85|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1372.00||||1372.00|589.96|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1372.00||||1372.00|252.28|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1372.00||||1372.00|227.28|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|UMR [2035]|UMR OPTIONS [203501]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1372.00||||1372.00|288.12|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1372.00||||1372.00|891.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1372.00||||1372.00|657.87|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1372.00||||1372.00|227.28|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1372.00||||1372.00|209.05|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|CHAMPVA [1240]|CHAMP VA [124000]|1372.00||||1372.00|1029|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1372.00||||1372.00|355.57|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|||1372.00||||1372.00|411.6|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|CORESOURCE [1315]|CORESOURCE [131500]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1372.00||||1372.00|236.23|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|GEHA [1415]|GEHA [141500]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1372.00||||1372.00|1372|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1372.00||||1372.00|247.34|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1372.00||||1372.00|361.11|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1372.00||||1372.00|1234.8|1372|209.05 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1372.00||||1372.00||| 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|AETNA [1015]|AETNA ACO WILCO [101532]|1372.00||||1372.00||| 36020553|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ SNGL/MULT TRIGGER POINT 3+ MUSCLES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1372.00||||1372.00||| 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|TRUSTMARK [2030]|STARMARK [203000]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|868.00||||868.00|219.5|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|868.00||||868.00|272.07|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|868.00||||868.00|227.28|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|868.00||||868.00|520.8|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|868.00||||868.00|259.7|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|868.00||||868.00|304.67|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|868.00||||868.00|373.24|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|868.00||||868.00|434.87|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|868.00||||868.00|369.77|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|868.00||||868.00|591.53|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|868.00||||868.00|272.07|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|868.00||||868.00|236.23|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|CORESOURCE [1315]|CORESOURCE [131500]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|868.00||||868.00|355.57|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|868.00||||868.00|209.05|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|||868.00||||868.00|260.4|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|868.00||||868.00|416.21|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|868.00||||868.00|868|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|868.00||||868.00|564.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|868.00||||868.00|182.28|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|868.00||||868.00|227.28|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|868.00||||868.00|361.11|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|UMR [2035]|UMR OPTIONS [203501]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|CHAMPVA [1240]|CHAMP VA [124000]|868.00||||868.00|651|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|868.00||||868.00|252.28|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|868.00||||868.00|373.24|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|868.00||||868.00|259.85|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|GEHA [1415]|GEHA [141500]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|FIRST HEALTH [1375]|QUALCHOICE [137513]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|FMH BENEFIT SERVICES [1390]|FMH [139000]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|HEALTHNET [1495]|HEALTHNET [149500]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MULTIPLAN [1680]|IHC HS [168011]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|868.00||||868.00|355.57|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|MULTIPLAN [1680]|HMA [168003]|868.00||||868.00|371|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|AETNA [1015]|COVENTRY HEALTHCARE [101502]|868.00||||868.00|781.2|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|868.00||||868.00|247.34|868|182.28 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|868.00||||868.00||| 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|868.00||||868.00||| 36020600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/O US|AETNA [1015]|AETNA ACO WILCO [101532]|868.00||||868.00||| 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|954.00||||954.00|272.07|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|954.00||||954.00|410.22|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|954.00||||954.00|477.95|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|954.00||||954.00|334.85|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|954.00||||954.00|259.7|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|954.00||||954.00|572.4|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|954.00||||954.00|278.54|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|954.00||||954.00|272.07|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|954.00||||954.00|269.01|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|AETNA [1015]|COVENTRY HEALTHCARE [101502]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MULTIPLAN [1680]|IHC HS [168011]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|954.00||||954.00|355.57|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MULTIPLAN [1680]|HMA [168003]|954.00||||954.00|371|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|HEALTHNET [1495]|HEALTHNET [149500]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|FMH BENEFIT SERVICES [1390]|FMH [139000]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|FIRST HEALTH [1375]|QUALCHOICE [137513]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|954.00||||954.00|318.46|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|954.00||||954.00|410.22|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|954.00||||954.00|252.28|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|TRUSTMARK [2030]|STARMARK [203000]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|UMR [2035]|UMR OPTIONS [203501]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|954.00||||954.00|361.11|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|954.00||||954.00|200.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|954.00||||954.00|954|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|954.00||||954.00|620.1|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|954.00||||954.00|406.4|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|954.00||||954.00|457.44|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|||954.00||||954.00|286.2|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|954.00||||954.00|591.53|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|954.00||||954.00|278.54|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|954.00||||954.00|247.34|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|954.00||||954.00|256.2|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|CHAMPVA [1240]|CHAMP VA [124000]|954.00||||954.00|715.5|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|954.00||||954.00|355.57|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|CORESOURCE [1315]|CORESOURCE [131500]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|954.00||||954.00|289.51|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|GEHA [1415]|GEHA [141500]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|954.00||||954.00|858.6|954|200.34 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|954.00||||954.00||| 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|AETNA [1015]|AETNA ACO WILCO [101532]|954.00||||954.00||| 36020604|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ SMALL JOINT W/US|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|954.00||||954.00||| 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|GEHA [1415]|GEHA [141500]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1153.00||||1153.00|236.23|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1153.00||||1153.00|355.57|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|CHAMPVA [1240]|CHAMP VA [124000]|1153.00||||1153.00|864.75|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1153.00||||1153.00|209.05|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1153.00||||1153.00|227.28|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|||1153.00||||1153.00|345.9|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1153.00||||1153.00|552.86|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1153.00||||1153.00|749.45|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1153.00||||1153.00|1153|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1153.00||||1153.00|242.13|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|UMR [2035]|UMR OPTIONS [203501]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1153.00||||1153.00|252.28|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1153.00||||1153.00|495.79|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1153.00||||1153.00|259.85|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|FIRST HEALTH [1375]|QUALCHOICE [137513]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|FMH BENEFIT SERVICES [1390]|FMH [139000]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1153.00||||1153.00|361.11|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|HEALTHNET [1495]|HEALTHNET [149500]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MULTIPLAN [1680]|IHC HS [168011]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1153.00||||1153.00|355.57|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MULTIPLAN [1680]|HMA [168003]|1153.00||||1153.00|371|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|AETNA [1015]|AETNA ACO WILCO [101532]|1153.00||||1153.00|1153|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|TRUSTMARK [2030]|STARMARK [203000]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1153.00||||1153.00|219.5|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|CORESOURCE [1315]|CORESOURCE [131500]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1153.00||||1153.00|272.07|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1153.00||||1153.00|227.28|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1153.00||||1153.00|691.8|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1153.00||||1153.00|259.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1153.00||||1153.00|495.79|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1153.00||||1153.00|577.65|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1153.00||||1153.00|404.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1153.00||||1153.00|491.18|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1153.00||||1153.00|591.53|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1153.00||||1153.00|247.34|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1153.00||||1153.00|272.07|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1153.00||||1153.00|1037.7|1153|209.05 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1153.00||||1153.00||| 36020605|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS INTERM JNT W/O US|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1153.00||||1153.00||| 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2223.00||||2223.00|649.64|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2223.00||||2223.00|1431.31|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2223.00||||2223.00|955.89|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2223.00||||2223.00|780.27|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2223.00||||2223.00|947|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2223.00||||2223.00|620.11|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2223.00||||2223.00|278.54|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2223.00||||2223.00|649.64|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|TRUSTMARK [2030]|STARMARK [203000]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MULTIPLAN [1680]|IHC HS [168011]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MULTIPLAN [1680]|HMA [168003]|2223.00||||2223.00|885.87|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|HEALTHNET [1495]|HEALTHNET [149500]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|FMH BENEFIT SERVICES [1390]|FMH [139000]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|FIRST HEALTH [1375]|QUALCHOICE [137513]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2223.00||||2223.00|849.02|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2223.00||||2223.00|318.46|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2223.00||||2223.00|955.89|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2223.00||||2223.00|602.39|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|UMR [2035]|UMR OPTIONS [203501]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2223.00||||2223.00|862.25|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2223.00||||2223.00|466.83|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2223.00||||2223.00|269.01|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2223.00||||2223.00|1333.8|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2223.00||||2223.00|2223|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2223.00||||2223.00|1444.95|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2223.00||||2223.00|1065.93|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|||2223.00||||2223.00|666.9|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2223.00||||2223.00|278.54|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2223.00||||2223.00|1113.72|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2223.00||||2223.00|590.58|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2223.00||||2223.00|256.2|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|CHAMPVA [1240]|CHAMP VA [124000]|2223.00||||2223.00|1667.25|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2223.00||||2223.00|849.02|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|CORESOURCE [1315]|CORESOURCE [131500]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2223.00||||2223.00|289.51|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|GEHA [1415]|GEHA [141500]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2223.00||||2223.00|2000.7|2223|256.2 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2223.00||||2223.00||| 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|AETNA [1015]|AETNA ACO WILCO [101532]|2223.00||||2223.00||| 36020606|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ INTERM JNT W/US|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2223.00||||2223.00||| 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2021.00||||2021.00|236.23|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|CORESOURCE [1315]|CORESOURCE [131500]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2021.00||||2021.00|355.57|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|CHAMPVA [1240]|CHAMP VA [124000]|2021.00||||2021.00|1515.75|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2021.00||||2021.00|209.05|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|||2021.00||||2021.00|606.3|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2021.00||||2021.00|969.07|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2021.00||||2021.00|2021|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2021.00||||2021.00|424.41|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2021.00||||2021.00|361.11|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2021.00||||2021.00|869.03|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2021.00||||2021.00|259.85|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2021.00||||2021.00|252.28|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|FIRST HEALTH [1375]|QUALCHOICE [137513]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|FMH BENEFIT SERVICES [1390]|FMH [139000]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|UMR [2035]|UMR OPTIONS [203501]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|HEALTHNET [1495]|HEALTHNET [149500]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MULTIPLAN [1680]|IHC HS [168011]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2021.00||||2021.00|355.57|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2021.00||||2021.00|1313.65|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MULTIPLAN [1680]|HMA [168003]|2021.00||||2021.00|371|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2021.00||||2021.00|227.28|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|TRUSTMARK [2030]|STARMARK [203000]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2021.00||||2021.00|219.5|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2021.00||||2021.00|272.07|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2021.00||||2021.00|227.28|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2021.00||||2021.00|1212.6|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|GEHA [1415]|GEHA [141500]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2021.00||||2021.00|259.7|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2021.00||||2021.00|869.03|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2021.00||||2021.00|1012.52|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2021.00||||2021.00|709.37|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2021.00||||2021.00|860.95|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2021.00||||2021.00|591.53|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2021.00||||2021.00|247.34|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2021.00||||2021.00|272.07|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2021.00||||2021.00|1818.9|2021|209.05 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2021.00||||2021.00||| 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|AETNA [1015]|AETNA ACO WILCO [101532]|2021.00||||2021.00||| 36020610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASP/INJ MAJOR JOINT W/O US|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2021.00||||2021.00||| 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2446.00||||2446.00|272.07|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2446.00||||2446.00|1051.78|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2446.00||||2446.00|1225.45|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2446.00||||2446.00|858.55|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2446.00||||2446.00|1042|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2446.00||||2446.00|259.7|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2446.00||||2446.00|1467.6|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2446.00||||2446.00|272.07|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2446.00||||2446.00|269.01|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MULTIPLAN [1680]|IHC HS [168011]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2446.00||||2446.00|355.57|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MULTIPLAN [1680]|HMA [168003]|2446.00||||2446.00|371|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|HEALTHNET [1495]|HEALTHNET [149500]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|FMH BENEFIT SERVICES [1390]|FMH [139000]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|FIRST HEALTH [1375]|QUALCHOICE [137513]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2446.00||||2446.00|318.46|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2446.00||||2446.00|1051.78|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2446.00||||2446.00|252.28|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|TRUSTMARK [2030]|STARMARK [203000]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|UMR [2035]|UMR OPTIONS [203501]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2446.00||||2446.00|361.11|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2446.00||||2446.00|513.66|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2446.00||||2446.00|278.54|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2446.00||||2446.00|2446|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2446.00||||2446.00|1589.9|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2446.00||||2446.00|1172.86|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|||2446.00||||2446.00|733.8|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2446.00||||2446.00|591.53|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2446.00||||2446.00|278.54|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2446.00||||2446.00|247.34|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2446.00||||2446.00|256.2|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|CHAMPVA [1240]|CHAMP VA [124000]|2446.00||||2446.00|1834.5|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2446.00||||2446.00|355.57|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|CORESOURCE [1315]|CORESOURCE [131500]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2446.00||||2446.00|289.51|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|GEHA [1415]|GEHA [141500]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2446.00||||2446.00|2201.4|2446|247.34 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|AETNA [1015]|AETNA ACO WILCO [101532]|2446.00||||2446.00||| 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2446.00||||2446.00||| 36020611|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2446.00||||2446.00||| 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|GEHA [1415]|GEHA [141500]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10364.00||||10364.00|3566.68|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10364.00||||10364.00|3745.99|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|CHAMPVA [1240]|CHAMP VA [124000]|10364.00||||10364.00|7773|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10364.00||||10364.00|3156.34|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10364.00||||10364.00|3431.56|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10364.00||||10364.00|4969.54|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10364.00||||10364.00|6736.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10364.00||||10364.00|10364|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10364.00||||10364.00|2176.44|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|UMR [2035]|UMR OPTIONS [203501]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10364.00||||10364.00|2657.84|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10364.00||||10364.00|4456.52|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10364.00||||10364.00|3923.35|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MULTIPLAN [1680]|IHC HS [168011]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10364.00||||10364.00|3804.36|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10364.00||||10364.00|3745.99|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MULTIPLAN [1680]|HMA [168003]|10364.00||||10364.00|3908.59|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|||10364.00||||10364.00|3109.2|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|HEALTHNET [1495]|HEALTHNET [149500]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|TRUSTMARK [2030]|STARMARK [203000]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10364.00||||10364.00|3314.15|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10364.00||||10364.00|2866.3|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10364.00||||10364.00|3431.56|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|CORESOURCE [1315]|CORESOURCE [131500]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10364.00||||10364.00|6218.4|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10364.00||||10364.00|2736.01|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10364.00||||10364.00|4456.52|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10364.00||||10364.00|5192.36|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10364.00||||10364.00|3637.76|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10364.00||||10364.00|4415.06|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10364.00||||10364.00|6270.42|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10364.00||||10364.00|2605.73|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10364.00||||10364.00|2866.3|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10364.00||||10364.00|9327.6|10364|2176.44 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10364.00||||10364.00||| 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|AETNA [1015]|AETNA ACO WILCO [101532]|10364.00||||10364.00||| 36022510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10364.00||||10364.00||| 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10364.00||||10364.00|2866.3|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10364.00||||10364.00|6270.42|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10364.00||||10364.00|4456.52|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10364.00||||10364.00|3637.76|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10364.00||||10364.00|4415.06|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10364.00||||10364.00|2736.01|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10364.00||||10364.00|3431.56|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10364.00||||10364.00|2866.3|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10364.00||||10364.00|3314.15|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|TRUSTMARK [2030]|STARMARK [203000]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10364.00||||10364.00|3745.99|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MULTIPLAN [1680]|HMA [168003]|10364.00||||10364.00|3908.59|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MULTIPLAN [1680]|IHC HS [168011]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10364.00||||10364.00|3923.35|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10364.00||||10364.00|4456.52|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10364.00||||10364.00|2657.84|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|HEALTHNET [1495]|HEALTHNET [149500]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|UMR [2035]|UMR OPTIONS [203501]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10364.00||||10364.00|3804.36|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10364.00||||10364.00|2176.44|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10364.00||||10364.00|10364|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10364.00||||10364.00|6736.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10364.00||||10364.00|6218.4|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10364.00||||10364.00|5192.36|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10364.00||||10364.00|4969.54|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|||10364.00||||10364.00|3109.2|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10364.00||||10364.00|3431.56|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10364.00||||10364.00|2605.73|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10364.00||||10364.00|3156.34|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|CHAMPVA [1240]|CHAMP VA [124000]|10364.00||||10364.00|7773|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10364.00||||10364.00|3745.99|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|CORESOURCE [1315]|CORESOURCE [131500]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10364.00||||10364.00|3566.68|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|GEHA [1415]|GEHA [141500]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10364.00||||10364.00|9327.6|10364|2176.44 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10364.00||||10364.00||| 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|AETNA [1015]|AETNA ACO WILCO [101532]|10364.00||||10364.00||| 36022511|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY LUMBOSACRAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10364.00||||10364.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|GEHA [1415]|GEHA [141500]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|CORESOURCE [1315]|CORESOURCE [131500]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|||11090.00||||11090.00|3327|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11090.00||||11090.00|5317.66|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11090.00||||11090.00|7208.5|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11090.00||||11090.00|11090|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11090.00||||11090.00|4768.7|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|UMR [2035]|UMR OPTIONS [203501]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11090.00||||11090.00|2328.9|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MULTIPLAN [1680]|IHC HS [168011]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|HEALTHNET [1495]|HEALTHNET [149500]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|TRUSTMARK [2030]|STARMARK [203000]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|CHAMPVA [1240]|CHAMP VA [124000]|11090.00||||11090.00|8317.5|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11090.00||||11090.00|6654|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11090.00||||11090.00|4768.7|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11090.00||||11090.00|5556.09|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11090.00||||11090.00|3892.59|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11090.00||||11090.00|4724.34|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11090.00||||11090.00|5545|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11090.00||||11090.00|9981|11090|2328.9 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MULTIPLAN [1680]|HMA [168003]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|AETNA [1015]|AETNA ACO WILCO [101532]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11090.00||||11090.00||| 36022512|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VERTEBROPLASTY CERVICOTHORACIC/LUMBOSACRAL ADDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11090.00||||11090.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3207.00||||3207.00|1603.5|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3207.00||||3207.00|1379.01|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3207.00||||3207.00|1606.71|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3207.00||||3207.00|1125.66|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3207.00||||3207.00|1924.2|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|TRUSTMARK [2030]|STARMARK [203000]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|HEALTHNET [1495]|HEALTHNET [149500]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MULTIPLAN [1680]|IHC HS [168011]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3207.00||||3207.00|1379.01|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|UMR [2035]|UMR OPTIONS [203501]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3207.00||||3207.00|673.47|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3207.00||||3207.00|3207|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3207.00||||3207.00|1366.18|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3207.00||||3207.00|2084.55|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3207.00||||3207.00|1537.76|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|||3207.00||||3207.00|962.1|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|3207.00||||3207.00|2405.25|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|CORESOURCE [1315]|CORESOURCE [131500]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|GEHA [1415]|GEHA [141500]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3207.00||||3207.00|2886.3|3207|673.47 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|MULTIPLAN [1680]|HMA [168003]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3207.00||||3207.00||| 36023350|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM SHOULDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3207.00||||3207.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|GEHA [1415]|GEHA [141500]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|CHAMPVA [1240]|CHAMP VA [124000]|1607.00||||1607.00|1205.25|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1607.00||||1607.00|770.56|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1607.00||||1607.00|1044.55|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1607.00||||1607.00|1607|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1607.00||||1607.00|337.47|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|UMR [2035]|UMR OPTIONS [203501]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1607.00||||1607.00|691.01|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|FIRST HEALTH [1375]|QUALCHOICE [137513]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|FMH BENEFIT SERVICES [1390]|FMH [139000]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MULTIPLAN [1680]|IHC HS [168011]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|HEALTHNET [1495]|HEALTHNET [149500]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|||1607.00||||1607.00|482.1|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|TRUSTMARK [2030]|STARMARK [203000]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|CORESOURCE [1315]|CORESOURCE [131500]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1607.00||||1607.00|964.2|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1607.00||||1607.00|691.01|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1607.00||||1607.00|805.11|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1607.00||||1607.00|564.06|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1607.00||||1607.00|684.58|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1607.00||||1607.00|803.5|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1607.00||||1607.00|1446.3|1607|337.47 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MULTIPLAN [1680]|HMA [168003]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|AETNA [1015]|AETNA ACO WILCO [101532]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1607.00||||1607.00||| 36025246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM WRIST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1607.00||||1607.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|823.00||||823.00|411.5|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|823.00||||823.00|353.89|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|823.00||||823.00|412.32|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|823.00||||823.00|288.87|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|823.00||||823.00|350.6|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|823.00||||823.00|493.8|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|TRUSTMARK [2030]|STARMARK [203000]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|HEALTHNET [1495]|HEALTHNET [149500]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MULTIPLAN [1680]|IHC HS [168011]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|FMH BENEFIT SERVICES [1390]|FMH [139000]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|FIRST HEALTH [1375]|QUALCHOICE [137513]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|823.00||||823.00|353.89|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|UMR [2035]|UMR OPTIONS [203501]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|823.00||||823.00|172.83|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|823.00||||823.00|823|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|823.00||||823.00|534.95|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|823.00||||823.00|394.63|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|||823.00||||823.00|246.9|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|CHAMPVA [1240]|CHAMP VA [124000]|823.00||||823.00|617.25|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|CORESOURCE [1315]|CORESOURCE [131500]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|GEHA [1415]|GEHA [141500]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|823.00||||823.00|740.7|823|172.83 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|AETNA [1015]|AETNA ACO WILCO [101532]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MULTIPLAN [1680]|HMA [168003]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|823.00||||823.00||| 36027093|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ARTHROGRAM HIP W/O ANES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|823.00||||823.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|CORESOURCE [1315]|CORESOURCE [131500]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|||805.00||||805.00|241.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|805.00||||805.00|386|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|805.00||||805.00|805|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|805.00||||805.00|346.15|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|FIRST HEALTH [1375]|QUALCHOICE [137513]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|FMH BENEFIT SERVICES [1390]|FMH [139000]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|UMR [2035]|UMR OPTIONS [203501]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MULTIPLAN [1680]|IHC HS [168011]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|805.00||||805.00|169.05|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|805.00||||805.00|523.25|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|HEALTHNET [1495]|HEALTHNET [149500]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|TRUSTMARK [2030]|STARMARK [203000]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|CHAMPVA [1240]|CHAMP VA [124000]|805.00||||805.00|603.75|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|805.00||||805.00|483|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|GEHA [1415]|GEHA [141500]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|805.00||||805.00|346.15|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|805.00||||805.00|403.31|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|805.00||||805.00|282.56|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|805.00||||805.00|342.93|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|805.00||||805.00|724.5|805|169.05 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MULTIPLAN [1680]|HMA [168003]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|AETNA [1015]|AETNA ACO WILCO [101532]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|805.00||||805.00||| 36027369|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|805.00||||805.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|480.00||||480.00|206.4|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|480.00||||480.00|240.48|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|480.00||||480.00|168.48|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|480.00||||480.00|288|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|480.00||||480.00|90.51|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|HEALTHNET [1495]|HEALTHNET [149500]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MULTIPLAN [1680]|IHC HS [168011]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|FMH BENEFIT SERVICES [1390]|FMH [139000]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|FIRST HEALTH [1375]|QUALCHOICE [137513]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|480.00||||480.00|107.14|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|480.00||||480.00|206.4|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|TRUSTMARK [2030]|STARMARK [203000]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|UMR [2035]|UMR OPTIONS [203501]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|480.00||||480.00|100.8|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|480.00||||480.00|93.71|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|480.00||||480.00|480|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|480.00||||480.00|312|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|480.00||||480.00|230.16|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|||480.00||||480.00|144|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|480.00||||480.00|204.48|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|480.00||||480.00|321.78|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|480.00||||480.00|93.71|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|480.00||||480.00|86.2|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|CHAMPVA [1240]|CHAMP VA [124000]|480.00||||480.00|360|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|CORESOURCE [1315]|CORESOURCE [131500]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|480.00||||480.00|97.4|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|GEHA [1415]|GEHA [141500]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|480.00||||480.00|432|480|86.2 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|MULTIPLAN [1680]|HMA [168003]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|AETNA [1015]|AETNA ACO WILCO [101532]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|480.00||||480.00||| 36029581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC APP MULTILY COMPRS LWR LEG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|480.00||||480.00||| 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|GEHA [1415]|GEHA [141500]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|898.00||||898.00|177.81|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|CORESOURCE [1315]|CORESOURCE [131500]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|898.00||||898.00|278.66|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|CHAMPVA [1240]|CHAMP VA [124000]|898.00||||898.00|673.5|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|898.00||||898.00|157.35|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|898.00||||898.00|171.07|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|898.00||||898.00|430.59|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|898.00||||898.00|583.7|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|898.00||||898.00|898|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|898.00||||898.00|188.58|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|UMR [2035]|UMR OPTIONS [203501]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|898.00||||898.00|197.72|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|898.00||||898.00|386.14|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|898.00||||898.00|195.59|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MULTIPLAN [1680]|IHC HS [168011]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|898.00||||898.00|283.01|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|898.00||||898.00|278.66|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MULTIPLAN [1680]|HMA [168003]|898.00||||898.00|290.76|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|HEALTHNET [1495]|HEALTHNET [149500]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|||898.00||||898.00|269.4|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|TRUSTMARK [2030]|STARMARK [203000]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|898.00||||898.00|165.21|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|898.00||||898.00|213.22|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|898.00||||898.00|171.07|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|898.00||||898.00|538.8|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|898.00||||898.00|203.53|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|898.00||||898.00|315.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|898.00||||898.00|386.14|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|898.00||||898.00|449.9|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|898.00||||898.00|382.55|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|898.00||||898.00|492.73|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|898.00||||898.00|193.84|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|898.00||||898.00|213.22|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|898.00||||898.00|808.2|898|157.35 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|898.00||||898.00||| 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|AETNA [1015]|AETNA ACO WILCO [101532]|898.00||||898.00||| 36031500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTUBATION ENDOTRACHEAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|898.00||||898.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|488.00||||488.00|391.93|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|488.00||||488.00|209.84|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|488.00||||488.00|244.49|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|488.00||||488.00|171.29|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|488.00||||488.00|207.89|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|TRUSTMARK [2030]|STARMARK [203000]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|HEALTHNET [1495]|HEALTHNET [149500]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|FMH BENEFIT SERVICES [1390]|FMH [139000]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|FIRST HEALTH [1375]|QUALCHOICE [137513]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MULTIPLAN [1680]|IHC HS [168011]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|488.00||||488.00|209.84|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|UMR [2035]|UMR OPTIONS [203501]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|488.00||||488.00|102.48|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|488.00||||488.00|292.8|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|488.00||||488.00|488|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|488.00||||488.00|317.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|488.00||||488.00|234|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|||488.00||||488.00|146.4|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|CHAMPVA [1240]|CHAMP VA [124000]|488.00||||488.00|366|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|CORESOURCE [1315]|CORESOURCE [131500]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|GEHA [1415]|GEHA [141500]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|488.00||||488.00|439.2|488|102.48 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|AETNA [1015]|AETNA ACO WILCO [101532]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MULTIPLAN [1680]|HMA [168003]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|488.00||||488.00||| 36031575|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGOSCOPY FLEX FIBEROPTIC DX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|488.00||||488.00||| 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1126.00||||1126.00|407.78|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|CORESOURCE [1315]|CORESOURCE [131500]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1126.00||||1126.00|513.3|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1126.00||||1126.00|360.87|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|||1126.00||||1126.00|337.8|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1126.00||||1126.00|539.92|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1126.00||||1126.00|1126|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1126.00||||1126.00|521.3|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|UMR [2035]|UMR OPTIONS [203501]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1126.00||||1126.00|484.18|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1126.00||||1126.00|448.56|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1126.00||||1126.00|364.2|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MULTIPLAN [1680]|IHC HS [168011]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1126.00||||1126.00|236.46|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1126.00||||1126.00|513.3|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MULTIPLAN [1680]|HMA [168003]|1126.00||||1126.00|535.58|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|HEALTHNET [1495]|HEALTHNET [149500]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1126.00||||1126.00|731.9|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1126.00||||1126.00|392.33|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|TRUSTMARK [2030]|STARMARK [203000]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1126.00||||1126.00|378.91|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|CHAMPVA [1240]|CHAMP VA [124000]|1126.00||||1126.00|844.5|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1126.00||||1126.00|392.76|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1126.00||||1126.00|392.33|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|GEHA [1415]|GEHA [141500]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1126.00||||1126.00|484.18|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1126.00||||1126.00|564.13|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1126.00||||1126.00|395.23|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1126.00||||1126.00|479.68|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1126.00||||1126.00|675.6|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1126.00||||1126.00|374.91|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1126.00||||1126.00|923.84|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1126.00||||1126.00|357.06|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1126.00||||1126.00|392.76|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1126.00||||1126.00|1013.4|1126|236.46 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1126.00||||1126.00||| 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|AETNA [1015]|AETNA ACO WILCO [101532]|1126.00||||1126.00||| 36031579|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LARYNGSC FLEX/RIGIS W/STROBSCOPY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1126.00||||1126.00||| 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2662.00||||2662.00|1497.95|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2662.00||||2662.00|1144.66|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2662.00||||2662.00|934.36|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2662.00||||2662.00|1134.01|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2662.00||||2662.00|1429.86|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2662.00||||2662.00|1597.2|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2662.00||||2662.00|922.23|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2662.00||||2662.00|1497.95|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2662.00||||2662.00|890.68|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|HEALTHNET [1495]|HEALTHNET [149500]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MULTIPLAN [1680]|IHC HS [168011]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2662.00||||2662.00|1957.68|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MULTIPLAN [1680]|HMA [168003]|2662.00||||2662.00|2042.65|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|FMH BENEFIT SERVICES [1390]|FMH [139000]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|FIRST HEALTH [1375]|QUALCHOICE [137513]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2662.00||||2662.00|1054.39|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|AETNA [1015]|AETNA ACO WILCO [101532]|2662.00||||2662.00|2240|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2662.00||||2662.00|1144.66|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2662.00||||2662.00|1389|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|TRUSTMARK [2030]|STARMARK [203000]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|UMR [2035]|UMR OPTIONS [203501]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2662.00||||2662.00|1988.18|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2662.00||||2662.00|559.02|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2662.00||||2662.00|2662|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2662.00||||2662.00|1730.3|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2662.00||||2662.00|2662|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2662.00||||2662.00|1276.43|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|||2662.00||||2662.00|798.6|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2662.00||||2662.00|1333.66|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2662.00||||2662.00|922.23|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2662.00||||2662.00|1361.77|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2662.00||||2662.00|848.27|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|CHAMPVA [1240]|CHAMP VA [124000]|2662.00||||2662.00|1996.5|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2662.00||||2662.00|1957.68|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|CORESOURCE [1315]|CORESOURCE [131500]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2662.00||||2662.00|958.54|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|GEHA [1415]|GEHA [141500]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2662.00||||2662.00|2395.8|2662|559.02 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2662.00||||2662.00||| 36031622|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2662.00||||2662.00||| 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|GEHA [1415]|GEHA [141500]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2928.00||||2928.00|958.54|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2928.00||||2928.00|1904.99|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|CHAMPVA [1240]|CHAMP VA [124000]|2928.00||||2928.00|2196|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2928.00||||2928.00|848.27|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2928.00||||2928.00|922.23|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|||2928.00||||2928.00|878.4|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2928.00||||2928.00|1403.98|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2928.00||||2928.00|1903.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2928.00||||2928.00|2928|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2928.00||||2928.00|614.88|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|UMR [2035]|UMR OPTIONS [203501]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2928.00||||2928.00|1351.62|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2928.00||||2928.00|1259.04|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2928.00||||2928.00|1054.39|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2928.00||||2928.00|1988.18|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MULTIPLAN [1680]|IHC HS [168011]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2928.00||||2928.00|1904.99|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MULTIPLAN [1680]|HMA [168003]|2928.00||||2928.00|1987.67|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|AETNA [1015]|AETNA ACO WILCO [101532]|2928.00||||2928.00|2240|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|HEALTHNET [1495]|HEALTHNET [149500]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|TRUSTMARK [2030]|STARMARK [203000]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2928.00||||2928.00|1361.77|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2928.00||||2928.00|890.68|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|CORESOURCE [1315]|CORESOURCE [131500]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2928.00||||2928.00|1457.63|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2928.00||||2928.00|922.23|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2928.00||||2928.00|1756.8|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2928.00||||2928.00|1391.37|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2928.00||||2928.00|2928|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2928.00||||2928.00|1259.04|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2928.00||||2928.00|1466.93|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2928.00||||2928.00|1247.33|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2928.00||||2928.00|1027.73|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2928.00||||2928.00|1325.12|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2928.00||||2928.00|1457.63|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2928.00||||2928.00|2635.2|2928|614.88 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2928.00||||2928.00||| 36031623|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BRUSHINGS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2928.00||||2928.00||| 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3475.00||||3475.00|1497.95|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3475.00||||3475.00|3272.94|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3475.00||||3475.00|1494.25|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3475.00||||3475.00|1219.73|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3475.00||||3475.00|1480.35|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3475.00||||3475.00|1429.86|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3475.00||||3475.00|922.23|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3475.00||||3475.00|1497.95|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|TRUSTMARK [2030]|STARMARK [203000]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|AETNA [1015]|AETNA ACO WILCO [101532]|3475.00||||3475.00|2240|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|HEALTHNET [1495]|HEALTHNET [149500]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3475.00||||3475.00|1957.68|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MULTIPLAN [1680]|HMA [168003]|3475.00||||3475.00|2042.65|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3475.00||||3475.00|1054.39|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3475.00||||3475.00|1494.25|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3475.00||||3475.00|1389|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MULTIPLAN [1680]|IHC HS [168011]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|UMR [2035]|UMR OPTIONS [203501]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3475.00||||3475.00|1988.18|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3475.00||||3475.00|729.75|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3475.00||||3475.00|890.68|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3475.00||||3475.00|2085|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3475.00||||3475.00|3475|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3475.00||||3475.00|2258.75|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3475.00||||3475.00|1740.98|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3475.00||||3475.00|1666.26|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|||3475.00||||3475.00|1042.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3475.00||||3475.00|922.23|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3475.00||||3475.00|1361.77|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3475.00||||3475.00|848.27|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|CHAMPVA [1240]|CHAMP VA [124000]|3475.00||||3475.00|2606.25|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3475.00||||3475.00|1957.68|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|CORESOURCE [1315]|CORESOURCE [131500]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3475.00||||3475.00|958.54|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|GEHA [1415]|GEHA [141500]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3475.00||||3475.00|3127.5|3475|729.75 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3475.00||||3475.00||| 36031624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSC ALVEOLAR LAVAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3475.00||||3475.00||| 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3475.00||||3475.00|958.54|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|CORESOURCE [1315]|CORESOURCE [131500]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3475.00||||3475.00|1957.68|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|CHAMPVA [1240]|CHAMP VA [124000]|3475.00||||3475.00|2606.25|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3475.00||||3475.00|848.27|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|||3475.00||||3475.00|1042.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3475.00||||3475.00|1666.26|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3475.00||||3475.00|3475|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3475.00||||3475.00|729.75|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3475.00||||3475.00|1988.18|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3475.00||||3475.00|1494.25|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3475.00||||3475.00|1054.39|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3475.00||||3475.00|1389|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|FIRST HEALTH [1375]|QUALCHOICE [137513]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|FMH BENEFIT SERVICES [1390]|FMH [139000]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|UMR [2035]|UMR OPTIONS [203501]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MULTIPLAN [1680]|IHC HS [168011]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3475.00||||3475.00|1957.68|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MULTIPLAN [1680]|HMA [168003]|3475.00||||3475.00|2042.65|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3475.00||||3475.00|2258.75|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|HEALTHNET [1495]|HEALTHNET [149500]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3475.00||||3475.00|922.23|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|TRUSTMARK [2030]|STARMARK [203000]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3475.00||||3475.00|890.68|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3475.00||||3475.00|1497.95|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3475.00||||3475.00|922.23|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3475.00||||3475.00|2085|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|GEHA [1415]|GEHA [141500]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3475.00||||3475.00|1429.86|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3475.00||||3475.00|1494.25|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3475.00||||3475.00|1740.98|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3475.00||||3475.00|1219.73|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3475.00||||3475.00|1480.35|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3475.00||||3475.00|3272.94|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3475.00||||3475.00|1361.77|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3475.00||||3475.00|1497.95|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3475.00||||3475.00|3127.5|3475|729.75 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3475.00||||3475.00||| 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|AETNA [1015]|AETNA ACO WILCO [101532]|3475.00||||3475.00||| 36031625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/BIOPSY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3475.00||||3475.00||| 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6932.00||||6932.00|2992.37|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6932.00||||6932.00|2980.76|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6932.00||||6932.00|3472.93|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6932.00||||6932.00|2433.13|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6932.00||||6932.00|2953.03|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6932.00||||6932.00|2856.36|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6932.00||||6932.00|4159.2|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6932.00||||6932.00|2992.37|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6932.00||||6932.00|890.68|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|HEALTHNET [1495]|HEALTHNET [149500]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6932.00||||6932.00|3910.76|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MULTIPLAN [1680]|HMA [168003]|6932.00||||6932.00|4080.51|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MULTIPLAN [1680]|IHC HS [168011]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|FMH BENEFIT SERVICES [1390]|FMH [139000]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|FIRST HEALTH [1375]|QUALCHOICE [137513]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6932.00||||6932.00|1054.39|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6932.00||||6932.00|2980.76|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6932.00||||6932.00|2774.75|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|UMR [2035]|UMR OPTIONS [203501]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6932.00||||6932.00|3971.69|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|TRUSTMARK [2030]|STARMARK [203000]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6932.00||||6932.00|1455.72|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6932.00||||6932.00|922.23|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6932.00||||6932.00|6932|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6932.00||||6932.00|4505.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6932.00||||6932.00|3323.89|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|||6932.00||||6932.00|2079.6|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6932.00||||6932.00|6550.84|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6932.00||||6932.00|922.23|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6932.00||||6932.00|2720.34|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6932.00||||6932.00|848.27|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|CHAMPVA [1240]|CHAMP VA [124000]|6932.00||||6932.00|5199|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6932.00||||6932.00|3910.76|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|CORESOURCE [1315]|CORESOURCE [131500]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6932.00||||6932.00|958.54|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|GEHA [1415]|GEHA [141500]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6932.00||||6932.00|6238.8|6932|848.27 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6932.00||||6932.00||| 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|AETNA [1015]|AETNA ACO WILCO [101532]|6932.00||||6932.00||| 36031629|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/TRANSBRONCH ASP BX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6932.00||||6932.00||| 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2928.00||||2928.00|958.54|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|GEHA [1415]|GEHA [141500]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2928.00||||2928.00|1957.68|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|CHAMPVA [1240]|CHAMP VA [124000]|2928.00||||2928.00|2196|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2928.00||||2928.00|848.27|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2928.00||||2928.00|922.23|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2928.00||||2928.00|1403.98|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2928.00||||2928.00|1903.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2928.00||||2928.00|2928|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2928.00||||2928.00|614.88|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|UMR [2035]|UMR OPTIONS [203501]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2928.00||||2928.00|1389|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2928.00||||2928.00|1259.04|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2928.00||||2928.00|1054.39|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|FIRST HEALTH [1375]|QUALCHOICE [137513]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|FMH BENEFIT SERVICES [1390]|FMH [139000]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|HEALTHNET [1495]|HEALTHNET [149500]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2928.00||||2928.00|1988.18|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MULTIPLAN [1680]|IHC HS [168011]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2928.00||||2928.00|1957.68|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MULTIPLAN [1680]|HMA [168003]|2928.00||||2928.00|2042.65|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|TRUSTMARK [2030]|STARMARK [203000]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|||2928.00||||2928.00|878.4|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2928.00||||2928.00|890.68|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2928.00||||2928.00|1497.95|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2928.00||||2928.00|922.23|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|CORESOURCE [1315]|CORESOURCE [131500]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2928.00||||2928.00|1756.8|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2928.00||||2928.00|1429.86|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2928.00||||2928.00|1259.04|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2928.00||||2928.00|1466.93|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2928.00||||2928.00|1027.73|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2928.00||||2928.00|1247.33|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2928.00||||2928.00|2928|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2928.00||||2928.00|1497.95|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2928.00||||2928.00|1361.77|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2928.00||||2928.00|2635.2|2928|614.88 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2928.00||||2928.00||| 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|AETNA [1015]|AETNA ACO WILCO [101532]|2928.00||||2928.00||| 36031635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHOSCOPY W/REMOVAL FB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2928.00||||2928.00||| 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2928.00||||2928.00|1497.95|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2928.00||||2928.00|2928|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2928.00||||2928.00|1259.04|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2928.00||||2928.00|1027.73|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2928.00||||2928.00|1247.33|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2928.00||||2928.00|1429.86|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2928.00||||2928.00|922.23|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2928.00||||2928.00|1497.95|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2928.00||||2928.00|890.68|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|TRUSTMARK [2030]|STARMARK [203000]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|HEALTHNET [1495]|HEALTHNET [149500]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2928.00||||2928.00|1957.68|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MULTIPLAN [1680]|HMA [168003]|2928.00||||2928.00|2042.65|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MULTIPLAN [1680]|IHC HS [168011]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2928.00||||2928.00|1054.39|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2928.00||||2928.00|1259.04|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2928.00||||2928.00|1389|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|UMR [2035]|UMR OPTIONS [203501]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2928.00||||2928.00|1988.18|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2928.00||||2928.00|614.88|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2928.00||||2928.00|2928|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2928.00||||2928.00|1903.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2928.00||||2928.00|1756.8|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2928.00||||2928.00|1466.93|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2928.00||||2928.00|1403.98|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|||2928.00||||2928.00|878.4|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2928.00||||2928.00|922.23|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2928.00||||2928.00|1361.77|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2928.00||||2928.00|848.27|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|CHAMPVA [1240]|CHAMP VA [124000]|2928.00||||2928.00|2196|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2928.00||||2928.00|1957.68|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2928.00||||2928.00|958.54|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|CORESOURCE [1315]|CORESOURCE [131500]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|GEHA [1415]|GEHA [141500]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2928.00||||2928.00|2635.2|2928|614.88 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2928.00||||2928.00||| 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|AETNA [1015]|AETNA ACO WILCO [101532]|2928.00||||2928.00||| 36031645|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP INITIAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2928.00||||2928.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|GEHA [1415]|GEHA [141500]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|CORESOURCE [1315]|CORESOURCE [131500]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|||2566.00||||2566.00|769.8|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2566.00||||2566.00|1230.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2566.00||||2566.00|1667.9|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2566.00||||2566.00|2566|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2566.00||||2566.00|1103.38|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|UMR [2035]|UMR OPTIONS [203501]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2566.00||||2566.00|538.86|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MULTIPLAN [1680]|IHC HS [168011]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|HEALTHNET [1495]|HEALTHNET [149500]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|TRUSTMARK [2030]|STARMARK [203000]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|CHAMPVA [1240]|CHAMP VA [124000]|2566.00||||2566.00|1924.5|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2566.00||||2566.00|1539.6|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2566.00||||2566.00|1103.38|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2566.00||||2566.00|1285.57|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2566.00||||2566.00|1093.12|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2566.00||||2566.00|900.67|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2566.00||||2566.00|923.84|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2566.00||||2566.00|2309.4|2566|538.86 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MULTIPLAN [1680]|HMA [168003]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|AETNA [1015]|AETNA ACO WILCO [101532]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2566.00||||2566.00||| 36031646|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCH W/TRANSBRNCH ASP SUBSEQUNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2566.00||||2566.00||| 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6672.00||||6672.00|6550.84|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6672.00||||6672.00|2868.96|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6672.00||||6672.00|3342.67|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6672.00||||6672.00|2341.87|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6672.00||||6672.00|2935.36|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6672.00||||6672.00|4003.2|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6672.00||||6672.00|3075.14|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6672.00||||6672.00|2537.97|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|TRUSTMARK [2030]|STARMARK [203000]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|HEALTHNET [1495]|HEALTHNET [149500]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MULTIPLAN [1680]|IHC HS [168011]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6672.00||||6672.00|4018.93|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MULTIPLAN [1680]|HMA [168003]|6672.00||||6672.00|4193.37|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|FMH BENEFIT SERVICES [1390]|FMH [139000]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|FIRST HEALTH [1375]|QUALCHOICE [137513]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6672.00||||6672.00|3004.47|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6672.00||||6672.00|2868.96|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6672.00||||6672.00|2851.49|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|UMR [2035]|UMR OPTIONS [203501]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6672.00||||6672.00|4081.55|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6672.00||||6672.00|1401.12|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6672.00||||6672.00|6672|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6672.00||||6672.00|2627.87|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6672.00||||6672.00|2842.27|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6672.00||||6672.00|4336.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6672.00||||6672.00|3199.22|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|||6672.00||||6672.00|2001.6|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6672.00||||6672.00|2627.87|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6672.00||||6672.00|3075.14|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6672.00||||6672.00|2795.58|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6672.00||||6672.00|2417.12|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|CHAMPVA [1240]|CHAMP VA [124000]|6672.00||||6672.00|5004|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6672.00||||6672.00|4018.93|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6672.00||||6672.00|2731.34|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|CORESOURCE [1315]|CORESOURCE [131500]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|GEHA [1415]|GEHA [141500]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6672.00||||6672.00|6004.8|6672|1401.12 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6672.00||||6672.00||| 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|AETNA [1015]|AETNA ACO WILCO [101532]|6672.00||||6672.00||| 36031652|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 1-2 NODE STN/STRUCT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6672.00||||6672.00||| 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|GEHA [1415]|GEHA [141500]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|CORESOURCE [1315]|CORESOURCE [131500]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7625.00||||7625.00|4018.93|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|CHAMPVA [1240]|CHAMP VA [124000]|7625.00||||7625.00|5718.75|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7625.00||||7625.00|2417.12|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7625.00||||7625.00|2627.87|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7625.00||||7625.00|3656.19|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7625.00||||7625.00|4956.25|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7625.00||||7625.00|7625|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7625.00||||7625.00|1601.25|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7625.00||||7625.00|4081.55|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|UMR [2035]|UMR OPTIONS [203501]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7625.00||||7625.00|2851.49|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7625.00||||7625.00|3278.75|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7625.00||||7625.00|3004.47|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|FIRST HEALTH [1375]|QUALCHOICE [137513]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|FMH BENEFIT SERVICES [1390]|FMH [139000]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MULTIPLAN [1680]|IHC HS [168011]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7625.00||||7625.00|4018.93|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MULTIPLAN [1680]|HMA [168003]|7625.00||||7625.00|4193.37|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|||7625.00||||7625.00|2287.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|HEALTHNET [1495]|HEALTHNET [149500]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|TRUSTMARK [2030]|STARMARK [203000]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7625.00||||7625.00|2537.97|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7625.00||||7625.00|2731.34|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7625.00||||7625.00|3075.14|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7625.00||||7625.00|2627.87|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7625.00||||7625.00|4575|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7625.00||||7625.00|2935.36|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7625.00||||7625.00|3278.75|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7625.00||||7625.00|3820.13|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7625.00||||7625.00|2676.38|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7625.00||||7625.00|3248.25|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7625.00||||7625.00|6550.84|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7625.00||||7625.00|2795.58|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7625.00||||7625.00|6862.5|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7625.00||||7625.00|3075.14|7625|1601.25 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7625.00||||7625.00||| 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|AETNA [1015]|AETNA ACO WILCO [101532]|7625.00||||7625.00||| 36031653|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS SAMPLNG 3+ NODE STN/STRUCTURE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7625.00||||7625.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6672.00||||6672.00|3336|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6672.00||||6672.00|2868.96|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6672.00||||6672.00|2341.87|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6672.00||||6672.00|2842.27|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6672.00||||6672.00|4003.2|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|TRUSTMARK [2030]|STARMARK [203000]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|HEALTHNET [1495]|HEALTHNET [149500]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MULTIPLAN [1680]|IHC HS [168011]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6672.00||||6672.00|2868.96|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|UMR [2035]|UMR OPTIONS [203501]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6672.00||||6672.00|1401.12|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6672.00||||6672.00|6672|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6672.00||||6672.00|4336.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6672.00||||6672.00|3342.67|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6672.00||||6672.00|3199.22|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|||6672.00||||6672.00|2001.6|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|CHAMPVA [1240]|CHAMP VA [124000]|6672.00||||6672.00|5004|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|CORESOURCE [1315]|CORESOURCE [131500]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|GEHA [1415]|GEHA [141500]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6672.00||||6672.00|6004.8|6672|1401.12 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|AETNA [1015]|AETNA ACO WILCO [101532]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MULTIPLAN [1680]|HMA [168003]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6672.00||||6672.00||| 36031654|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EBUS PERIPH LESION INTERVENTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6672.00||||6672.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|CORESOURCE [1315]|CORESOURCE [131500]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|||6045.00||||6045.00|1813.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6045.00||||6045.00|2898.58|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6045.00||||6045.00|6045|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6045.00||||6045.00|2599.35|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|UMR [2035]|UMR OPTIONS [203501]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MULTIPLAN [1680]|IHC HS [168011]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6045.00||||6045.00|1269.45|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6045.00||||6045.00|3929.25|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|HEALTHNET [1495]|HEALTHNET [149500]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|TRUSTMARK [2030]|STARMARK [203000]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|CHAMPVA [1240]|CHAMP VA [124000]|6045.00||||6045.00|4533.75|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6045.00||||6045.00|3627|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|GEHA [1415]|GEHA [141500]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6045.00||||6045.00|2599.35|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6045.00||||6045.00|3028.55|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6045.00||||6045.00|2575.17|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6045.00||||6045.00|2121.8|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6045.00||||6045.00|6045|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6045.00||||6045.00|5440.5|6045|1269.45 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MULTIPLAN [1680]|HMA [168003]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|AETNA [1015]|AETNA ACO WILCO [101532]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6045.00||||6045.00||| 36031660|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY 1 LOBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6045.00||||6045.00|2599.35|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6045.00||||6045.00|3028.55|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6045.00||||6045.00|2121.8|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6045.00||||6045.00|3627|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|HEALTHNET [1495]|HEALTHNET [149500]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MULTIPLAN [1680]|IHC HS [168011]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6045.00||||6045.00|2599.35|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|TRUSTMARK [2030]|STARMARK [203000]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|UMR [2035]|UMR OPTIONS [203501]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6045.00||||6045.00|1269.45|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6045.00||||6045.00|6045|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6045.00||||6045.00|3929.25|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6045.00||||6045.00|2898.58|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|||6045.00||||6045.00|1813.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6045.00||||6045.00|2575.17|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6045.00||||6045.00|6045|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|CHAMPVA [1240]|CHAMP VA [124000]|6045.00||||6045.00|4533.75|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|CORESOURCE [1315]|CORESOURCE [131500]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|GEHA [1415]|GEHA [141500]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6045.00||||6045.00|5440.5|6045|1269.45 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|AETNA [1015]|AETNA ACO WILCO [101532]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|MULTIPLAN [1680]|HMA [168003]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6045.00||||6045.00||| 36031661|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BRONCHIAL THERMOPLASTY > 1 LOBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6045.00||||6045.00||| 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2434.00||||2434.00|1437.21|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2434.00||||2434.00|1907.56|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MULTIPLAN [1680]|IHC HS [168011]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|HEALTHNET [1495]|HEALTHNET [149500]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2434.00||||2434.00|2434|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MULTIPLAN [1680]|HMA [168003]|2434.00||||2434.00|1959.83|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2434.00||||2434.00|2434|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2434.00||||2434.00|1460.4|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2434.00||||2434.00|511.14|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2434.00||||2434.00|1036.88|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2434.00||||2434.00|1437.21|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|CHAMPVA [1240]|CHAMP VA [124000]|2434.00||||2434.00|1825.5|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2434.00||||2434.00|854.33|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2434.00||||2434.00|790.68|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|CORESOURCE [1315]|CORESOURCE [131500]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2434.00||||2434.00|1371.88|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2434.00||||2434.00|893.47|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2434.00||||2434.00|1878.3|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|||2434.00||||2434.00|730.2|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|UMR [2035]|UMR OPTIONS [203501]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2434.00||||2434.00|859.62|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2434.00||||2434.00|1582.1|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2434.00||||2434.00|982.82|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2434.00||||2434.00|1332.68|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2434.00||||2434.00|1219.43|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2434.00||||2434.00|1878.3|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2434.00||||2434.00|1046.62|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2434.00||||2434.00|1167.1|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2434.00||||2434.00|859.62|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|TRUSTMARK [2030]|STARMARK [203000]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|GEHA [1415]|GEHA [141500]|2434.00||||2434.00|2190.6|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2434.00||||2434.00|1046.62|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2434.00||||2434.00|830.21|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2434.00||||2434.00|1306.55|2434|511.14 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2434.00||||2434.00||| 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2434.00||||2434.00||| 36032405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LUNG/MEDIAST PERC NDL|AETNA [1015]|AETNA ACO WILCO [101532]|2434.00||||2434.00||| 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8829.00||||8829.00|3098.98|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|8829.00||||8829.00|3761.15|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8829.00||||8829.00|7044.8|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8829.00||||8829.00|2708.71|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8829.00||||8829.00|3796.47|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|HEALTHNET [1495]|HEALTHNET [149500]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8829.00||||8829.00|5297.4|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|AETNA [1015]|AETNA ACO WILCO [101532]|8829.00||||8829.00|2240|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8829.00||||8829.00|2616.05|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|TRUSTMARK [2030]|STARMARK [203000]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MULTIPLAN [1680]|IHC HS [168011]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8829.00||||8829.00|3255.69|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|UMR [2035]|UMR OPTIONS [203501]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8829.00||||8829.00|4321.19|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|8829.00||||8829.00|3096.91|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8829.00||||8829.00|4233.51|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8829.00||||8829.00|3796.47|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|||8829.00||||8829.00|2648.7|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8829.00||||8829.00|3255.69|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8829.00||||8829.00|3107.71|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|8829.00||||8829.00|4254.9|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|CORESOURCE [1315]|CORESOURCE [131500]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8829.00||||8829.00|2708.71|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8829.00||||8829.00|2491.48|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|8829.00||||8829.00|4254.9|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8829.00||||8829.00|5738.85|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MULTIPLAN [1680]|HMA [168003]|8829.00||||8829.00|4439.58|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8829.00||||8829.00|1854.09|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|CHAMPVA [1240]|CHAMP VA [124000]|8829.00||||8829.00|6621.75|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|8829.00||||8829.00|2815.37|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|8829.00||||8829.00|4423.33|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8829.00||||8829.00|8829|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8829.00||||8829.00|2959.72|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|GEHA [1415]|GEHA [141500]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8829.00||||8829.00|3018.92|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|8829.00||||8829.00|7946.1|8829|1854.09 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8829.00||||8829.00||| 36032550|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELL TUNNELLED PLEURAL CATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|8829.00||||8829.00||| 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|GEHA [1415]|GEHA [141500]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2017.00||||2017.00|454.13|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2017.00||||2017.00|513.17|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2017.00||||2017.00|1311.05|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2017.00||||2017.00|493.73|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2017.00||||2017.00|2017|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2017.00||||2017.00|423.57|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2017.00||||2017.00|2017|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2017.00||||2017.00|1583.69|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|||2017.00||||2017.00|605.1|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2017.00||||2017.00|564.49|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|CORESOURCE [1315]|CORESOURCE [131500]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|HEALTHNET [1495]|HEALTHNET [149500]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2017.00||||2017.00|2017|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MULTIPLAN [1680]|IHC HS [168011]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2017.00||||2017.00|1210.2|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|CHAMPVA [1240]|CHAMP VA [124000]|2017.00||||2017.00|1512.75|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2017.00||||2017.00|1630.27|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2017.00||||2017.00|967.15|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2017.00||||2017.00|1707.9|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2017.00||||2017.00|867.31|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2017.00||||2017.00|493.73|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2017.00||||2017.00|2017|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2017.00||||2017.00|707.97|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2017.00||||2017.00|867.31|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|2017.00||||2017.00|2017|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2017.00||||2017.00|1010.52|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MULTIPLAN [1680]|HMA [168003]|2017.00||||2017.00|2328.96|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|TRUSTMARK [2030]|STARMARK [203000]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2017.00||||2017.00|1707.9|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2017.00||||2017.00|2017|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2017.00||||2017.00|1552.64|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2017.00||||2017.00|476.83|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|UMR [2035]|UMR OPTIONS [203501]|2017.00||||2017.00|1815.3|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2017.00||||2017.00|859.24|2328.96|423.57 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2017.00||||2017.00||| 36032551|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERTION OF CHEST TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2017.00||||2017.00||| 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4120.00||||4120.00|2472|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4120.00||||4120.00|876.25|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4120.00||||4120.00|660.19|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4120.00||||4120.00|496.66|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4120.00||||4120.00|630.18|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|TRUSTMARK [2030]|STARMARK [203000]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4120.00||||4120.00|862.8|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4120.00||||4120.00|612.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|UMR [2035]|UMR OPTIONS [203501]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|||4120.00||||4120.00|1236|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4120.00||||4120.00|1975.54|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4120.00||||4120.00|862.8|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4120.00||||4120.00|1446.12|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MULTIPLAN [1680]|HMA [168003]|4120.00||||4120.00|900.25|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4120.00||||4120.00|514.26|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|4120.00||||4120.00|1933|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4120.00||||4120.00|865.2|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|4120.00||||4120.00|3090|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4120.00||||4120.00|1771.6|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4120.00||||4120.00|473.01|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4120.00||||4120.00|514.26|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4120.00||||4120.00|587.96|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4120.00||||4120.00|2678|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|GEHA [1415]|GEHA [141500]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4120.00||||4120.00|4120|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MULTIPLAN [1680]|IHC HS [168011]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4120.00||||4120.00|1755.12|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4120.00||||4120.00|534.51|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4120.00||||4120.00|600.17|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4120.00||||4120.00|660.19|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4120.00||||4120.00|1771.6|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4120.00||||4120.00|3708|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4120.00||||4120.00|1481.98|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4120.00||||4120.00|2064.12|4120|473.01 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4120.00||||4120.00||| 36032555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC THORACENTESIS W/ IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4120.00||||4120.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|CHAMPVA [1240]|CHAMP VA [124000]|2253.00||||2253.00|1689.75|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|GEHA [1415]|GEHA [141500]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2253.00||||2253.00|2253|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2253.00||||2253.00|1464.45|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|UMR [2035]|UMR OPTIONS [203501]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|||2253.00||||2253.00|675.9|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2253.00||||2253.00|968.79|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|TRUSTMARK [2030]|STARMARK [203000]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MULTIPLAN [1680]|IHC HS [168011]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|HEALTHNET [1495]|HEALTHNET [149500]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2253.00||||2253.00|473.13|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|CORESOURCE [1315]|CORESOURCE [131500]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2253.00||||2253.00|1080.31|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2253.00||||2253.00|2253|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2253.00||||2253.00|1351.8|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2253.00||||2253.00|790.8|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2253.00||||2253.00|959.78|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2253.00||||2253.00|968.79|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2253.00||||2253.00|1128.75|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2253.00||||2253.00|2027.7|2253|473.13 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|AETNA [1015]|AETNA ACO WILCO [101532]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MULTIPLAN [1680]|HMA [168003]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2253.00||||2253.00||| 36032557|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INDWELLING CATH PLEURA W/ IMAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2253.00||||2253.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|967.00||||967.00|415.81|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|TRUSTMARK [2030]|STARMARK [203000]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|967.00||||967.00|580.2|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|967.00||||967.00|411.94|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|967.00||||967.00|967|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|967.00||||967.00|484.47|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|HEALTHNET [1495]|HEALTHNET [149500]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MULTIPLAN [1680]|IHC HS [168011]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|967.00||||967.00|967|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|967.00||||967.00|203.07|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|UMR [2035]|UMR OPTIONS [203501]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|967.00||||967.00|339.42|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|||967.00||||967.00|290.1|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|967.00||||967.00|463.68|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|CHAMPVA [1240]|CHAMP VA [124000]|967.00||||967.00|725.25|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|967.00||||967.00|628.55|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|967.00||||967.00|415.81|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|GEHA [1415]|GEHA [141500]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|CORESOURCE [1315]|CORESOURCE [131500]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|967.00||||967.00|870.3|967|203.07 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|AETNA [1015]|AETNA ACO WILCO [101532]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MULTIPLAN [1680]|HMA [168003]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|967.00||||967.00||| 36032561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE INIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|CHAMPVA [1240]|CHAMP VA [124000]|967.00||||967.00|725.25|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|||967.00||||967.00|290.1|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|967.00||||967.00|967|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|967.00||||967.00|463.68|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|UMR [2035]|UMR OPTIONS [203501]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|CORESOURCE [1315]|CORESOURCE [131500]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|TRUSTMARK [2030]|STARMARK [203000]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|967.00||||967.00|967|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|GEHA [1415]|GEHA [141500]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|967.00||||967.00|415.81|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|967.00||||967.00|339.42|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|967.00||||967.00|580.2|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|967.00||||967.00|628.55|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|967.00||||967.00|411.94|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|HEALTHNET [1495]|HEALTHNET [149500]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|967.00||||967.00|484.47|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|967.00||||967.00|203.07|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|967.00||||967.00|415.81|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MULTIPLAN [1680]|IHC HS [168011]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|967.00||||967.00|870.3|967|203.07 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MULTIPLAN [1680]|HMA [168003]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|AETNA [1015]|AETNA ACO WILCO [101532]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|967.00||||967.00||| 36032562|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC FIBRINOLYSIS VIA CHEST TUBE SUBQ DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|967.00||||967.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MULTIPLAN [1680]|IHC HS [168011]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|HEALTHNET [1495]|HEALTHNET [149500]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1591.00||||1591.00|684.13|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|UMR [2035]|UMR OPTIONS [203501]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1591.00||||1591.00|334.11|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1591.00||||1591.00|1034.15|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1591.00||||1591.00|762.88|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|CHAMPVA [1240]|CHAMP VA [124000]|1591.00||||1591.00|1193.25|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1591.00||||1591.00|1591|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|||1591.00||||1591.00|477.3|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|GEHA [1415]|GEHA [141500]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|CORESOURCE [1315]|CORESOURCE [131500]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1591.00||||1591.00|795.5|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1591.00||||1591.00|677.77|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1591.00||||1591.00|797.09|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1591.00||||1591.00|684.13|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1591.00||||1591.00|558.44|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1591.00||||1591.00|954.6|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|TRUSTMARK [2030]|STARMARK [203000]|1591.00||||1591.00|1431.9|1591|334.11 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MULTIPLAN [1680]|HMA [168003]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|AETNA [1015]|AETNA ACO WILCO [101532]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1591.00||||1591.00||| 36036005|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ VENOGRAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1591.00||||1591.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2194.00||||2194.00|1426.1|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|CORESOURCE [1315]|CORESOURCE [131500]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|||2194.00||||2194.00|658.2|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|UMR [2035]|UMR OPTIONS [203501]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2194.00||||2194.00|943.42|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2194.00||||2194.00|460.74|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|CHAMPVA [1240]|CHAMP VA [124000]|2194.00||||2194.00|1645.5|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|GEHA [1415]|GEHA [141500]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2194.00||||2194.00|934.64|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2194.00||||2194.00|2194|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2194.00||||2194.00|1052.02|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2194.00||||2194.00|943.42|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MULTIPLAN [1680]|IHC HS [168011]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|TRUSTMARK [2030]|STARMARK [203000]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2194.00||||2194.00|1316.4|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2194.00||||2194.00|1099.19|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|HEALTHNET [1495]|HEALTHNET [149500]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2194.00||||2194.00|770.09|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2194.00||||2194.00|1097|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2194.00||||2194.00|1974.6|2194|460.74 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MULTIPLAN [1680]|HMA [168003]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|AETNA [1015]|AETNA ACO WILCO [101532]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2194.00||||2194.00||| 36036010|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRO CATH SUP/INF VENA CAVA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2194.00||||2194.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|974.00||||974.00|584.4|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|974.00||||974.00|414.92|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|974.00||||974.00|487.97|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|974.00||||974.00|418.82|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|974.00||||974.00|487|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MULTIPLAN [1680]|IHC HS [168011]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|UMR [2035]|UMR OPTIONS [203501]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|974.00||||974.00|974|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|HEALTHNET [1495]|HEALTHNET [149500]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|TRUSTMARK [2030]|STARMARK [203000]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|||974.00||||974.00|292.2|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|974.00||||974.00|633.1|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|974.00||||974.00|467.03|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|CHAMPVA [1240]|CHAMP VA [124000]|974.00||||974.00|730.5|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|974.00||||974.00|418.82|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|CORESOURCE [1315]|CORESOURCE [131500]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|974.00||||974.00|204.54|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|GEHA [1415]|GEHA [141500]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|974.00||||974.00|876.6|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|974.00||||974.00|341.87|974|204.54 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|AETNA [1015]|AETNA ACO WILCO [101532]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MULTIPLAN [1680]|HMA [168003]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|974.00||||974.00||| 36036011|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 1ST ORDER VEIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|974.00||||974.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|GEHA [1415]|GEHA [141500]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|CHAMPVA [1240]|CHAMP VA [124000]|2301.00||||2301.00|1725.75|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|CORESOURCE [1315]|CORESOURCE [131500]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2301.00||||2301.00|1103.33|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2301.00||||2301.00|2301|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2301.00||||2301.00|1495.65|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2301.00||||2301.00|483.21|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|UMR [2035]|UMR OPTIONS [203501]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2301.00||||2301.00|989.43|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|TRUSTMARK [2030]|STARMARK [203000]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|HEALTHNET [1495]|HEALTHNET [149500]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MULTIPLAN [1680]|IHC HS [168011]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|||2301.00||||2301.00|690.3|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2301.00||||2301.00|807.65|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2301.00||||2301.00|989.43|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2301.00||||2301.00|1380.6|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2301.00||||2301.00|1152.8|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2301.00||||2301.00|980.23|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2301.00||||2301.00|1150.5|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2301.00||||2301.00|2070.9|2301|483.21 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|AETNA [1015]|AETNA ACO WILCO [101532]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MULTIPLAN [1680]|HMA [168003]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2301.00||||2301.00||| 36036012|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE 2ND ORDER VEIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2301.00||||2301.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3267.00||||3267.00|1404.81|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3267.00||||3267.00|1636.77|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3267.00||||3267.00|1960.2|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3267.00||||3267.00|1633.5|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|HEALTHNET [1495]|HEALTHNET [149500]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3267.00||||3267.00|1146.72|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MULTIPLAN [1680]|IHC HS [168011]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3267.00||||3267.00|1404.81|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|UMR [2035]|UMR OPTIONS [203501]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|TRUSTMARK [2030]|STARMARK [203000]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3267.00||||3267.00|2123.55|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3267.00||||3267.00|1566.53|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|||3267.00||||3267.00|980.1|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3267.00||||3267.00|3267|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3267.00||||3267.00|686.07|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3267.00||||3267.00|1391.74|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|CHAMPVA [1240]|CHAMP VA [124000]|3267.00||||3267.00|2450.25|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|CORESOURCE [1315]|CORESOURCE [131500]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|GEHA [1415]|GEHA [141500]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3267.00||||3267.00|2940.3|3267|686.07 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|AETNA [1015]|AETNA ACO WILCO [101532]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MULTIPLAN [1680]|HMA [168003]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3267.00||||3267.00||| 36036200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INTRODUCTION OF CATH AORTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3267.00||||3267.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|CORESOURCE [1315]|CORESOURCE [131500]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6574.00||||6574.00|4273.1|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6574.00||||6574.00|3152.23|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6574.00||||6574.00|6574|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6574.00||||6574.00|1380.54|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|UMR [2035]|UMR OPTIONS [203501]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|GEHA [1415]|GEHA [141500]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6574.00||||6574.00|2826.82|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|TRUSTMARK [2030]|STARMARK [203000]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|HEALTHNET [1495]|HEALTHNET [149500]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6574.00||||6574.00|2546.16|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6574.00||||6574.00|2877.09|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|||6574.00||||6574.00|1972.2|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6574.00||||6574.00|2826.82|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6574.00||||6574.00|2768.1|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6574.00||||6574.00|6313.87|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6574.00||||6574.00|3164.8|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MULTIPLAN [1680]|IHC HS [168011]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6574.00||||6574.00|2768.1|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6574.00||||6574.00|3944.4|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6574.00||||6574.00|2673.54|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|CHAMPVA [1240]|CHAMP VA [124000]|6574.00||||6574.00|4930.5|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|FMH BENEFIT SERVICES [1390]|FMH [139000]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|FIRST HEALTH [1375]|QUALCHOICE [137513]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6574.00||||6574.00|3293.57|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6574.00||||6574.00|2307.47|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6574.00||||6574.00|2800.52|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6574.00||||6574.00|5916.6|6574|1380.54 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MULTIPLAN [1680]|HMA [168003]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|AETNA [1015]|AETNA ACO WILCO [101532]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6574.00||||6574.00||| 36036221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NONSEL CATH THOR AORTA ANGIO INTR/XTRCRAN ART|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6574.00||||6574.00||| 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6574.00||||6574.00|2768.1|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6574.00||||6574.00|6313.87|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6574.00||||6574.00|2800.52|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|HEALTHNET [1495]|HEALTHNET [149500]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6574.00||||6574.00|3792.28|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6574.00||||6574.00|2673.54|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6574.00||||6574.00|2901.72|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|TRUSTMARK [2030]|STARMARK [203000]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6574.00||||6574.00|3944.4|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|AETNA [1015]|AETNA ACO WILCO [101532]|6574.00||||6574.00|2240|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MULTIPLAN [1680]|IHC HS [168011]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MULTIPLAN [1680]|HMA [168003]|6574.00||||6574.00|3956.89|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6574.00||||6574.00|2307.47|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6574.00||||6574.00|3851.37|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6574.00||||6574.00|3164.8|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|UMR [2035]|UMR OPTIONS [203501]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6574.00||||6574.00|2826.82|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6574.00||||6574.00|2901.72|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6574.00||||6574.00|3293.57|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6574.00||||6574.00|2826.82|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6574.00||||6574.00|2769.82|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6574.00||||6574.00|6574|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6574.00||||6574.00|4273.1|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|||6574.00||||6574.00|1972.2|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6574.00||||6574.00|2768.1|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6574.00||||6574.00|3152.23|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6574.00||||6574.00|2690.69|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6574.00||||6574.00|2546.16|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|CHAMPVA [1240]|CHAMP VA [124000]|6574.00||||6574.00|4930.5|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6574.00||||6574.00|3792.28|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6574.00||||6574.00|2877.09|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|CORESOURCE [1315]|CORESOURCE [131500]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6574.00||||6574.00|1380.54|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6574.00||||6574.00|2637.93|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|GEHA [1415]|GEHA [141500]|6574.00||||6574.00|5916.6|6574|1380.54 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6574.00||||6574.00||| 36036222|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/EXT CRANIAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6574.00||||6574.00||| 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|CHAMPVA [1240]|CHAMP VA [124000]|6574.00||||6574.00|4930.5|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6574.00||||6574.00|2546.16|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6574.00||||6574.00|2768.1|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|||6574.00||||6574.00|1972.2|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6574.00||||6574.00|3152.23|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6574.00||||6574.00|6574|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6574.00||||6574.00|1380.54|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6574.00||||6574.00|6387.53|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6574.00||||6574.00|6289.53|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6574.00||||6574.00|2877.09|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|UMR [2035]|UMR OPTIONS [203501]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6574.00||||6574.00|4462.52|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6574.00||||6574.00|2826.82|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MULTIPLAN [1680]|HMA [168003]|6574.00||||6574.00|6562.54|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|CORESOURCE [1315]|CORESOURCE [131500]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6574.00||||6574.00|2673.54|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6574.00||||6574.00|4273.1|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|GEHA [1415]|GEHA [141500]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|AETNA [1015]|AETNA ACO WILCO [101532]|6574.00||||6574.00|2240|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6574.00||||6574.00|2826.82|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6574.00||||6574.00|4812.53|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|TRUSTMARK [2030]|STARMARK [203000]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6574.00||||6574.00|6574|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6574.00||||6574.00|4593.77|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6574.00||||6574.00|3944.4|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|HEALTHNET [1495]|HEALTHNET [149500]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MULTIPLAN [1680]|IHC HS [168011]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6574.00||||6574.00|3293.57|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6574.00||||6574.00|2800.52|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6574.00||||6574.00|2307.47|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6574.00||||6574.00|6289.53|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6574.00||||6574.00|3164.8|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6574.00||||6574.00|5916.6|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6574.00||||6574.00|2768.1|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6574.00||||6574.00|4812.53|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6574.00||||6574.00|4375.02|6574|1380.54 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6574.00||||6574.00||| 36036223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH CAROTID/INT CRANIAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6574.00||||6574.00||| 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10751.00||||10751.00|6988.15|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10751.00||||10751.00|4527.06|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|||10751.00||||10751.00|3225.3|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10751.00||||10751.00|5155.1|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10751.00||||10751.00|4164.09|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10751.00||||10751.00|2257.71|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10751.00||||10751.00|10751|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10751.00||||10751.00|6289.53|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10751.00||||10751.00|4705.31|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|CORESOURCE [1315]|CORESOURCE [131500]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|GEHA [1415]|GEHA [141500]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|CHAMPVA [1240]|CHAMP VA [124000]|10751.00||||10751.00|8063.25|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10751.00||||10751.00|4812.53|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10751.00||||10751.00|5386.25|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10751.00||||10751.00|3773.6|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10751.00||||10751.00|10460.93|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10751.00||||10751.00|6450.6|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10751.00||||10751.00|4527.06|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10751.00||||10751.00|4372.41|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10751.00||||10751.00|4812.53|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|TRUSTMARK [2030]|STARMARK [203000]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|HEALTHNET [1495]|HEALTHNET [149500]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10751.00||||10751.00|4593.77|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10751.00||||10751.00|4579.93|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10751.00||||10751.00|4622.93|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|AETNA [1015]|AETNA ACO WILCO [101532]|10751.00||||10751.00|3566|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MULTIPLAN [1680]|IHC HS [168011]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10751.00||||10751.00|6289.53|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|MULTIPLAN [1680]|HMA [168003]|10751.00||||10751.00|6562.54|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|FMH BENEFIT SERVICES [1390]|FMH [139000]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10751.00||||10751.00|4622.93|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10751.00||||10751.00|4462.52|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10751.00||||10751.00|5175.85|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10751.00||||10751.00|4375.02|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|FIRST HEALTH [1375]|QUALCHOICE [137513]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|UMR [2035]|UMR OPTIONS [203501]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10751.00||||10751.00|6387.53|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10751.00||||10751.00|9675.9|10751|2257.71 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10751.00||||10751.00||| 36036224|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH ICA CAROTID EXTRA/INTRA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10751.00||||10751.00||| 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|GEHA [1415]|GEHA [141500]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10751.00||||10751.00|4705.31|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10751.00||||10751.00|4164.09|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|||10751.00||||10751.00|3225.3|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10751.00||||10751.00|6988.15|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10751.00||||10751.00|2257.71|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10751.00||||10751.00|6289.53|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10751.00||||10751.00|6387.53|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|UMR [2035]|UMR OPTIONS [203501]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10751.00||||10751.00|4462.52|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10751.00||||10751.00|4622.93|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10751.00||||10751.00|5175.85|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MULTIPLAN [1680]|IHC HS [168011]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10751.00||||10751.00|6289.53|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|AETNA [1015]|AETNA ACO WILCO [101532]|10751.00||||10751.00|3566|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|HEALTHNET [1495]|HEALTHNET [149500]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|TRUSTMARK [2030]|STARMARK [203000]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10751.00||||10751.00|4527.06|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|CHAMPVA [1240]|CHAMP VA [124000]|10751.00||||10751.00|8063.25|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10751.00||||10751.00|10751|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10751.00||||10751.00|5155.1|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10751.00||||10751.00|4372.41|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10751.00||||10751.00|4812.53|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10751.00||||10751.00|4527.06|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MULTIPLAN [1680]|HMA [168003]|10751.00||||10751.00|6562.54|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10751.00||||10751.00|6450.6|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10751.00||||10751.00|4593.77|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|CORESOURCE [1315]|CORESOURCE [131500]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10751.00||||10751.00|10460.93|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10751.00||||10751.00|4622.93|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10751.00||||10751.00|5386.25|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10751.00||||10751.00|3773.6|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10751.00||||10751.00|4579.93|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10751.00||||10751.00|4375.02|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10751.00||||10751.00|9675.9|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10751.00||||10751.00|4812.53|10751|2257.71 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10751.00||||10751.00||| 36036226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH VERTEBRAL ART UNILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10751.00||||10751.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|235.00||||235.00|117.74|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|235.00||||235.00|100.11|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235.00||||235.00|141|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235.00||||235.00|101.05|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|TRUSTMARK [2030]|STARMARK [203000]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|HEALTHNET [1495]|HEALTHNET [149500]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MULTIPLAN [1680]|IHC HS [168011]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|FIRST HEALTH [1375]|QUALCHOICE [137513]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235.00||||235.00|235|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|FMH BENEFIT SERVICES [1390]|FMH [139000]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235.00||||235.00|152.75|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235.00||||235.00|112.68|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235.00||||235.00|82.49|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235.00||||235.00|117.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|||235.00||||235.00|70.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|UMR [2035]|UMR OPTIONS [203501]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235.00||||235.00|101.05|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|CHAMPVA [1240]|CHAMP VA [124000]|235.00||||235.00|176.25|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|CORESOURCE [1315]|CORESOURCE [131500]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|GEHA [1415]|GEHA [141500]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235.00||||235.00|49.35|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235.00||||235.00|211.5|235|49.35 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|AETNA [1015]|AETNA ACO WILCO [101532]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MULTIPLAN [1680]|HMA [168003]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|235.00||||235.00||| 36036227|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE CATH EXTRNL CAROTID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|235.00||||235.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|GEHA [1415]|GEHA [141500]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|CHAMPVA [1240]|CHAMP VA [124000]|2937.00||||2937.00|2202.75|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|||2937.00||||2937.00|881.1|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2937.00||||2937.00|1408.29|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2937.00||||2937.00|1909.05|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2937.00||||2937.00|2937|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2937.00||||2937.00|616.77|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|CORESOURCE [1315]|CORESOURCE [131500]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|UMR [2035]|UMR OPTIONS [203501]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2937.00||||2937.00|1262.91|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|HEALTHNET [1495]|HEALTHNET [149500]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|TRUSTMARK [2030]|STARMARK [203000]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MULTIPLAN [1680]|IHC HS [168011]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2937.00||||2937.00|1762.2|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2937.00||||2937.00|1468.5|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2937.00||||2937.00|1262.91|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2937.00||||2937.00|1471.44|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2937.00||||2937.00|1251.16|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2937.00||||2937.00|1030.89|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2937.00||||2937.00|2643.3|2937|616.77 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MULTIPLAN [1680]|HMA [168003]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2937.00||||2937.00||| 36036245|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 1ST ORDER|AETNA [1015]|AETNA ACO WILCO [101532]|2937.00||||2937.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3040.00||||3040.00|1523.04|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3040.00||||3040.00|1067.04|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3040.00||||3040.00|1520|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|TRUSTMARK [2030]|STARMARK [203000]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3040.00||||3040.00|1295.04|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MULTIPLAN [1680]|IHC HS [168011]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3040.00||||3040.00|1307.2|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3040.00||||3040.00|638.4|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|HEALTHNET [1495]|HEALTHNET [149500]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3040.00||||3040.00|1824|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3040.00||||3040.00|1976|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3040.00||||3040.00|3040|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3040.00||||3040.00|1457.68|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|||3040.00||||3040.00|912|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|UMR [2035]|UMR OPTIONS [203501]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3040.00||||3040.00|1307.2|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|CHAMPVA [1240]|CHAMP VA [124000]|3040.00||||3040.00|2280|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|CORESOURCE [1315]|CORESOURCE [131500]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|GEHA [1415]|GEHA [141500]|3040.00||||3040.00|2736|3040|638.4 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MULTIPLAN [1680]|HMA [168003]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|AETNA [1015]|AETNA ACO WILCO [101532]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3040.00||||3040.00||| 36036246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 2ND ORDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3040.00||||3040.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|GEHA [1415]|GEHA [141500]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|||3219.00||||3219.00|965.7|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3219.00||||3219.00|2092.35|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3219.00||||3219.00|675.99|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|UMR [2035]|UMR OPTIONS [203501]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|CORESOURCE [1315]|CORESOURCE [131500]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3219.00||||3219.00|1384.17|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|TRUSTMARK [2030]|STARMARK [203000]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3219.00||||3219.00|3219|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3219.00||||3219.00|1543.51|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|HEALTHNET [1495]|HEALTHNET [149500]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|CHAMPVA [1240]|CHAMP VA [124000]|3219.00||||3219.00|2414.25|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3219.00||||3219.00|1931.4|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MULTIPLAN [1680]|IHC HS [168011]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3219.00||||3219.00|1609.5|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3219.00||||3219.00|1384.17|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3219.00||||3219.00|1612.72|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3219.00||||3219.00|1129.87|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3219.00||||3219.00|1371.29|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|3219.00||||3219.00|2897.1|3219|675.99 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|AETNA [1015]|AETNA ACO WILCO [101532]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MULTIPLAN [1680]|HMA [168003]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3219.00||||3219.00||| 36036247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD 3RD ORDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3219.00||||3219.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|307.00||||307.00|132.01|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|307.00||||307.00|130.78|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|307.00||||307.00|184.2|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|TRUSTMARK [2030]|STARMARK [203000]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|307.00||||307.00|107.76|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|HEALTHNET [1495]|HEALTHNET [149500]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MULTIPLAN [1680]|IHC HS [168011]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|307.00||||307.00|64.47|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|307.00||||307.00|307|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|307.00||||307.00|153.81|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|307.00||||307.00|153.5|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|307.00||||307.00|199.55|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|307.00||||307.00|147.21|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|||307.00||||307.00|92.1|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|UMR [2035]|UMR OPTIONS [203501]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|307.00||||307.00|132.01|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|FIRST HEALTH [1375]|QUALCHOICE [137513]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|CHAMPVA [1240]|CHAMP VA [124000]|307.00||||307.00|230.25|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|CORESOURCE [1315]|CORESOURCE [131500]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|GEHA [1415]|GEHA [141500]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|FMH BENEFIT SERVICES [1390]|FMH [139000]|307.00||||307.00|276.3|307|64.47 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MULTIPLAN [1680]|HMA [168003]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|AETNA [1015]|AETNA ACO WILCO [101532]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|307.00||||307.00||| 36036248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE ABD EA ADD VESS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|307.00||||307.00||| 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4514.00||||4514.00|2754.56|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|CORESOURCE [1315]|CORESOURCE [131500]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|CHAMPVA [1240]|CHAMP VA [124000]|4514.00||||4514.00|3385.5|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4514.00||||4514.00|2650.21|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|||4514.00||||4514.00|1354.2|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4514.00||||4514.00|2164.46|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4514.00||||4514.00|2934.1|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4514.00||||4514.00|4514|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4514.00||||4514.00|947.94|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4514.00||||4514.00|3851.37|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|UMR [2035]|UMR OPTIONS [203501]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4514.00||||4514.00|2690.69|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4514.00||||4514.00|1941.02|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4514.00||||4514.00|3030.02|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|FIRST HEALTH [1375]|QUALCHOICE [137513]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|FMH BENEFIT SERVICES [1390]|FMH [139000]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MULTIPLAN [1680]|IHC HS [168011]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MULTIPLAN [1680]|HMA [168003]|4514.00||||4514.00|3956.89|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|AETNA [1015]|AETNA ACO WILCO [101532]|4514.00||||4514.00|2240|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|GEHA [1415]|GEHA [141500]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4514.00||||4514.00|2437.73|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4514.00||||4514.00|2559.68|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4514.00||||4514.00|2901.72|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4514.00||||4514.00|2650.21|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|HEALTHNET [1495]|HEALTHNET [149500]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|TRUSTMARK [2030]|STARMARK [203000]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4514.00||||4514.00|3792.28|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4514.00||||4514.00|1941.02|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4514.00||||4514.00|2261.51|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4514.00||||4514.00|3792.28|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4514.00||||4514.00|1584.41|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4514.00||||4514.00|1922.96|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4514.00||||4514.00|2708.4|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4514.00||||4514.00|2769.82|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4514.00||||4514.00|4514|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4514.00||||4514.00|2901.72|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4514.00||||4514.00|2637.93|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4514.00||||4514.00|4062.6|4514|947.94 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4514.00||||4514.00||| 36036251|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST UNI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4514.00||||4514.00||| 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4498.00||||4498.00|2901.72|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4498.00||||4498.00|4498|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4498.00||||4498.00|2769.82|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4498.00||||4498.00|2253.5|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4498.00||||4498.00|1916.15|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4498.00||||4498.00|2650.21|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4498.00||||4498.00|2559.68|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4498.00||||4498.00|2901.72|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|TRUSTMARK [2030]|STARMARK [203000]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|4498.00||||4498.00|2240|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4498.00||||4498.00|3792.28|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4498.00||||4498.00|1934.14|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MULTIPLAN [1680]|HMA [168003]|4498.00||||4498.00|3956.89|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|HEALTHNET [1495]|HEALTHNET [149500]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4498.00||||4498.00|3030.02|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4498.00||||4498.00|1934.14|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4498.00||||4498.00|2690.69|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|UMR [2035]|UMR OPTIONS [203501]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MULTIPLAN [1680]|IHC HS [168011]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4498.00||||4498.00|2698.8|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4498.00||||4498.00|944.58|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4498.00||||4498.00|1578.8|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4498.00||||4498.00|2923.7|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4498.00||||4498.00|2156.79|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|||4498.00||||4498.00|1349.4|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4498.00||||4498.00|4498|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4498.00||||4498.00|3851.37|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4498.00||||4498.00|2650.21|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4498.00||||4498.00|2637.93|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4498.00||||4498.00|2437.73|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|CHAMPVA [1240]|CHAMP VA [124000]|4498.00||||4498.00|3373.5|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4498.00||||4498.00|3792.28|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|CORESOURCE [1315]|CORESOURCE [131500]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|GEHA [1415]|GEHA [141500]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4498.00||||4498.00|4048.2|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4498.00||||4498.00|2754.56|4498|944.58 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4498.00||||4498.00||| 36036252|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH PLACE RENAL ART 1ST BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4498.00||||4498.00||| 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|GEHA [1415]|GEHA [141500]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|CORESOURCE [1315]|CORESOURCE [131500]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|CHAMPVA [1240]|CHAMP VA [124000]|4813.00||||4813.00|3609.75|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4813.00||||4813.00|2437.73|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4813.00||||4813.00|2650.21|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|||4813.00||||4813.00|1443.9|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4813.00||||4813.00|3128.45|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4813.00||||4813.00|1010.73|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4813.00||||4813.00|4813|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4813.00||||4813.00|4813|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|UMR [2035]|UMR OPTIONS [203501]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4813.00||||4813.00|4462.52|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4813.00||||4813.00|2069.59|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4813.00||||4813.00|3030.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|HEALTHNET [1495]|HEALTHNET [149500]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MULTIPLAN [1680]|IHC HS [168011]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4813.00||||4813.00|2754.56|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MULTIPLAN [1680]|HMA [168003]|4813.00||||4813.00|6562.54|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|AETNA [1015]|AETNA ACO WILCO [101532]|4813.00||||4813.00|2240|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4813.00||||4813.00|4813|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4813.00||||4813.00|2307.83|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|TRUSTMARK [2030]|STARMARK [203000]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4813.00||||4813.00|2559.68|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4813.00||||4813.00|4812.53|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4813.00||||4813.00|2650.21|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4813.00||||4813.00|4813|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4813.00||||4813.00|2069.59|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4813.00||||4813.00|2411.31|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|FMH BENEFIT SERVICES [1390]|FMH [139000]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4813.00||||4813.00|1689.36|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4813.00||||4813.00|2050.34|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4813.00||||4813.00|2887.8|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4813.00||||4813.00|4593.77|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|FIRST HEALTH [1375]|QUALCHOICE [137513]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4813.00||||4813.00|4813|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4813.00||||4813.00|4812.53|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4813.00||||4813.00|4375.02|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4813.00||||4813.00|4331.7|6562.54|1010.73 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4813.00||||4813.00||| 36036253|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRASELECT UNIRENAL MAIN ART|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4813.00||||4813.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|334.00||||334.00|143.62|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|334.00||||334.00|142.28|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|334.00||||334.00|167|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|334.00||||334.00|200.4|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|TRUSTMARK [2030]|STARMARK [203000]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MULTIPLAN [1680]|IHC HS [168011]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|HEALTHNET [1495]|HEALTHNET [149500]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|FMH BENEFIT SERVICES [1390]|FMH [139000]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|UMR [2035]|UMR OPTIONS [203501]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|334.00||||334.00|334|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|334.00||||334.00|117.23|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|334.00||||334.00|70.14|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|334.00||||334.00|217.1|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|334.00||||334.00|160.15|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|334.00||||334.00|167.33|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|||334.00||||334.00|100.2|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|334.00||||334.00|143.62|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|FIRST HEALTH [1375]|QUALCHOICE [137513]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|CHAMPVA [1240]|CHAMP VA [124000]|334.00||||334.00|250.5|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|CORESOURCE [1315]|CORESOURCE [131500]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|GEHA [1415]|GEHA [141500]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|334.00||||334.00|300.6|334|70.14 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|AETNA [1015]|AETNA ACO WILCO [101532]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MULTIPLAN [1680]|HMA [168003]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|334.00||||334.00||| 36036410|EAP|0300 - LABORATORY-GENERAL|HC VENPNCTR>AGE 3 REQRNG MD/QHP SKILL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|334.00||||334.00||| 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|CORESOURCE [1315]|CORESOURCE [131500]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|CHAMPVA [1240]|CHAMP VA [124000]|58.00||||58.00|43.5|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.00||||58.00|3.25|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|||58.00||||58.00|17.4|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.00||||58.00|27.81|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.00||||58.00|37.7|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.00||||58.00|2.99|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.00||||58.00|58|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.00||||58.00|12.18|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.00||||58.00|4.38|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|GEHA [1415]|GEHA [141500]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|UMR [2035]|UMR OPTIONS [203501]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.00||||58.00|3.38|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.00||||58.00|3.06|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.00||||58.00|3.72|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.00||||58.00|4.31|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MULTIPLAN [1680]|IHC HS [168011]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MULTIPLAN [1680]|HMA [168003]|58.00||||58.00|4.5|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.00||||58.00|4.31|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|TRUSTMARK [2030]|STARMARK [203000]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.00||||58.00|1.8|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.00||||58.00|3.14|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.00||||58.00|3.3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.00||||58.00|3.25|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|HEALTHNET [1495]|HEALTHNET [149500]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.00||||58.00|24.71|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.00||||58.00|29.06|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.00||||58.00|20.36|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.00||||58.00|34.8|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.00||||58.00|3.15|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.00||||58.00|29|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.00||||58.00|3.3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.00||||58.00|3|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.00||||58.00|52.2|58|1.8 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|AETNA [1015]|AETNA ACO WILCO [101532]|58.00||||58.00||| 36036415|EAP|0300 - LABORATORY-GENERAL|HC ROUTINE VENIPUNCTURE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.00||||58.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4338.00||||4338.00|2173.34|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4338.00||||4338.00|1847.99|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4338.00||||4338.00|2980.63|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4338.00||||4338.00|1061.99|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4338.00||||4338.00|1025.72|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|TRUSTMARK [2030]|STARMARK [203000]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4338.00||||4338.00|1522.64|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4338.00||||4338.00|1865.34|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MULTIPLAN [1680]|IHC HS [168011]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4338.00||||4338.00|1865.34|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4338.00||||4338.00|1214.19|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|UMR [2035]|UMR OPTIONS [203501]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4338.00||||4338.00|910.98|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|HEALTHNET [1495]|HEALTHNET [149500]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4338.00||||4338.00|2602.8|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4338.00||||4338.00|2819.7|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4338.00||||4338.00|4338|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4338.00||||4338.00|2080.07|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|||4338.00||||4338.00|1301.4|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4338.00||||4338.00|1061.99|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4338.00||||4338.00|976.85|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|CHAMPVA [1240]|CHAMP VA [124000]|4338.00||||4338.00|3253.5|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4338.00||||4338.00|1103.81|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|CORESOURCE [1315]|CORESOURCE [131500]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|GEHA [1415]|GEHA [141500]|4338.00||||4338.00|3904.2|4338|910.98 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MULTIPLAN [1680]|HMA [168003]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|AETNA [1015]|AETNA ACO WILCO [101532]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4338.00||||4338.00||| 36036514|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLASMA EXCHANGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4338.00||||4338.00||| 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|CORESOURCE [1315]|CORESOURCE [131500]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5882.00||||5882.00|913.32|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5882.00||||5882.00|992.95|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|||5882.00||||5882.00|1764.6|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5882.00||||5882.00|2820.42|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5882.00||||5882.00|3823.3|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5882.00||||5882.00|1235.22|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5882.00||||5882.00|2172|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5882.00||||5882.00|2205.84|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|UMR [2035]|UMR OPTIONS [203501]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|GEHA [1415]|GEHA [141500]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5882.00||||5882.00|1541.07|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5882.00||||5882.00|2529.26|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5882.00||||5882.00|1135.26|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|FIRST HEALTH [1375]|QUALCHOICE [137513]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|FMH BENEFIT SERVICES [1390]|FMH [139000]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MULTIPLAN [1680]|IHC HS [168011]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MULTIPLAN [1680]|HMA [168003]|5882.00||||5882.00|2266.28|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5882.00||||5882.00|1032.05|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5882.00||||5882.00|5882|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|TRUSTMARK [2030]|STARMARK [203000]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5882.00||||5882.00|958.98|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5882.00||||5882.00|1661.94|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5882.00||||5882.00|992.95|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5882.00||||5882.00|2172|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|CHAMPVA [1240]|CHAMP VA [124000]|5882.00||||5882.00|4411.5|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5882.00||||5882.00|2529.26|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5882.00||||5882.00|2946.88|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|HEALTHNET [1495]|HEALTHNET [149500]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5882.00||||5882.00|2064.58|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5882.00||||5882.00|2505.73|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5882.00||||5882.00|3529.2|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5882.00||||5882.00|1586.39|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5882.00||||5882.00|2614.04|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5882.00||||5882.00|1661.94|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5882.00||||5882.00|1510.85|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5882.00||||5882.00|5293.8|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|AETNA [1015]|AETNA ACO WILCO [101532]|5882.00||||5882.00|1933|5882|913.32 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5882.00||||5882.00||| 36036556|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT NON-TUNNL CVC => 5 YRS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5882.00||||5882.00||| 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8708.00||||8708.00|2901.72|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8708.00||||8708.00|2769.82|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8708.00||||8708.00|5224.8|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|8708.00||||8708.00|3709.61|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8708.00||||8708.00|3056.51|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8708.00||||8708.00|2252.9|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8708.00||||8708.00|2175.82|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8708.00||||8708.00|3744.44|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|TRUSTMARK [2030]|STARMARK [203000]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|8708.00||||8708.00|4362.71|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|AETNA [1015]|AETNA ACO WILCO [101532]|8708.00||||8708.00|2240|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|8708.00||||8708.00|3792.28|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|HEALTHNET [1495]|HEALTHNET [149500]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|FMH BENEFIT SERVICES [1390]|FMH [139000]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|FIRST HEALTH [1375]|QUALCHOICE [137513]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|8708.00||||8708.00|2575.77|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8708.00||||8708.00|2690.69|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MULTIPLAN [1680]|HMA [168003]|8708.00||||8708.00|3956.89|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8708.00||||8708.00|6313.87|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MULTIPLAN [1680]|IHC HS [168011]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8708.00||||8708.00|3851.37|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8708.00||||8708.00|8708|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8708.00||||8708.00|2901.72|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8708.00||||8708.00|1828.68|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8708.00||||8708.00|5660.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8708.00||||8708.00|4175.49|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|||8708.00||||8708.00|2612.4|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8708.00||||8708.00|2252.9|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8708.00||||8708.00|2637.93|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8708.00||||8708.00|3744.44|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8708.00||||8708.00|2072.21|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|CHAMPVA [1240]|CHAMP VA [124000]|8708.00||||8708.00|6531|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|8708.00||||8708.00|3792.28|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|CORESOURCE [1315]|CORESOURCE [131500]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|GEHA [1415]|GEHA [141500]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|8708.00||||8708.00|2341.61|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|UMR [2035]|UMR OPTIONS [203501]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8708.00||||8708.00|7837.2|8708|1828.68 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8708.00||||8708.00||| 36036558|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TNNL W/O SUBQ PORT =>5 YRS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|8708.00||||8708.00||| 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8725.00||||8725.00|2690.69|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|8725.00||||8725.00|3094.81|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|FIRST HEALTH [1375]|QUALCHOICE [137513]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MULTIPLAN [1680]|IHC HS [168011]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|8725.00||||8725.00|3792.28|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MULTIPLAN [1680]|HMA [168003]|8725.00||||8725.00|3956.89|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|AETNA [1015]|AETNA ACO WILCO [101532]|8725.00||||8725.00|3566|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|HEALTHNET [1495]|HEALTHNET [149500]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|TRUSTMARK [2030]|STARMARK [203000]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|FMH BENEFIT SERVICES [1390]|FMH [139000]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8725.00||||8725.00|2614.27|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8725.00||||8725.00|2901.72|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8725.00||||8725.00|5235|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8725.00||||8725.00|2769.82|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8725.00||||8725.00|3751.75|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8725.00||||8725.00|3751.75|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|8725.00||||8725.00|4371.23|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8725.00||||8725.00|2706.88|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8725.00||||8725.00|3062.48|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|8725.00||||8725.00|3716.85|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8725.00||||8725.00|6313.87|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8725.00||||8725.00|2901.72|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|GEHA [1415]|GEHA [141500]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|CORESOURCE [1315]|CORESOURCE [131500]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|8725.00||||8725.00|3792.28|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|CHAMPVA [1240]|CHAMP VA [124000]|8725.00||||8725.00|6543.75|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8725.00||||8725.00|2489.79|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8725.00||||8725.00|2706.88|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|8725.00||||8725.00|2813.46|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|||8725.00||||8725.00|2617.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8725.00||||8725.00|4183.64|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8725.00||||8725.00|5671.25|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8725.00||||8725.00|2637.93|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8725.00||||8725.00|8725|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8725.00||||8725.00|1832.25|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8725.00||||8725.00|3851.37|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|UMR [2035]|UMR OPTIONS [203501]|8725.00||||8725.00|7852.5|8725|1832.25 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8725.00||||8725.00||| 36036561|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INST TUNNL W/SUBQ PORT =>5 YRS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|8725.00||||8725.00||| 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9337.00||||9337.00|6313.87|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|9337.00||||9337.00|4677.84|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9337.00||||9337.00|3277.29|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|9337.00||||9337.00|3977.56|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9337.00||||9337.00|2769.82|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9337.00||||9337.00|5602.2|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9337.00||||9337.00|2706.88|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9337.00||||9337.00|2614.27|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|TRUSTMARK [2030]|STARMARK [203000]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|HEALTHNET [1495]|HEALTHNET [149500]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|AETNA [1015]|AETNA ACO WILCO [101532]|9337.00||||9337.00|3566|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MULTIPLAN [1680]|IHC HS [168011]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|9337.00||||9337.00|3792.28|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MULTIPLAN [1680]|HMA [168003]|9337.00||||9337.00|3956.89|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|FMH BENEFIT SERVICES [1390]|FMH [139000]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|FIRST HEALTH [1375]|QUALCHOICE [137513]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|9337.00||||9337.00|3094.81|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9337.00||||9337.00|4014.91|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9337.00||||9337.00|2690.69|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|UMR [2035]|UMR OPTIONS [203501]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9337.00||||9337.00|3851.37|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9337.00||||9337.00|2901.72|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9337.00||||9337.00|1960.77|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9337.00||||9337.00|9337|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9337.00||||9337.00|6069.05|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9337.00||||9337.00|4477.09|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|||9337.00||||9337.00|2801.1|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9337.00||||9337.00|4014.91|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9337.00||||9337.00|2706.88|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9337.00||||9337.00|2901.72|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9337.00||||9337.00|2637.93|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9337.00||||9337.00|2489.79|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|CHAMPVA [1240]|CHAMP VA [124000]|9337.00||||9337.00|7002.75|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|9337.00||||9337.00|3792.28|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|CORESOURCE [1315]|CORESOURCE [131500]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|9337.00||||9337.00|2813.46|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|GEHA [1415]|GEHA [141500]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9337.00||||9337.00|8403.3|9337|1960.77 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9337.00||||9337.00||| 36036565|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUNNL 2 SITE W/O SUBQ PORT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|9337.00||||9337.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|GEHA [1415]|GEHA [141500]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|CORESOURCE [1315]|CORESOURCE [131500]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|CHAMPVA [1240]|CHAMP VA [124000]|5961.00||||5961.00|4470.75|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|||5961.00||||5961.00|1788.3|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5961.00||||5961.00|3874.65|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5961.00||||5961.00|1251.81|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|UMR [2035]|UMR OPTIONS [203501]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5961.00||||5961.00|2563.23|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|FIRST HEALTH [1375]|QUALCHOICE [137513]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|FMH BENEFIT SERVICES [1390]|FMH [139000]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|HEALTHNET [1495]|HEALTHNET [149500]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MULTIPLAN [1680]|IHC HS [168011]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5961.00||||5961.00|5961|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5961.00||||5961.00|2858.3|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|TRUSTMARK [2030]|STARMARK [203000]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5961.00||||5961.00|2563.23|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5961.00||||5961.00|2986.46|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5961.00||||5961.00|2092.31|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5961.00||||5961.00|2539.39|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5961.00||||5961.00|3576.6|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5961.00||||5961.00|1481.98|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5961.00||||5961.00|5364.9|5961|1251.81 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MULTIPLAN [1680]|HMA [168003]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|AETNA [1015]|AETNA ACO WILCO [101532]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5961.00||||5961.00||| 36036568|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|INSERTION PICC W/O IMG GDN < 5 YR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5961.00||||5961.00||| 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4285.00||||4285.00|1707.9|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4285.00||||4285.00|2614.04|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4285.00||||4285.00|1630.27|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4285.00||||4285.00|2571|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4285.00||||4285.00|2146.79|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4285.00||||4285.00|1504.04|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4285.00||||4285.00|1825.41|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4285.00||||4285.00|992.95|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4285.00||||4285.00|1707.9|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4285.00||||4285.00|958.98|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|TRUSTMARK [2030]|STARMARK [203000]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|AETNA [1015]|AETNA ACO WILCO [101532]|4285.00||||4285.00|1933|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MULTIPLAN [1680]|IHC HS [168011]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4285.00||||4285.00|2232.08|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|HEALTHNET [1495]|HEALTHNET [149500]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|FMH BENEFIT SERVICES [1390]|FMH [139000]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|FIRST HEALTH [1375]|QUALCHOICE [137513]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MULTIPLAN [1680]|HMA [168003]|4285.00||||4285.00|2328.96|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4285.00||||4285.00|1135.26|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4285.00||||4285.00|1842.55|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4285.00||||4285.00|1583.69|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|UMR [2035]|UMR OPTIONS [203501]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4285.00||||4285.00|2266.85|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4285.00||||4285.00|899.85|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4285.00||||4285.00|4285|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4285.00||||4285.00|2785.25|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4285.00||||4285.00|2054.66|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4285.00||||4285.00|1842.55|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|||4285.00||||4285.00|1285.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4285.00||||4285.00|992.95|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4285.00||||4285.00|1552.64|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4285.00||||4285.00|913.32|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|CHAMPVA [1240]|CHAMP VA [124000]|4285.00||||4285.00|3213.75|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4285.00||||4285.00|2232.08|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|CORESOURCE [1315]|CORESOURCE [131500]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|GEHA [1415]|GEHA [141500]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4285.00||||4285.00|3856.5|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4285.00||||4285.00|1032.05|4285|899.85 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4285.00||||4285.00||| 36036569|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS PICC W/O SUBQ PORT=>5YRS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4285.00||||4285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|GEHA [1415]|GEHA [141500]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|CORESOURCE [1315]|CORESOURCE [131500]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|CHAMPVA [1240]|CHAMP VA [124000]|7285.00||||7285.00|5463.75|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|||7285.00||||7285.00|2185.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7285.00||||7285.00|3493.16|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7285.00||||7285.00|4735.25|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7285.00||||7285.00|7285|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7285.00||||7285.00|1529.85|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|UMR [2035]|UMR OPTIONS [203501]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7285.00||||7285.00|3132.55|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|FIRST HEALTH [1375]|QUALCHOICE [137513]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|FMH BENEFIT SERVICES [1390]|FMH [139000]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MULTIPLAN [1680]|IHC HS [168011]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|HEALTHNET [1495]|HEALTHNET [149500]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|TRUSTMARK [2030]|STARMARK [203000]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7285.00||||7285.00|4371|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7285.00||||7285.00|3132.55|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7285.00||||7285.00|3649.79|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7285.00||||7285.00|2557.04|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7285.00||||7285.00|3103.41|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7285.00||||7285.00|6313.87|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7285.00||||7285.00|6556.5|7285|1529.85 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MULTIPLAN [1680]|HMA [168003]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|AETNA [1015]|AETNA ACO WILCO [101532]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7285.00||||7285.00||| 36036578|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH REPLACE W/SUBQ PORT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7285.00||||7285.00||| 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5292.00||||5292.00|2614.04|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5292.00||||5292.00|2275.56|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5292.00||||5292.00|2651.29|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5292.00||||5292.00|1857.49|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5292.00||||5292.00|2254.39|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5292.00||||5292.00|3175.2|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5292.00||||5292.00|992.95|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5292.00||||5292.00|958.98|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|TRUSTMARK [2030]|STARMARK [203000]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|HEALTHNET [1495]|HEALTHNET [149500]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MULTIPLAN [1680]|IHC HS [168011]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5292.00||||5292.00|2172|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MULTIPLAN [1680]|HMA [168003]|5292.00||||5292.00|2266.28|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|FMH BENEFIT SERVICES [1390]|FMH [139000]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|FIRST HEALTH [1375]|QUALCHOICE [137513]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5292.00||||5292.00|1135.26|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5292.00||||5292.00|2275.56|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5292.00||||5292.00|1541.07|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|UMR [2035]|UMR OPTIONS [203501]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5292.00||||5292.00|2205.84|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5292.00||||5292.00|1661.94|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5292.00||||5292.00|1111.32|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5292.00||||5292.00|5292|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5292.00||||5292.00|1586.39|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5292.00||||5292.00|3439.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5292.00||||5292.00|2537.51|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|||5292.00||||5292.00|1587.6|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5292.00||||5292.00|992.95|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5292.00||||5292.00|1661.94|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5292.00||||5292.00|1510.85|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5292.00||||5292.00|913.32|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|CHAMPVA [1240]|CHAMP VA [124000]|5292.00||||5292.00|3969|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5292.00||||5292.00|2172|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|CORESOURCE [1315]|CORESOURCE [131500]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5292.00||||5292.00|1032.05|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|GEHA [1415]|GEHA [141500]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5292.00||||5292.00|4762.8|5292|913.32 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|AETNA [1015]|AETNA ACO WILCO [101532]|5292.00||||5292.00||| 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5292.00||||5292.00||| 36036580|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL NON-TUN CVC W/O SUBQ PORT/PMP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5292.00||||5292.00||| 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|GEHA [1415]|GEHA [141500]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7285.00||||7285.00|2341.61|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|CORESOURCE [1315]|CORESOURCE [131500]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|CHAMPVA [1240]|CHAMP VA [124000]|7285.00||||7285.00|5463.75|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7285.00||||7285.00|2072.21|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7285.00||||7285.00|2252.9|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|||7285.00||||7285.00|2185.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7285.00||||7285.00|4735.25|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7285.00||||7285.00|1529.85|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7285.00||||7285.00|3851.37|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|UMR [2035]|UMR OPTIONS [203501]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7285.00||||7285.00|2690.69|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7285.00||||7285.00|3132.55|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7285.00||||7285.00|2575.77|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|FIRST HEALTH [1375]|QUALCHOICE [137513]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|FMH BENEFIT SERVICES [1390]|FMH [139000]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MULTIPLAN [1680]|IHC HS [168011]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7285.00||||7285.00|3792.28|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MULTIPLAN [1680]|HMA [168003]|7285.00||||7285.00|3956.89|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|AETNA [1015]|AETNA ACO WILCO [101532]|7285.00||||7285.00|2240|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7285.00||||7285.00|7285|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7285.00||||7285.00|3493.16|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|HEALTHNET [1495]|HEALTHNET [149500]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|TRUSTMARK [2030]|STARMARK [203000]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7285.00||||7285.00|3792.28|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7285.00||||7285.00|2175.82|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7285.00||||7285.00|2901.72|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7285.00||||7285.00|2252.9|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7285.00||||7285.00|4371|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7285.00||||7285.00|2769.82|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7285.00||||7285.00|3132.55|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7285.00||||7285.00|3649.79|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7285.00||||7285.00|2557.04|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7285.00||||7285.00|3103.41|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7285.00||||7285.00|6313.87|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7285.00||||7285.00|2637.93|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7285.00||||7285.00|2901.72|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7285.00||||7285.00|6556.5|7285|1529.85 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7285.00||||7285.00||| 36036581|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE COMPL TUN CVC W/O SUBQ PORT/PUMP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7285.00||||7285.00||| 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12860.00||||12860.00|2901.72|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12860.00||||12860.00|6313.87|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12860.00||||12860.00|5529.8|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12860.00||||12860.00|6442.86|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12860.00||||12860.00|5478.36|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12860.00||||12860.00|2769.82|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12860.00||||12860.00|7716|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12860.00||||12860.00|2706.88|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12860.00||||12860.00|2901.72|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12860.00||||12860.00|2614.27|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|TRUSTMARK [2030]|STARMARK [203000]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|HEALTHNET [1495]|HEALTHNET [149500]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|AETNA [1015]|AETNA ACO WILCO [101532]|12860.00||||12860.00|3566|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12860.00||||12860.00|3792.28|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MULTIPLAN [1680]|HMA [168003]|12860.00||||12860.00|3956.89|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MULTIPLAN [1680]|IHC HS [168011]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|FMH BENEFIT SERVICES [1390]|FMH [139000]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|FIRST HEALTH [1375]|QUALCHOICE [137513]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12860.00||||12860.00|3094.81|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12860.00||||12860.00|5529.8|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12860.00||||12860.00|2690.69|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|UMR [2035]|UMR OPTIONS [203501]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12860.00||||12860.00|3851.37|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12860.00||||12860.00|2700.6|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12860.00||||12860.00|12860|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12860.00||||12860.00|8359|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12860.00||||12860.00|6166.37|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12860.00||||12860.00|4513.86|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|||12860.00||||12860.00|3858|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12860.00||||12860.00|2706.88|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12860.00||||12860.00|2637.93|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12860.00||||12860.00|2489.79|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|CHAMPVA [1240]|CHAMP VA [124000]|12860.00||||12860.00|9645|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12860.00||||12860.00|3792.28|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|CORESOURCE [1315]|CORESOURCE [131500]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12860.00||||12860.00|2813.46|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|GEHA [1415]|GEHA [141500]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12860.00||||12860.00|11574|12860|2489.79 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12860.00||||12860.00||| 36036582|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CMPLT REPLACE CATH W/SUBQ PORT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12860.00||||12860.00||| 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6711.00||||6711.00|668.97|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|CORESOURCE [1315]|CORESOURCE [131500]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6711.00||||6711.00|862.8|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|CHAMPVA [1240]|CHAMP VA [124000]|6711.00||||6711.00|5033.25|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6711.00||||6711.00|643.63|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|||6711.00||||6711.00|2013.3|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6711.00||||6711.00|3217.92|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6711.00||||6711.00|4362.15|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6711.00||||6711.00|6711|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6711.00||||6711.00|1409.31|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6711.00||||6711.00|876.25|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|UMR [2035]|UMR OPTIONS [203501]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6711.00||||6711.00|612.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6711.00||||6711.00|2885.73|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6711.00||||6711.00|735.87|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|FIRST HEALTH [1375]|QUALCHOICE [137513]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|FMH BENEFIT SERVICES [1390]|FMH [139000]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|HEALTHNET [1495]|HEALTHNET [149500]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MULTIPLAN [1680]|IHC HS [168011]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6711.00||||6711.00|862.8|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MULTIPLAN [1680]|HMA [168003]|6711.00||||6711.00|900.25|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|AETNA [1015]|AETNA ACO WILCO [101532]|6711.00||||6711.00|1933|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|TRUSTMARK [2030]|STARMARK [203000]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6711.00||||6711.00|592.03|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6711.00||||6711.00|621.65|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6711.00||||6711.00|660.19|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|GEHA [1415]|GEHA [141500]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6711.00||||6711.00|643.63|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6711.00||||6711.00|2885.73|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6711.00||||6711.00|3362.21|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6711.00||||6711.00|2355.56|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6711.00||||6711.00|2858.89|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6711.00||||6711.00|4026.6|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6711.00||||6711.00|630.18|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6711.00||||6711.00|1481.98|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6711.00||||6711.00|660.19|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6711.00||||6711.00|600.17|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6711.00||||6711.00|6039.9|6711|592.03 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6711.00||||6711.00||| 36036589|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/O SUBQ PORT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6711.00||||6711.00||| 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3791.00||||3791.00|660.19|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3791.00||||3791.00|1481.98|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3791.00||||3791.00|2274.6|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3791.00||||3791.00|1614.97|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3791.00||||3791.00|1630.13|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3791.00||||3791.00|1330.64|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3791.00||||3791.00|1112.36|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3791.00||||3791.00|1074.36|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|TRUSTMARK [2030]|STARMARK [203000]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|AETNA [1015]|AETNA ACO WILCO [101532]|3791.00||||3791.00|1933|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3791.00||||3791.00|862.8|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MULTIPLAN [1680]|HMA [168003]|3791.00||||3791.00|900.25|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|HEALTHNET [1495]|HEALTHNET [149500]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|FMH BENEFIT SERVICES [1390]|FMH [139000]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|FIRST HEALTH [1375]|QUALCHOICE [137513]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3791.00||||3791.00|1271.78|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3791.00||||3791.00|1630.13|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MULTIPLAN [1680]|IHC HS [168011]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3791.00||||3791.00|612.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|UMR [2035]|UMR OPTIONS [203501]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3791.00||||3791.00|876.25|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3791.00||||3791.00|660.19|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3791.00||||3791.00|796.11|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3791.00||||3791.00|3791|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3791.00||||3791.00|2464.15|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3791.00||||3791.00|1817.78|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|||3791.00||||3791.00|1137.3|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3791.00||||3791.00|1899.29|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3791.00||||3791.00|630.18|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3791.00||||3791.00|1112.36|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3791.00||||3791.00|600.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3791.00||||3791.00|1023.17|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|CHAMPVA [1240]|CHAMP VA [124000]|3791.00||||3791.00|2843.25|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3791.00||||3791.00|862.8|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|CORESOURCE [1315]|CORESOURCE [131500]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|GEHA [1415]|GEHA [141500]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3791.00||||3791.00|3411.9|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3791.00||||3791.00|1156.16|3791|600.17 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3791.00||||3791.00||| 36036590|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RMVL TUNNL CATH W/SUBQ PORT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3791.00||||3791.00||| 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|GEHA [1415]|GEHA [141500]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|CORESOURCE [1315]|CORESOURCE [131500]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1112.00||||1112.00|423.66|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|CHAMPVA [1240]|CHAMP VA [124000]|1112.00||||1112.00|834|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1112.00||||1112.00|195.93|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1112.00||||1112.00|213.01|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|||1112.00||||1112.00|333.6|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1112.00||||1112.00|722.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1112.00||||1112.00|1112|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1112.00||||1112.00|233.52|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1112.00||||1112.00|430.26|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|UMR [2035]|UMR OPTIONS [203501]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1112.00||||1112.00|300.59|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1112.00||||1112.00|478.16|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1112.00||||1112.00|243.54|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|HEALTHNET [1495]|HEALTHNET [149500]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MULTIPLAN [1680]|IHC HS [168011]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1112.00||||1112.00|423.66|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MULTIPLAN [1680]|HMA [168003]|1112.00||||1112.00|442.05|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1112.00||||1112.00|533.2|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|TRUSTMARK [2030]|STARMARK [203000]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1112.00||||1112.00|205.72|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1112.00||||1112.00|324.17|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1112.00||||1112.00|213.01|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1112.00||||1112.00|221.4|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1112.00||||1112.00|478.16|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1112.00||||1112.00|557.11|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1112.00||||1112.00|390.31|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1112.00||||1112.00|473.71|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1112.00||||1112.00|667.2|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1112.00||||1112.00|309.44|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1112.00||||1112.00|689.3|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1112.00||||1112.00|324.17|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1112.00||||1112.00|294.7|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1112.00||||1112.00|1000.8|1112|195.93 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1112.00||||1112.00||| 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|AETNA [1015]|AETNA ACO WILCO [101532]|1112.00||||1112.00||| 36036593|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DECLOT VASCULAR DEVICE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1112.00||||1112.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2536.00||||2536.00|1270.54|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2536.00||||2536.00|890.14|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2536.00||||2536.00|1080.34|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2536.00||||2536.00|2536|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2536.00||||2536.00|1521.6|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|TRUSTMARK [2030]|STARMARK [203000]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|HEALTHNET [1495]|HEALTHNET [149500]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MULTIPLAN [1680]|IHC HS [168011]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|FMH BENEFIT SERVICES [1390]|FMH [139000]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|FIRST HEALTH [1375]|QUALCHOICE [137513]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2536.00||||2536.00|1090.48|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|UMR [2035]|UMR OPTIONS [203501]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2536.00||||2536.00|532.56|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2536.00||||2536.00|2536|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2536.00||||2536.00|1648.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2536.00||||2536.00|1216.01|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|||2536.00||||2536.00|760.8|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2536.00||||2536.00|1090.48|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|CHAMPVA [1240]|CHAMP VA [124000]|2536.00||||2536.00|1902|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|CORESOURCE [1315]|CORESOURCE [131500]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|GEHA [1415]|GEHA [141500]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2536.00||||2536.00|2282.4|2536|532.56 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|AETNA [1015]|AETNA ACO WILCO [101532]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MULTIPLAN [1680]|HMA [168003]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2536.00||||2536.00||| 36036597|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPOSITION CVC W/ FLUORO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2536.00||||2536.00||| 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|GEHA [1415]|GEHA [141500]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|485.00||||485.00|221.4|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|485.00||||485.00|251.43|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|CHAMPVA [1240]|CHAMP VA [124000]|485.00||||485.00|363.75|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|485.00||||485.00|213.01|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|||485.00||||485.00|145.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|485.00||||485.00|232.56|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|485.00||||485.00|315.25|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|485.00||||485.00|485|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|485.00||||485.00|101.85|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|485.00||||485.00|255.35|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|UMR [2035]|UMR OPTIONS [203501]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|485.00||||485.00|178.4|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|485.00||||485.00|208.55|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|485.00||||485.00|243.54|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|FIRST HEALTH [1375]|QUALCHOICE [137513]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|FMH BENEFIT SERVICES [1390]|FMH [139000]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MULTIPLAN [1680]|IHC HS [168011]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|485.00||||485.00|251.43|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MULTIPLAN [1680]|HMA [168003]|485.00||||485.00|262.35|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|HEALTHNET [1495]|HEALTHNET [149500]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|TRUSTMARK [2030]|STARMARK [203000]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|485.00||||485.00|195.93|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|485.00||||485.00|205.72|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|485.00||||485.00|192.39|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|CORESOURCE [1315]|CORESOURCE [131500]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|485.00||||485.00|213.01|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|485.00||||485.00|291|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|485.00||||485.00|183.64|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|485.00||||485.00|447.39|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|485.00||||485.00|208.55|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|485.00||||485.00|242.99|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|485.00||||485.00|206.61|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|485.00||||485.00|170.24|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|485.00||||485.00|174.9|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|485.00||||485.00|436.5|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|485.00||||485.00|192.39|485|101.85 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|AETNA [1015]|AETNA ACO WILCO [101532]|485.00||||485.00||| 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|485.00||||485.00||| 36036598|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CNTRST EVAL EXST CVC DEV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|485.00||||485.00||| 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|311.00||||311.00|254.52|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|311.00||||311.00|155.81|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|311.00||||311.00|109.16|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|311.00||||311.00|132.49|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|311.00||||311.00|186.6|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|311.00||||311.00|23.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|311.00||||311.00|114.16|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|311.00||||311.00|22.96|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|TRUSTMARK [2030]|STARMARK [203000]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MULTIPLAN [1680]|IHC HS [168011]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|311.00||||311.00|149.2|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MULTIPLAN [1680]|HMA [168003]|311.00||||311.00|155.68|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|311.00||||311.00|27.19|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|311.00||||311.00|133.73|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|HEALTHNET [1495]|HEALTHNET [149500]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|311.00||||311.00|105.86|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|UMR [2035]|UMR OPTIONS [203501]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|311.00||||311.00|65.31|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|311.00||||311.00|311|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|311.00||||311.00|106.04|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|311.00||||311.00|202.15|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|311.00||||311.00|149.12|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|||311.00||||311.00|93.3|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|311.00||||311.00|133.73|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|311.00||||311.00|23.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|311.00||||311.00|114.16|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|311.00||||311.00|103.78|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|311.00||||311.00|21.87|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|CHAMPVA [1240]|CHAMP VA [124000]|311.00||||311.00|233.25|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|311.00||||311.00|149.2|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|CORESOURCE [1315]|CORESOURCE [131500]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|311.00||||311.00|24.72|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|GEHA [1415]|GEHA [141500]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|311.00||||311.00|279.9|311|21.87 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|AETNA [1015]|AETNA ACO WILCO [101532]|311.00||||311.00||| 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|311.00||||311.00||| 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|311.00||||311.00||| 36036600|EAP|0761 - SPECIALTY SERVICES-TREATMENT ROOM|HC PUNCTURE ARTERIAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|311.00||||311.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|GEHA [1415]|GEHA [141500]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|CORESOURCE [1315]|CORESOURCE [131500]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|CHAMPVA [1240]|CHAMP VA [124000]|1628.00||||1628.00|1221|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|||1628.00||||1628.00|488.4|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1628.00||||1628.00|780.63|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1628.00||||1628.00|1058.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1628.00||||1628.00|341.88|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|UMR [2035]|UMR OPTIONS [203501]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1628.00||||1628.00|700.04|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|FIRST HEALTH [1375]|QUALCHOICE [137513]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|FMH BENEFIT SERVICES [1390]|FMH [139000]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MULTIPLAN [1680]|IHC HS [168011]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1628.00||||1628.00|1628|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|HEALTHNET [1495]|HEALTHNET [149500]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|TRUSTMARK [2030]|STARMARK [203000]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1628.00||||1628.00|976.8|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1628.00||||1628.00|700.04|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1628.00||||1628.00|815.63|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1628.00||||1628.00|571.43|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1628.00||||1628.00|693.53|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1628.00||||1628.00|814|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1628.00||||1628.00|1465.2|1628|341.88 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MULTIPLAN [1680]|HMA [168003]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|AETNA [1015]|AETNA ACO WILCO [101532]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1628.00||||1628.00||| 36036620|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERC CATH/CANNULATION ART|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1628.00||||1628.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34183.00||||34183.00|935.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34183.00||||34183.00|17091.5|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34183.00||||34183.00|14698.69|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34183.00||||34183.00|17125.68|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34183.00||||34183.00|14561.96|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34183.00||||34183.00|892.54|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34183.00||||34183.00|20509.8|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34183.00||||34183.00|935.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|TRUSTMARK [2030]|STARMARK [203000]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|HEALTHNET [1495]|HEALTHNET [149500]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MULTIPLAN [1680]|IHC HS [168011]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MULTIPLAN [1680]|HMA [168003]|34183.00||||34183.00|1275.06|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|FMH BENEFIT SERVICES [1390]|FMH [139000]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34183.00||||34183.00|1181.56|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|FIRST HEALTH [1375]|QUALCHOICE [137513]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34183.00||||34183.00|14698.69|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34183.00||||34183.00|867.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|UMR [2035]|UMR OPTIONS [203501]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34183.00||||34183.00|1190.06|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34183.00||||34183.00|7178.43|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34183.00||||34183.00|34183|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34183.00||||34183.00|11998.23|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34183.00||||34183.00|22218.95|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34183.00||||34183.00|16390.75|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|||34183.00||||34183.00|10254.9|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34183.00||||34183.00|850.04|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|CHAMPVA [1240]|CHAMP VA [124000]|34183.00||||34183.00|25637.25|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34183.00||||34183.00|1181.56|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|CORESOURCE [1315]|CORESOURCE [131500]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|GEHA [1415]|GEHA [141500]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34183.00||||34183.00|30764.7|34183|850.04 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|AETNA [1015]|AETNA ACO WILCO [101532]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34183.00||||34183.00||| 36037182|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT HEPATIC SHUNT (TIPS)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34183.00||||34183.00||| 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|GEHA [1415]|GEHA [141500]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13388.00||||13388.00|3780.33|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13388.00||||13388.00|6779.05|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|CHAMPVA [1240]|CHAMP VA [124000]|13388.00||||13388.00|10041|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13388.00||||13388.00|3345.43|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13388.00||||13388.00|3637.12|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|||13388.00||||13388.00|4016.4|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13388.00||||13388.00|6419.55|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13388.00||||13388.00|8702.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13388.00||||13388.00|13388|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13388.00||||13388.00|2811.48|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13388.00||||13388.00|6884.67|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|UMR [2035]|UMR OPTIONS [203501]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13388.00||||13388.00|4809.84|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13388.00||||13388.00|5756.84|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13388.00||||13388.00|4158.36|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|FIRST HEALTH [1375]|QUALCHOICE [137513]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|FMH BENEFIT SERVICES [1390]|FMH [139000]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MULTIPLAN [1680]|IHC HS [168011]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13388.00||||13388.00|6779.05|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MULTIPLAN [1680]|HMA [168003]|13388.00||||13388.00|7073.29|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|AETNA [1015]|AETNA ACO WILCO [101532]|13388.00||||13388.00|12441|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|HEALTHNET [1495]|HEALTHNET [149500]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|TRUSTMARK [2030]|STARMARK [203000]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13388.00||||13388.00|3512.7|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13388.00||||13388.00|5187.08|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|CORESOURCE [1315]|CORESOURCE [131500]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13388.00||||13388.00|3637.12|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13388.00||||13388.00|8032.8|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13388.00||||13388.00|4951.31|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13388.00||||13388.00|5756.84|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13388.00||||13388.00|6707.39|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13388.00||||13388.00|4699.19|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13388.00||||13388.00|5703.29|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13388.00||||13388.00|11182.79|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13388.00||||13388.00|4715.53|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13388.00||||13388.00|12049.2|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13388.00||||13388.00|5187.08|13388|2811.48 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13388.00||||13388.00||| 36037187|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS MECH THROMBECTOMY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13388.00||||13388.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14327.00||||14327.00|6313.87|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14327.00||||14327.00|7177.83|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14327.00||||14327.00|5028.78|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14327.00||||14327.00|6103.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14327.00||||14327.00|8596.2|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|TRUSTMARK [2030]|STARMARK [203000]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MULTIPLAN [1680]|IHC HS [168011]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14327.00||||14327.00|6160.61|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|HEALTHNET [1495]|HEALTHNET [149500]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|UMR [2035]|UMR OPTIONS [203501]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14327.00||||14327.00|3008.67|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14327.00||||14327.00|14327|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14327.00||||14327.00|9312.55|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14327.00||||14327.00|6869.8|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|||14327.00||||14327.00|4298.1|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14327.00||||14327.00|6160.61|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|CHAMPVA [1240]|CHAMP VA [124000]|14327.00||||14327.00|10745.25|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|CORESOURCE [1315]|CORESOURCE [131500]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|GEHA [1415]|GEHA [141500]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14327.00||||14327.00|12894.3|14327|3008.67 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|AETNA [1015]|AETNA ACO WILCO [101532]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MULTIPLAN [1680]|HMA [168003]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14327.00||||14327.00||| 36037188|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VENOUS PERC THROMBECTOMY ADDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14327.00||||14327.00||| 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|GEHA [1415]|GEHA [141500]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|CORESOURCE [1315]|CORESOURCE [131500]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|CHAMPVA [1240]|CHAMP VA [124000]|7896.00||||7896.00|5922|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7896.00||||7896.00|3613.71|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7896.00||||7896.00|3928.8|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|||7896.00||||7896.00|2368.8|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7896.00||||7896.00|5132.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7896.00||||7896.00|1658.16|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7896.00||||7896.00|6387.53|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|UMR [2035]|UMR OPTIONS [203501]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7896.00||||7896.00|4462.52|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7896.00||||7896.00|3395.28|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7896.00||||7896.00|4491.85|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|HEALTHNET [1495]|HEALTHNET [149500]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MULTIPLAN [1680]|IHC HS [168011]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7896.00||||7896.00|7896|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7896.00||||7896.00|6289.53|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MULTIPLAN [1680]|HMA [168003]|7896.00||||7896.00|6562.54|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|AETNA [1015]|AETNA ACO WILCO [101532]|7896.00||||7896.00|3566|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7896.00||||7896.00|3786.13|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|TRUSTMARK [2030]|STARMARK [203000]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7896.00||||7896.00|6289.53|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7896.00||||7896.00|3794.39|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7896.00||||7896.00|4812.53|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7896.00||||7896.00|3928.8|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7896.00||||7896.00|4083.5|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7896.00||||7896.00|3395.28|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7896.00||||7896.00|3955.9|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7896.00||||7896.00|2771.5|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7896.00||||7896.00|3363.7|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7896.00||||7896.00|4737.6|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7896.00||||7896.00|4593.77|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7896.00||||7896.00|7896|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7896.00||||7896.00|4812.53|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7896.00||||7896.00|4375.02|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7896.00||||7896.00|7106.4|7896|1658.16 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7896.00||||7896.00||| 36037191|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7896.00||||7896.00||| 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4915.00||||4915.00|2901.72|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4915.00||||4915.00|4915|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4915.00||||4915.00|2769.82|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4915.00||||4915.00|2949|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4915.00||||4915.00|2113.45|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4915.00||||4915.00|2462.42|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4915.00||||4915.00|1725.17|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4915.00||||4915.00|2949.09|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4915.00||||4915.00|2901.72|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4915.00||||4915.00|2848.19|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|TRUSTMARK [2030]|STARMARK [203000]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|AETNA [1015]|AETNA ACO WILCO [101532]|4915.00||||4915.00|3566|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MULTIPLAN [1680]|IHC HS [168011]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4915.00||||4915.00|3792.28|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|HEALTHNET [1495]|HEALTHNET [149500]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MULTIPLAN [1680]|HMA [168003]|4915.00||||4915.00|3956.89|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4915.00||||4915.00|3371.73|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4915.00||||4915.00|2113.45|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4915.00||||4915.00|2690.69|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|UMR [2035]|UMR OPTIONS [203501]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4915.00||||4915.00|3851.37|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4915.00||||4915.00|1032.15|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4915.00||||4915.00|4915|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4915.00||||4915.00|3194.75|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4915.00||||4915.00|2356.74|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4915.00||||4915.00|2093.79|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|||4915.00||||4915.00|1474.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4915.00||||4915.00|2949.09|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4915.00||||4915.00|2637.93|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4915.00||||4915.00|2712.57|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|CHAMPVA [1240]|CHAMP VA [124000]|4915.00||||4915.00|3686.25|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4915.00||||4915.00|3792.28|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|CORESOURCE [1315]|CORESOURCE [131500]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|GEHA [1415]|GEHA [141500]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4915.00||||4915.00|4423.5|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4915.00||||4915.00|3065.21|4915|1032.15 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4915.00||||4915.00||| 36037193|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RETRIV IVC FILTR W/ACCES/IMAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4915.00||||4915.00||| 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7914.00||||7914.00|2887.67|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|GEHA [1415]|GEHA [141500]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|CORESOURCE [1315]|CORESOURCE [131500]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7914.00||||7914.00|3792.28|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|CHAMPVA [1240]|CHAMP VA [124000]|7914.00||||7914.00|5935.5|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7914.00||||7914.00|2778.28|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|||7914.00||||7914.00|2374.2|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7914.00||||7914.00|3794.76|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7914.00||||7914.00|5144.1|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7914.00||||7914.00|7914|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7914.00||||7914.00|1661.94|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7914.00||||7914.00|3851.37|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|UMR [2035]|UMR OPTIONS [203501]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7914.00||||7914.00|2690.69|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7914.00||||7914.00|3403.02|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7914.00||||7914.00|3176.44|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|HEALTHNET [1495]|HEALTHNET [149500]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MULTIPLAN [1680]|IHC HS [168011]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7914.00||||7914.00|3792.28|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MULTIPLAN [1680]|HMA [168003]|7914.00||||7914.00|3956.89|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|AETNA [1015]|AETNA ACO WILCO [101532]|7914.00||||7914.00|3566|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|TRUSTMARK [2030]|STARMARK [203000]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7914.00||||7914.00|2683.24|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7914.00||||7914.00|2901.72|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7914.00||||7914.00|2555.47|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7914.00||||7914.00|2778.28|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7914.00||||7914.00|3403.02|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7914.00||||7914.00|3964.91|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7914.00||||7914.00|2777.81|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7914.00||||7914.00|3371.36|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7914.00||||7914.00|4748.4|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7914.00||||7914.00|2769.82|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7914.00||||7914.00|6313.87|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7914.00||||7914.00|2901.72|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7914.00||||7914.00|2637.93|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7914.00||||7914.00|7122.6|7914|1661.94 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7914.00||||7914.00||| 36037197|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATH RETRIEVAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7914.00||||7914.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5425.00||||5425.00|2332.75|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5425.00||||5425.00|2717.93|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5425.00||||5425.00|2311.05|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5425.00||||5425.00|1904.18|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5425.00||||5425.00|5425|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5425.00||||5425.00|3255|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|TRUSTMARK [2030]|STARMARK [203000]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|HEALTHNET [1495]|HEALTHNET [149500]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MULTIPLAN [1680]|IHC HS [168011]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|FMH BENEFIT SERVICES [1390]|FMH [139000]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|FIRST HEALTH [1375]|QUALCHOICE [137513]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5425.00||||5425.00|2332.75|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|UMR [2035]|UMR OPTIONS [203501]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5425.00||||5425.00|1139.25|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5425.00||||5425.00|5425|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5425.00||||5425.00|3526.25|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5425.00||||5425.00|2601.29|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|||5425.00||||5425.00|1627.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|CHAMPVA [1240]|CHAMP VA [124000]|5425.00||||5425.00|4068.75|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|CORESOURCE [1315]|CORESOURCE [131500]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|GEHA [1415]|GEHA [141500]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5425.00||||5425.00|4882.5|5425|1139.25 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MULTIPLAN [1680]|HMA [168003]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|AETNA [1015]|AETNA ACO WILCO [101532]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5425.00||||5425.00||| 36037200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRANSCATHETER BIOPSY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5425.00||||5425.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|GEHA [1415]|GEHA [141500]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|CORESOURCE [1315]|CORESOURCE [131500]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|CHAMPVA [1240]|CHAMP VA [124000]|11838.00||||11838.00|8878.5|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|||11838.00||||11838.00|3551.4|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11838.00||||11838.00|7694.7|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11838.00||||11838.00|2485.98|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|UMR [2035]|UMR OPTIONS [203501]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11838.00||||11838.00|5090.34|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|HEALTHNET [1495]|HEALTHNET [149500]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MULTIPLAN [1680]|IHC HS [168011]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11838.00||||11838.00|11838|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11838.00||||11838.00|5676.32|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|TRUSTMARK [2030]|STARMARK [203000]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11838.00||||11838.00|5090.34|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11838.00||||11838.00|5930.84|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11838.00||||11838.00|4155.14|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11838.00||||11838.00|5042.99|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11838.00||||11838.00|7102.8|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11838.00||||11838.00|10460.93|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11838.00||||11838.00|10654.2|11838|2485.98 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MULTIPLAN [1680]|HMA [168003]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|AETNA [1015]|AETNA ACO WILCO [101532]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11838.00||||11838.00||| 36037211|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS ART NONCOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11838.00||||11838.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2703.00||||2703.00|1354.2|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2703.00||||2703.00|948.75|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2703.00||||2703.00|1151.48|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2703.00||||2703.00|2703|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2703.00||||2703.00|1621.8|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|TRUSTMARK [2030]|STARMARK [203000]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|HEALTHNET [1495]|HEALTHNET [149500]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MULTIPLAN [1680]|IHC HS [168011]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2703.00||||2703.00|1162.29|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|UMR [2035]|UMR OPTIONS [203501]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2703.00||||2703.00|567.63|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2703.00||||2703.00|2703|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2703.00||||2703.00|1756.95|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2703.00||||2703.00|1296.09|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|||2703.00||||2703.00|810.9|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2703.00||||2703.00|1162.29|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|CHAMPVA [1240]|CHAMP VA [124000]|2703.00||||2703.00|2027.25|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|CORESOURCE [1315]|CORESOURCE [131500]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|GEHA [1415]|GEHA [141500]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2703.00||||2703.00|2432.7|2703|567.63 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MULTIPLAN [1680]|HMA [168003]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2703.00||||2703.00||| 36037212|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS VENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2703.00||||2703.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|CORESOURCE [1315]|CORESOURCE [131500]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|CHAMPVA [1240]|CHAMP VA [124000]|6029.00||||6029.00|4521.75|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|||6029.00||||6029.00|1808.7|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6029.00||||6029.00|2890.91|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6029.00||||6029.00|3918.85|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6029.00||||6029.00|6029|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6029.00||||6029.00|1266.09|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|UMR [2035]|UMR OPTIONS [203501]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6029.00||||6029.00|2592.47|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|HEALTHNET [1495]|HEALTHNET [149500]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MULTIPLAN [1680]|IHC HS [168011]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|TRUSTMARK [2030]|STARMARK [203000]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|GEHA [1415]|GEHA [141500]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6029.00||||6029.00|2592.47|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6029.00||||6029.00|3020.53|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6029.00||||6029.00|2116.18|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6029.00||||6029.00|2568.35|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6029.00||||6029.00|3617.4|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6029.00||||6029.00|2614.04|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6029.00||||6029.00|5426.1|6029|1266.09 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MULTIPLAN [1680]|HMA [168003]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|AETNA [1015]|AETNA ACO WILCO [101532]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6029.00||||6029.00||| 36037213|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCT THROMBOLYSIS SUBSEQ DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6029.00||||6029.00||| 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13544.00||||13544.00|10374.85|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13544.00||||13544.00|13544|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13544.00||||13544.00|8126.4|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13544.00||||13544.00|5823.92|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13544.00||||13544.00|6785.54|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13544.00||||13544.00|5769.74|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13544.00||||13544.00|4880.63|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13544.00||||13544.00|4713.67|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|TRUSTMARK [2030]|STARMARK [203000]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|AETNA [1015]|AETNA ACO WILCO [101532]|13544.00||||13544.00|3769|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13544.00||||13544.00|13544|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MULTIPLAN [1680]|HMA [168003]|13544.00||||13544.00|14147.52|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|HEALTHNET [1495]|HEALTHNET [149500]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13544.00||||13544.00|5580.08|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13544.00||||13544.00|5823.92|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MULTIPLAN [1680]|IHC HS [168011]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13544.00||||13544.00|9620.32|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|UMR [2035]|UMR OPTIONS [203501]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13544.00||||13544.00|13544|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13544.00||||13544.00|10374.85|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13544.00||||13544.00|2844.24|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13544.00||||13544.00|13544|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13544.00||||13544.00|4753.94|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13544.00||||13544.00|8803.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13544.00||||13544.00|6494.35|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|||13544.00||||13544.00|4063.2|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13544.00||||13544.00|9903.27|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13544.00||||13544.00|4880.63|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13544.00||||13544.00|9431.68|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13544.00||||13544.00|4489.21|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|CHAMPVA [1240]|CHAMP VA [124000]|13544.00||||13544.00|10158|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13544.00||||13544.00|13544|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|CORESOURCE [1315]|CORESOURCE [131500]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|GEHA [1415]|GEHA [141500]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13544.00||||13544.00|12189.6|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13544.00||||13544.00|5072.8|14147.52|2844.24 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13544.00||||13544.00||| 36037221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANG ILIAC OPN/PERC INIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|GEHA [1415]|GEHA [141500]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|CORESOURCE [1315]|CORESOURCE [131500]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|CHAMPVA [1240]|CHAMP VA [124000]|13544.00||||13544.00|10158|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13544.00||||13544.00|4489.21|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13544.00||||13544.00|4880.63|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|||13544.00||||13544.00|4063.2|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13544.00||||13544.00|8803.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13544.00||||13544.00|13544|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13544.00||||13544.00|2844.24|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|UMR [2035]|UMR OPTIONS [203501]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13544.00||||13544.00|5823.92|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13544.00||||13544.00|5580.08|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|FIRST HEALTH [1375]|QUALCHOICE [137513]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|FMH BENEFIT SERVICES [1390]|FMH [139000]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|HEALTHNET [1495]|HEALTHNET [149500]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MULTIPLAN [1680]|IHC HS [168011]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13544.00||||13544.00|6494.35|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|TRUSTMARK [2030]|STARMARK [203000]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13544.00||||13544.00|4713.67|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13544.00||||13544.00|4880.63|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13544.00||||13544.00|5072.8|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13544.00||||13544.00|5823.92|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13544.00||||13544.00|6785.54|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13544.00||||13544.00|4753.94|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13544.00||||13544.00|5769.74|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13544.00||||13544.00|8126.4|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13544.00||||13544.00|6772|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13544.00||||13544.00|12189.6|13544|2844.24 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MULTIPLAN [1680]|HMA [168003]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|AETNA [1015]|AETNA ACO WILCO [101532]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13544.00||||13544.00||| 36037223|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT ILIAC OPN/PERC EA ADD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13544.00||||13544.00||| 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25158.00||||25158.00|10374.85|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25158.00||||25158.00|23111.3|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25158.00||||25158.00|9903.27|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25158.00||||25158.00|15094.8|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25158.00||||25158.00|10817.94|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25158.00||||25158.00|12604.16|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25158.00||||25158.00|8830.46|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25158.00||||25158.00|10717.31|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25158.00||||25158.00|10361.47|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25158.00||||25158.00|10374.85|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25158.00||||25158.00|10007.01|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|TRUSTMARK [2030]|STARMARK [203000]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|AETNA [1015]|AETNA ACO WILCO [101532]|25158.00||||25158.00|3769|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MULTIPLAN [1680]|IHC HS [168011]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25158.00||||25158.00|13558.99|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|HEALTHNET [1495]|HEALTHNET [149500]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|FMH BENEFIT SERVICES [1390]|FMH [139000]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|FIRST HEALTH [1375]|QUALCHOICE [137513]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MULTIPLAN [1680]|HMA [168003]|25158.00||||25158.00|14147.52|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25158.00||||25158.00|11846.4|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25158.00||||25158.00|10817.94|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25158.00||||25158.00|9620.32|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|UMR [2035]|UMR OPTIONS [203501]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25158.00||||25158.00|13770.26|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25158.00||||25158.00|5283.18|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25158.00||||25158.00|25158|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25158.00||||25158.00|16352.7|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25158.00||||25158.00|12063.26|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|||25158.00||||25158.00|7547.4|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25158.00||||25158.00|10361.47|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25158.00||||25158.00|9431.68|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25158.00||||25158.00|9530.49|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|CHAMPVA [1240]|CHAMP VA [124000]|25158.00||||25158.00|18868.5|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25158.00||||25158.00|13558.99|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|CORESOURCE [1315]|CORESOURCE [131500]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|GEHA [1415]|GEHA [141500]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25158.00||||25158.00|22642.2|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25158.00||||25158.00|10769.45|25158|3769 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25158.00||||25158.00||| 36037226|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC STENT/ANGIO FEM POP OPN/PERC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25158.00||||25158.00||| 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28402.00||||28402.00|11598.88|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|CORESOURCE [1315]|CORESOURCE [131500]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28402.00||||28402.00|13558.99|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|CHAMPVA [1240]|CHAMP VA [124000]|28402.00||||28402.00|21301.5|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28402.00||||28402.00|11159.48|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|||28402.00||||28402.00|8520.6|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28402.00||||28402.00|13618.76|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28402.00||||28402.00|18461.3|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28402.00||||28402.00|28402|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28402.00||||28402.00|5964.42|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28402.00||||28402.00|13770.26|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|UMR [2035]|UMR OPTIONS [203501]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28402.00||||28402.00|9620.32|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28402.00||||28402.00|12212.86|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28402.00||||28402.00|12758.77|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|FIRST HEALTH [1375]|QUALCHOICE [137513]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|FMH BENEFIT SERVICES [1390]|FMH [139000]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|HEALTHNET [1495]|HEALTHNET [149500]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MULTIPLAN [1680]|IHC HS [168011]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28402.00||||28402.00|13558.99|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MULTIPLAN [1680]|HMA [168003]|28402.00||||28402.00|14147.52|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|AETNA [1015]|AETNA ACO WILCO [101532]|28402.00||||28402.00|3566|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|TRUSTMARK [2030]|STARMARK [203000]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28402.00||||28402.00|10264.5|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28402.00||||28402.00|9177.83|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28402.00||||28402.00|10777.72|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28402.00||||28402.00|10374.85|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|GEHA [1415]|GEHA [141500]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28402.00||||28402.00|11159.48|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28402.00||||28402.00|12212.86|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28402.00||||28402.00|14229.4|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28402.00||||28402.00|9969.1|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28402.00||||28402.00|12099.25|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28402.00||||28402.00|17041.2|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28402.00||||28402.00|9903.27|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28402.00||||28402.00|23111.3|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28402.00||||28402.00|10374.85|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28402.00||||28402.00|9431.68|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28402.00||||28402.00|25561.8|28402|3566 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28402.00||||28402.00||| 36037236|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST ARTERY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28402.00||||28402.00||| 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28402.00||||28402.00|10374.85|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28402.00||||28402.00|23111.3|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28402.00||||28402.00|17041.2|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28402.00||||28402.00|12212.86|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28402.00||||28402.00|14229.4|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28402.00||||28402.00|12099.25|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28402.00||||28402.00|11159.48|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28402.00||||28402.00|10374.85|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28402.00||||28402.00|10777.72|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|TRUSTMARK [2030]|STARMARK [203000]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|AETNA [1015]|AETNA ACO WILCO [101532]|28402.00||||28402.00|3566|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28402.00||||28402.00|13558.99|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MULTIPLAN [1680]|HMA [168003]|28402.00||||28402.00|14147.52|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|HEALTHNET [1495]|HEALTHNET [149500]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|FMH BENEFIT SERVICES [1390]|FMH [139000]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|FIRST HEALTH [1375]|QUALCHOICE [137513]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28402.00||||28402.00|12758.77|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28402.00||||28402.00|12212.86|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MULTIPLAN [1680]|IHC HS [168011]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28402.00||||28402.00|9620.32|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|UMR [2035]|UMR OPTIONS [203501]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28402.00||||28402.00|13770.26|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28402.00||||28402.00|5964.42|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28402.00||||28402.00|28402|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28402.00||||28402.00|9969.1|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28402.00||||28402.00|18461.3|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28402.00||||28402.00|13618.76|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|||28402.00||||28402.00|8520.6|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28402.00||||28402.00|9903.27|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28402.00||||28402.00|11159.48|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28402.00||||28402.00|9431.68|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28402.00||||28402.00|10264.5|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|CHAMPVA [1240]|CHAMP VA [124000]|28402.00||||28402.00|21301.5|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28402.00||||28402.00|13558.99|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|CORESOURCE [1315]|CORESOURCE [131500]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|GEHA [1415]|GEHA [141500]|28402.00||||28402.00|25561.8|28402|3566 36037238|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT 1ST VEIN(INC PTA SAME VEIN IF PERF)|NATIONAL TELEPHONE 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[225500]|29123.00||||29123.00|10450.32|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29123.00||||29123.00|10374.85|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29123.00||||29123.00|10820.48|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|HEALTHNET [1495]|HEALTHNET [149500]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29123.00||||29123.00|17473.8|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29123.00||||29123.00|9903.27|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29123.00||||29123.00|12522.89|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29123.00||||29123.00|14590.62|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29123.00||||29123.00|10222.17|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29123.00||||29123.00|12406.4|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|MAYO CLINIC HEALTH 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SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|||29123.00||||29123.00|8736.9|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29123.00||||29123.00|9952.69|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29123.00||||29123.00|9620.32|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|CHAMPVA [1240]|CHAMP VA [124000]|29123.00||||29123.00|21842.25|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29123.00||||29123.00|29123|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29123.00||||29123.00|9431.68|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29123.00||||29123.00|9431.68|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC 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SKY COMMUNITY CARE [292000]|29123.00||||29123.00|12371.19|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29123.00||||29123.00|13964.48|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|CORESOURCE [1315]|CORESOURCE [131500]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29123.00||||29123.00|9431.68|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|UMR [2035]|UMR OPTIONS [203501]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29123.00||||29123.00|10820.48|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29123.00||||29123.00|9431.68|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29123.00||||29123.00|11246.54|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29123.00||||29123.00|13558.99|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29123.00||||29123.00|9431.68|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29123.00||||29123.00|12522.89|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|29123.00||||29123.00|3566|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29123.00||||29123.00|18929.95|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|MULTIPLAN [1680]|HMA [168003]|29123.00||||29123.00|14147.52|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29123.00||||29123.00|6115.83|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|GEHA [1415]|GEHA [141500]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|MULTIPLAN [1680]|IHC HS [168011]|29123.00||||29123.00|26210.7|29123|3566 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29123.00||||29123.00||| 36037241|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE VENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29123.00||||29123.00||| 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|CHAMPVA [1240]|CHAMP VA [124000]|29123.00||||29123.00|21842.25|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29123.00||||29123.00|12406.4|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29123.00||||29123.00|9952.69|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29123.00||||29123.00|13558.99|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|CORESOURCE [1315]|CORESOURCE [131500]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29123.00||||29123.00|10820.48|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29123.00||||29123.00|10374.85|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29123.00||||29123.00|14590.62|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29123.00||||29123.00|13770.26|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|TRUSTMARK [2030]|STARMARK [203000]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|GEHA [1415]|GEHA [141500]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29123.00||||29123.00|13558.99|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|||29123.00||||29123.00|8736.9|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|HEALTHNET [1495]|HEALTHNET [149500]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|AETNA [1015]|AETNA ACO WILCO [101532]|29123.00||||29123.00|3566|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29123.00||||29123.00|17473.8|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29123.00||||29123.00|10820.48|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29123.00||||29123.00|23111.3|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29123.00||||29123.00|12371.19|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29123.00||||29123.00|11246.54|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29123.00||||29123.00|12522.89|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29123.00||||29123.00|9620.32|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29123.00||||29123.00|18929.95|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MULTIPLAN [1680]|HMA [168003]|29123.00||||29123.00|14147.52|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29123.00||||29123.00|12522.89|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|UMR [2035]|UMR OPTIONS [203501]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29123.00||||29123.00|13964.48|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29123.00||||29123.00|10222.17|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29123.00||||29123.00|9903.27|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|FIRST HEALTH [1375]|QUALCHOICE [137513]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29123.00||||29123.00|29123|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29123.00||||29123.00|6115.83|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29123.00||||29123.00|10450.32|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29123.00||||29123.00|10374.85|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|MULTIPLAN [1680]|IHC HS [168011]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29123.00||||29123.00|9431.68|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|FMH BENEFIT SERVICES [1390]|FMH [139000]|29123.00||||29123.00|26210.7|29123|3566 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29123.00||||29123.00||| 36037242|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ARTERY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29123.00||||29123.00||| 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29123.00||||29123.00|9903.27|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29123.00||||29123.00|12371.19|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29123.00||||29123.00|23111.3|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29123.00||||29123.00|12406.4|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29123.00||||29123.00|10374.85|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29123.00||||29123.00|14590.62|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29123.00||||29123.00|17473.8|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29123.00||||29123.00|10374.85|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29123.00||||29123.00|12522.89|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|GEHA [1415]|GEHA [141500]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29123.00||||29123.00|10450.32|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|CORESOURCE [1315]|CORESOURCE [131500]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29123.00||||29123.00|13964.48|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29123.00||||29123.00|11246.54|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29123.00||||29123.00|9952.69|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29123.00||||29123.00|6115.83|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29123.00||||29123.00|10820.48|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|||29123.00||||29123.00|8736.9|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29123.00||||29123.00|13558.99|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29123.00||||29123.00|13770.26|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29123.00||||29123.00|10222.17|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29123.00||||29123.00|18929.95|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|UMR [2035]|UMR OPTIONS [203501]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29123.00||||29123.00|13558.99|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29123.00||||29123.00|12522.89|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|TRUSTMARK [2030]|STARMARK [203000]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29123.00||||29123.00|29123|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|HEALTHNET [1495]|HEALTHNET [149500]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29123.00||||29123.00|10820.48|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29123.00||||29123.00|9620.32|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MULTIPLAN [1680]|IHC HS [168011]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|MULTIPLAN [1680]|HMA [168003]|29123.00||||29123.00|14147.52|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|CHAMPVA [1240]|CHAMP VA [124000]|29123.00||||29123.00|21842.25|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29123.00||||29123.00|9431.68|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|29123.00||||29123.00|26210.7|29123|6115.83 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29123.00||||29123.00||| 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29123.00||||29123.00||| 36037243|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE ORGAN|AETNA [1015]|AETNA ACO WILCO [101532]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29123.00||||29123.00|23111.3|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29123.00||||29123.00|10222.17|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29123.00||||29123.00|17473.8|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29123.00||||29123.00|12406.4|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|FIRST HEALTH [1375]|QUALCHOICE [137513]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29123.00||||29123.00|14590.62|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|UMR [2035]|UMR OPTIONS [203501]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|HEALTHNET [1495]|HEALTHNET [149500]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29123.00||||29123.00|12522.89|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|TRUSTMARK [2030]|STARMARK [203000]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29123.00||||29123.00|6115.83|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29123.00||||29123.00|13964.48|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29123.00||||29123.00|18929.95|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|CORESOURCE [1315]|CORESOURCE [131500]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|CHAMPVA [1240]|CHAMP VA [124000]|29123.00||||29123.00|21842.25|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MULTIPLAN [1680]|IHC HS [168011]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|GEHA [1415]|GEHA [141500]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|FMH BENEFIT SERVICES [1390]|FMH [139000]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29123.00||||29123.00|12522.89|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|||29123.00||||29123.00|8736.9|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29123.00||||29123.00|29123|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29123.00||||29123.00|26210.7|29123|6115.83 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MULTIPLAN [1680]|HMA [168003]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|AETNA [1015]|AETNA ACO WILCO [101532]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29123.00||||29123.00||| 36037244|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC VASC EMBOLIZE/OCCLUDE BLEED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29123.00||||29123.00||| 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39604.00||||39604.00|11182.79|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39604.00||||39604.00|35643.6|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39604.00||||39604.00|23762.4|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39604.00||||39604.00|13901|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39604.00||||39604.00|4715.53|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39604.00||||39604.00|19841.6|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39604.00||||39604.00|4715.53|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39604.00||||39604.00|5187.08|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39604.00||||39604.00|4951.31|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39604.00||||39604.00|16871.3|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|GEHA [1415]|GEHA [141500]|39604.00||||39604.00|35643.6|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39604.00||||39604.00|6779.05|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH 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36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39604.00||||39604.00|35643.6|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39604.00||||39604.00|35643.6|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39604.00||||39604.00|35643.6|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39604.00||||39604.00|4715.53|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39604.00||||39604.00|35643.6|39604|4715.53 36037246|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PTA ARTERY INITIAL VESSEL-S/R|FIRST 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INITIAL VESSEL-S/R|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39604.00||||39604.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15279.00||||15279.00|7639.5|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15279.00||||15279.00|5362.93|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15279.00||||15279.00|6508.85|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15279.00||||15279.00|7654.78|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15279.00||||15279.00|9167.4|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|TRUSTMARK [2030]|STARMARK [203000]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|NORTHAMERICA ADMINISTRATORS 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[139000]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|FIRST HEALTH [1375]|QUALCHOICE [137513]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15279.00||||15279.00|7326.28|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15279.00||||15279.00|13751.1|15279|3208.59 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|BOON-CHAPMAN [2375]|BOON-CHAPMAN 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S&I EA ADDL ART|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ IMG S&I EA ADDL ART|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15279.00||||15279.00||| 36037247|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC 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(NMHC) [280000]|15279.00||||15279.00||| 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|CHAMPVA [1240]|CHAMP VA [124000]|18634.00||||18634.00|13975.5|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18634.00||||18634.00|6884.67|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18634.00||||18634.00|8012.62|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18634.00||||18634.00|6779.05|18634|3913.14 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[203601]|18634.00||||18634.00|8935|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|GEHA [1415]|GEHA [141500]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18634.00||||18634.00|6613.57|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|UMR [2035]|UMR OPTIONS [203501]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18634.00||||18634.00|7274.93|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MULTIPLAN [1680]|HMA [168003]|18634.00||||18634.00|7073.29|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18634.00||||18634.00|6779.05|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|AETNA [1015]|AETNA ACO WILCO [101532]|18634.00||||18634.00|5505|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18634.00||||18634.00|12112.1|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|TRUSTMARK [2030]|STARMARK [203000]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18634.00||||18634.00|6363.03|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18634.00||||18634.00|6145.35|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18634.00||||18634.00|4809.84|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18634.00||||18634.00|5187.08|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MULTIPLAN [1680]|IHC HS [168011]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18634.00||||18634.00|18634|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|HEALTHNET [1495]|HEALTHNET [149500]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18634.00||||18634.00|7938.08|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18634.00||||18634.00|4951.31|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18634.00||||18634.00|9335.63|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18634.00||||18634.00|11182.79|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18634.00||||18634.00|5187.08|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18634.00||||18634.00|6540.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18634.00||||18634.00|8012.62|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18634.00||||18634.00|4715.53|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18634.00||||18634.00|16770.6|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18634.00||||18634.00|11180.4|18634|3913.14 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18634.00||||18634.00||| 36037248|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SP ANGIOPLASTY OPEN/PERQ 1ST VEIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18634.00||||18634.00|9317|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18634.00||||18634.00|8012.62|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18634.00||||18634.00|9335.63|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18634.00||||18634.00|6540.53|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|TRUSTMARK [2030]|STARMARK [203000]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18634.00||||18634.00|8012.62|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MULTIPLAN [1680]|IHC HS [168011]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18634.00||||18634.00|18634|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18634.00||||18634.00|11180.4|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|UMR [2035]|UMR OPTIONS [203501]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|||18634.00||||18634.00|5590.2|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|HEALTHNET [1495]|HEALTHNET [149500]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|CORESOURCE [1315]|CORESOURCE [131500]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18634.00||||18634.00|7938.08|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18634.00||||18634.00|12112.1|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|GEHA [1415]|GEHA [141500]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|CHAMPVA [1240]|CHAMP VA [124000]|18634.00||||18634.00|13975.5|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18634.00||||18634.00|3913.14|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18634.00||||18634.00|8935|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18634.00||||18634.00|16770.6|18634|3913.14 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|AETNA [1015]|AETNA ACO WILCO [101532]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MULTIPLAN [1680]|HMA [168003]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18634.00||||18634.00||| 36037249|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ANGIOPLASTY OPEN/PERQ ADD VEIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18634.00||||18634.00||| 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5917.00||||5917.00|286.51|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5917.00||||5917.00|275.66|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5917.00||||5917.00|253.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5917.00||||5917.00|1878.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5917.00||||5917.00|2837.2|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5917.00||||5917.00|3846.05|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5917.00||||5917.00|1332.68|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5917.00||||5917.00|5917|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5917.00||||5917.00|2544.31|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|FMH BENEFIT SERVICES [1390]|FMH [139000]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|FIRST HEALTH [1375]|QUALCHOICE [137513]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MULTIPLAN [1680]|IHC HS [168011]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MULTIPLAN [1680]|HMA [168003]|5917.00||||5917.00|1959.83|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5917.00||||5917.00|1878.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5917.00||||5917.00|315.16|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|TRUSTMARK [2030]|STARMARK [203000]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|CORESOURCE [1315]|CORESOURCE [131500]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|||5917.00||||5917.00|1775.1|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|UMR [2035]|UMR OPTIONS [203501]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5917.00||||5917.00|3287.78|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5917.00||||5917.00|1271.38|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5917.00||||5917.00|266.22|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|GEHA [1415]|GEHA [141500]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|CHAMPVA [1240]|CHAMP VA [124000]|5917.00||||5917.00|4437.75|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5917.00||||5917.00|1437.21|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5917.00||||5917.00|1371.88|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5917.00||||5917.00|275.66|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5917.00||||5917.00|2964.42|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5917.00||||5917.00|2076.87|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5917.00||||5917.00|1242.57|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5917.00||||5917.00|2544.31|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5917.00||||5917.00|2520.64|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5917.00||||5917.00|1907.56|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5917.00||||5917.00|1437.21|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5917.00||||5917.00|3550.2|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|HEALTHNET [1495]|HEALTHNET [149500]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5917.00||||5917.00|5325.3|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5917.00||||5917.00|1306.55|5917|253.55 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5917.00||||5917.00||| 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|AETNA [1015]|AETNA ACO WILCO [101532]|5917.00||||5917.00||| 36038221|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY BONE MARROW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5917.00||||5917.00||| 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6593.00||||6593.00|2808.62|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6593.00||||6593.00|1437.21|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6593.00||||6593.00|694.91|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6593.00||||6593.00|2834.99|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6593.00||||6593.00|3303.09|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6593.00||||6593.00|3955.8|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6593.00||||6593.00|1371.88|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6593.00||||6593.00|1437.21|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6593.00||||6593.00|2314.14|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|HEALTHNET [1495]|HEALTHNET [149500]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MULTIPLAN [1680]|HMA [168003]|6593.00||||6593.00|1959.83|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|TRUSTMARK [2030]|STARMARK [203000]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6593.00||||6593.00|1878.3|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6593.00||||6593.00|3161.34|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6593.00||||6593.00|1332.68|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6593.00||||6593.00|6593|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6593.00||||6593.00|2834.99|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|UMR [2035]|UMR OPTIONS [203501]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6593.00||||6593.00|1907.56|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|FIRST HEALTH [1375]|QUALCHOICE [137513]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6593.00||||6593.00|1384.53|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6593.00||||6593.00|794.5|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MULTIPLAN [1680]|IHC HS [168011]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6593.00||||6593.00|4285.45|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|CORESOURCE [1315]|CORESOURCE [131500]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|||6593.00||||6593.00|1977.9|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6593.00||||6593.00|671.13|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6593.00||||6593.00|3287.78|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6593.00||||6593.00|123.23|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6593.00||||6593.00|1878.3|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6593.00||||6593.00|694.91|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6593.00||||6593.00|722.27|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|GEHA [1415]|GEHA [141500]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6593.00||||6593.00|1306.55|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|CHAMPVA [1240]|CHAMP VA [124000]|6593.00||||6593.00|4944.75|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6593.00||||6593.00|639.18|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6593.00||||6593.00|5933.7|6593|123.23 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6593.00||||6593.00||| 36038505|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NEEDLE BIOPSY LYMPH NODE|AETNA [1015]|AETNA ACO WILCO [101532]|6593.00||||6593.00||| 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1005.00||||1005.00|353.02|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1005.00||||1005.00|497.55|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1005.00||||1005.00|107.81|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1005.00||||1005.00|99.17|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1005.00||||1005.00|481.9|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1005.00||||1005.00|653.25|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1005.00||||1005.00|432.15|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1005.00||||1005.00|832.18|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|UMR [2035]|UMR OPTIONS [203501]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|GEHA [1415]|GEHA [141500]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1005.00||||1005.00|123.26|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MULTIPLAN [1680]|IHC HS [168011]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|HEALTHNET [1495]|HEALTHNET [149500]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1005.00||||1005.00|505.3|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1005.00||||1005.00|497.55|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|TRUSTMARK [2030]|STARMARK [203000]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1005.00||||1005.00|112.06|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|||1005.00||||1005.00|301.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|CHAMPVA [1240]|CHAMP VA [124000]|1005.00||||1005.00|753.75|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|CORESOURCE [1315]|CORESOURCE [131500]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1005.00||||1005.00|380.71|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1005.00||||1005.00|428.13|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1005.00||||1005.00|104.13|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1005.00||||1005.00|107.81|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1005.00||||1005.00|503.51|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1005.00||||1005.00|352.76|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MULTIPLAN [1680]|HMA [168003]|1005.00||||1005.00|519.14|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1005.00||||1005.00|346.1|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1005.00||||1005.00|380.71|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1005.00||||1005.00|211.05|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1005.00||||1005.00|1005|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1005.00||||1005.00|432.15|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1005.00||||1005.00|904.5|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1005.00||||1005.00|363.4|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1005.00||||1005.00|603|1005|99.17 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1005.00||||1005.00||| 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|AETNA [1015]|AETNA ACO WILCO [101532]|1005.00||||1005.00||| 36043752|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE GASTRIC TUBE PHYSICIAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1005.00||||1005.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1998.00||||1998.00|859.14|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1998.00||||1998.00|1198.8|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1998.00||||1998.00|1820.3|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1998.00||||1998.00|851.15|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1998.00||||1998.00|701.3|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|HEALTHNET [1495]|HEALTHNET [149500]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|TRUSTMARK [2030]|STARMARK [203000]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MULTIPLAN [1680]|IHC HS [168011]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1998.00||||1998.00|1998|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|UMR [2035]|UMR OPTIONS [203501]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1998.00||||1998.00|419.58|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1998.00||||1998.00|859.14|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1998.00||||1998.00|1298.7|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|||1998.00||||1998.00|599.4|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|CORESOURCE [1315]|CORESOURCE [131500]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1998.00||||1998.00|958.04|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1998.00||||1998.00|1001|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|CHAMPVA [1240]|CHAMP VA [124000]|1998.00||||1998.00|1498.5|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|GEHA [1415]|GEHA [141500]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1998.00||||1998.00|1798.2|1998|419.58 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MULTIPLAN [1680]|HMA [168003]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1998.00||||1998.00||| 36044500|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT OF LONG GI TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1998.00||||1998.00||| 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|GEHA [1415]|GEHA [141500]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2710.00||||2710.00|859.62|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|CHAMPVA [1240]|CHAMP VA [124000]|2710.00||||2710.00|2032.5|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2710.00||||2710.00|790.68|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2710.00||||2710.00|893.47|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|||2710.00||||2710.00|813|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2710.00||||2710.00|1299.45|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2710.00||||2710.00|982.82|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2710.00||||2710.00|1907.56|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2710.00||||2710.00|2710|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|TRUSTMARK [2030]|STARMARK [203000]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MULTIPLAN [1680]|HMA [168003]|2710.00||||2710.00|1959.83|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MULTIPLAN [1680]|IHC HS [168011]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2710.00||||2710.00|1878.3|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|FMH BENEFIT SERVICES [1390]|FMH [139000]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|HEALTHNET [1495]|HEALTHNET [149500]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2710.00||||2710.00|1165.3|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2710.00||||2710.00|1332.68|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2710.00||||2710.00|2710|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2710.00||||2710.00|1761.5|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|UMR [2035]|UMR OPTIONS [203501]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|FIRST HEALTH [1375]|QUALCHOICE [137513]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2710.00||||2710.00|1437.21|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2710.00||||2710.00|1154.46|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2710.00||||2710.00|859.62|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2710.00||||2710.00|830.21|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2710.00||||2710.00|1437.21|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|CORESOURCE [1315]|CORESOURCE [131500]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2710.00||||2710.00|1878.3|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2710.00||||2710.00|569.1|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2710.00||||2710.00|1371.88|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2710.00||||2710.00|951.21|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2710.00||||2710.00|1626|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2710.00||||2710.00|1165.3|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2710.00||||2710.00|1306.55|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2710.00||||2710.00|1357.71|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2710.00||||2710.00|2439|2710|569.1 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2710.00||||2710.00||| 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|AETNA [1015]|AETNA ACO WILCO [101532]|2710.00||||2710.00||| 36047000|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY LIVER NEEDLE PERC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2710.00||||2710.00||| 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MULTIPLAN [1680]|HMA [168003]|14191.00||||14191.00|6901.66|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14191.00||||14191.00|5061.22|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14191.00||||14191.00|4567.42|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14191.00||||14191.00|6102.13|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14191.00||||14191.00|8514.6|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14191.00||||14191.00|6045.37|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14191.00||||14191.00|4831.17|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14191.00||||14191.00|4411.16|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14191.00||||14191.00|5061.22|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|HEALTHNET [1495]|HEALTHNET [149500]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MULTIPLAN [1680]|IHC HS [168011]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14191.00||||14191.00|6614.56|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14191.00||||14191.00|4747.26|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14191.00||||14191.00|5221.99|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14191.00||||14191.00|6102.13|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14191.00||||14191.00|4693.13|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14191.00||||14191.00|14191|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|UMR [2035]|UMR OPTIONS [203501]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14191.00||||14191.00|6717.62|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14191.00||||14191.00|2980.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|TRUSTMARK [2030]|STARMARK [203000]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14191.00||||14191.00|9224.15|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|||14191.00||||14191.00|4257.3|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14191.00||||14191.00|10985.17|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14191.00||||14191.00|7109.69|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14191.00||||14191.00|4981.04|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14191.00||||14191.00|6614.56|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14191.00||||14191.00|4567.42|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14191.00||||14191.00|6804.58|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|GEHA [1415]|GEHA [141500]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|CORESOURCE [1315]|CORESOURCE [131500]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|CHAMPVA [1240]|CHAMP VA [124000]|14191.00||||14191.00|10643.25|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14191.00||||14191.00|4601.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14191.00||||14191.00|12771.9|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14191.00||||14191.00|4201.11|14191|2980.11 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14191.00||||14191.00||| 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|AETNA [1015]|AETNA ACO WILCO [101532]|14191.00||||14191.00||| 36047382|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ RF ABLATE LIVER TUMOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14191.00||||14191.00||| 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|||4754.00||||4754.00|1426.2|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4754.00||||4754.00|4254.9|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4754.00||||4754.00|2733.86|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|GEHA [1415]|GEHA [141500]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|CHAMPVA [1240]|CHAMP VA [124000]|4754.00||||4754.00|3565.5|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4754.00||||4754.00|2514.61|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|CORESOURCE [1315]|CORESOURCE [131500]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4754.00||||4754.00|2841.51|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4754.00||||4754.00|2279.54|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4754.00||||4754.00|3090.1|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4754.00||||4754.00|2044.22|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4754.00||||4754.00|4754|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|UMR [2035]|UMR OPTIONS [203501]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4754.00||||4754.00|4321.19|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4754.00||||4754.00|3018.92|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4754.00||||4754.00|3125.66|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MULTIPLAN [1680]|HMA [168003]|4754.00||||4754.00|4439.58|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|FMH BENEFIT SERVICES [1390]|FMH [139000]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|HEALTHNET [1495]|HEALTHNET [149500]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4754.00||||4754.00|4254.9|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4754.00||||4754.00|998.34|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|FIRST HEALTH [1375]|QUALCHOICE [137513]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|TRUSTMARK [2030]|STARMARK [203000]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4754.00||||4754.00|3255.69|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4754.00||||4754.00|1668.65|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4754.00||||4754.00|2640.34|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4754.00||||4754.00|2733.86|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MULTIPLAN [1680]|IHC HS [168011]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4754.00||||4754.00|4754|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4754.00||||4754.00|2025.2|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4754.00||||4754.00|3255.69|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4754.00||||4754.00|2959.72|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4754.00||||4754.00|4278.6|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4754.00||||4754.00|2044.22|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4754.00||||4754.00|2852.4|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4754.00||||4754.00|3107.71|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4754.00||||4754.00|2381.75|4754|998.34 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4754.00||||4754.00||| 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|AETNA [1015]|AETNA ACO WILCO [101532]|4754.00||||4754.00||| 36047490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4754.00||||4754.00||| 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|884.00||||884.00|482.27|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|884.00||||884.00|2959.72|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|FIRST HEALTH [1375]|QUALCHOICE [137513]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|884.00||||884.00|3018.92|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|884.00||||884.00|2959.72|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|884.00||||884.00|2959.72|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|UMR [2035]|UMR OPTIONS [203501]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|884.00||||884.00|185.64|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|884.00||||884.00|380.12|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|884.00||||884.00|530.5|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|FMH BENEFIT SERVICES [1390]|FMH [139000]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|884.00||||884.00|574.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|884.00||||884.00|2959.72|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|||884.00||||884.00|265.2|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|884.00||||884.00|464|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|884.00||||884.00|426.8|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|884.00||||884.00|2959.72|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|CHAMPVA [1240]|CHAMP VA [124000]|884.00||||884.00|663|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|GEHA [1415]|GEHA [141500]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|884.00||||884.00|423.88|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|CORESOURCE [1315]|CORESOURCE [131500]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MULTIPLAN [1680]|IHC HS [168011]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MULTIPLAN [1680]|HMA [168003]|884.00||||884.00|4439.58|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|884.00||||884.00|442.88|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|884.00||||884.00|310.28|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|884.00||||884.00|2959.72|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|884.00||||884.00|380.12|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|884.00||||884.00|3255.69|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|884.00||||884.00|376.58|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|884.00||||884.00|530.4|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|884.00||||884.00|464|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|884.00||||884.00|3255.69|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|884.00||||884.00|448.15|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|TRUSTMARK [2030]|STARMARK [203000]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|HEALTHNET [1495]|HEALTHNET [149500]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|884.00||||884.00|884|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|884.00||||884.00|795.6|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|884.00||||884.00|2959.72|4439.58|185.64 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|884.00||||884.00||| 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|884.00||||884.00||| 36047531|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM EXISTING ACCESS|AETNA [1015]|AETNA ACO WILCO [101532]|884.00||||884.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5972.00||||5972.00|2872.19|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|GEHA [1415]|GEHA [141500]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5972.00||||5972.00|2641.91|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|CORESOURCE [1315]|CORESOURCE [131500]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|||5972.00||||5972.00|1791.6|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5972.00||||5972.00|2863.57|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5972.00||||5972.00|5972|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|UMR [2035]|UMR OPTIONS [203501]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|FMH BENEFIT SERVICES [1390]|FMH [139000]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MULTIPLAN [1680]|IHC HS [168011]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|FIRST HEALTH [1375]|QUALCHOICE [137513]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5972.00||||5972.00|1254.12|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5972.00||||5972.00|3881.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|HEALTHNET [1495]|HEALTHNET [149500]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|TRUSTMARK [2030]|STARMARK [203000]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5972.00||||5972.00|3283.81|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5972.00||||5972.00|2567.96|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5972.00||||5972.00|2774.08|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5972.00||||5972.00|2985.28|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|CHAMPVA [1240]|CHAMP VA [124000]|5972.00||||5972.00|4479|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5972.00||||5972.00|2872.19|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5972.00||||5972.00|3583.2|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5972.00||||5972.00|2567.96|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5972.00||||5972.00|5374.8|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5972.00||||5972.00|2544.07|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5972.00||||5972.00|2096.17|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5972.00||||5972.00|2991.97|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5972.00||||5972.00|5972|5972|1254.12 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MULTIPLAN [1680]|HMA [168003]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|AETNA [1015]|AETNA ACO WILCO [101532]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5972.00||||5972.00||| 36047532|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHOLANGIOGRAM NEW ACCESS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5972.00||||5972.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6600.00||||6600.00|2838|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6600.00||||6600.00|2316.6|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6600.00||||6600.00|2811.6|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6600.00||||6600.00|3960|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|HEALTHNET [1495]|HEALTHNET [149500]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MULTIPLAN [1680]|IHC HS [168011]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6600.00||||6600.00|2838|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|UMR [2035]|UMR OPTIONS [203501]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|TRUSTMARK [2030]|STARMARK [203000]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6600.00||||6600.00|1386|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6600.00||||6600.00|6600|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6600.00||||6600.00|4290|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6600.00||||6600.00|6600|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6600.00||||6600.00|3164.7|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|||6600.00||||6600.00|1980|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6600.00||||6600.00|3306.6|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|GEHA [1415]|GEHA [141500]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|CORESOURCE [1315]|CORESOURCE [131500]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|CHAMPVA [1240]|CHAMP VA [124000]|6600.00||||6600.00|4950|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6600.00||||6600.00|5940|6600|1386 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|AETNA [1015]|AETNA ACO WILCO [101532]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|MULTIPLAN [1680]|HMA [168003]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6600.00||||6600.00||| 36047533|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILIARY CATH EXTERNAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|GEHA [1415]|GEHA [141500]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|CORESOURCE [1315]|CORESOURCE [131500]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|||6600.00||||6600.00|1980|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6600.00||||6600.00|3164.7|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6600.00||||6600.00|4290|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6600.00||||6600.00|6600|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6600.00||||6600.00|1386|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|FIRST HEALTH [1375]|QUALCHOICE [137513]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|FMH BENEFIT SERVICES [1390]|FMH [139000]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MULTIPLAN [1680]|IHC HS [168011]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|HEALTHNET [1495]|HEALTHNET [149500]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|TRUSTMARK [2030]|STARMARK [203000]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|UMR [2035]|UMR OPTIONS [203501]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|CHAMPVA [1240]|CHAMP VA [124000]|6600.00||||6600.00|4950|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6600.00||||6600.00|6600|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6600.00||||6600.00|2811.6|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6600.00||||6600.00|5940|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6600.00||||6600.00|2316.6|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6600.00||||6600.00|3306.6|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6600.00||||6600.00|2838|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6600.00||||6600.00|3960|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6600.00||||6600.00|2838|6600|1386 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MULTIPLAN [1680]|HMA [168003]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|AETNA [1015]|AETNA ACO WILCO [101532]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6600.00||||6600.00||| 36047534|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE BILI CATH INTERN-EXTERN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6600.00||||6600.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6930.00||||6930.00|3471.93|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6930.00||||6930.00|2432.43|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6930.00||||6930.00|6930|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|TRUSTMARK [2030]|STARMARK [203000]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|HEALTHNET [1495]|HEALTHNET [149500]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|FIRST HEALTH [1375]|QUALCHOICE [137513]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6930.00||||6930.00|2979.9|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|FMH BENEFIT SERVICES [1390]|FMH [139000]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|UMR [2035]|UMR OPTIONS [203501]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6930.00||||6930.00|1455.3|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6930.00||||6930.00|6930|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MULTIPLAN [1680]|IHC HS [168011]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6930.00||||6930.00|4504.5|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6930.00||||6930.00|4158|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6930.00||||6930.00|3322.94|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|||6930.00||||6930.00|2079|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6930.00||||6930.00|2979.9|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6930.00||||6930.00|2952.18|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|CHAMPVA [1240]|CHAMP VA [124000]|6930.00||||6930.00|5197.5|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|GEHA [1415]|GEHA [141500]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|CORESOURCE [1315]|CORESOURCE [131500]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6930.00||||6930.00|6237|6930|1455.3 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|AETNA [1015]|AETNA ACO WILCO [101532]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MULTIPLAN [1680]|HMA [168003]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6930.00||||6930.00||| 36047535|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVERT EXT BILI CATH INT/EXT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6930.00||||6930.00||| 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6930.00||||6930.00|4254.9|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|CORESOURCE [1315]|CORESOURCE [131500]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6930.00||||6930.00|2641.84|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6930.00||||6930.00|2985.28|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|||6930.00||||6930.00|2079|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6930.00||||6930.00|3322.94|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6930.00||||6930.00|6930|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6930.00||||6930.00|1455.3|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6930.00||||6930.00|4321.19|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|GEHA [1415]|GEHA [141500]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6930.00||||6930.00|3018.92|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MULTIPLAN [1680]|IHC HS [168011]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6930.00||||6930.00|4254.9|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MULTIPLAN [1680]|HMA [168003]|6930.00||||6930.00|4439.58|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6930.00||||6930.00|2979.9|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6930.00||||6930.00|4504.5|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|HEALTHNET [1495]|HEALTHNET [149500]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|TRUSTMARK [2030]|STARMARK [203000]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6930.00||||6930.00|3283.81|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6930.00||||6930.00|2872.19|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|UMR [2035]|UMR OPTIONS [203501]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6930.00||||6930.00|2773.93|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|CHAMPVA [1240]|CHAMP VA [124000]|6930.00||||6930.00|5197.5|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6930.00||||6930.00|3255.69|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6930.00||||6930.00|2872.19|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6930.00||||6930.00|4158|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6930.00||||6930.00|2979.9|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6930.00||||6930.00|3255.69|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6930.00||||6930.00|6237|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6930.00||||6930.00|2952.18|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6930.00||||6930.00|2432.43|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6930.00||||6930.00|2959.72|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6930.00||||6930.00|6930|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6930.00||||6930.00|3471.93|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6930.00||||6930.00|3107.71|6930|1455.3 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6930.00||||6930.00||| 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|AETNA [1015]|AETNA ACO WILCO [101532]|6930.00||||6930.00||| 36047536|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE BILIARY DRAIN CATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6930.00||||6930.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2111.00||||2111.00|615.22|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2111.00||||2111.00|907.73|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2111.00||||2111.00|740.96|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2111.00||||2111.00|899.29|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2111.00||||2111.00|1820.3|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2111.00||||2111.00|1266.6|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|HEALTHNET [1495]|HEALTHNET [149500]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2111.00||||2111.00|907.73|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|UMR [2035]|UMR OPTIONS [203501]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2111.00||||2111.00|728.27|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2111.00||||2111.00|443.31|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2111.00||||2111.00|2111|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|TRUSTMARK [2030]|STARMARK [203000]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2111.00||||2111.00|1372.15|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|FMH BENEFIT SERVICES [1390]|FMH [139000]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MULTIPLAN [1680]|IHC HS [168011]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2111.00||||2111.00|1012.22|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|||2111.00||||2111.00|633.3|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2111.00||||2111.00|636.98|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2111.00||||2111.00|636.98|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2111.00||||2111.00|1057.61|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2111.00||||2111.00|662.06|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|FIRST HEALTH [1375]|QUALCHOICE [137513]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|GEHA [1415]|GEHA [141500]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|CORESOURCE [1315]|CORESOURCE [131500]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|CHAMPVA [1240]|CHAMP VA [124000]|2111.00||||2111.00|1583.25|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2111.00||||2111.00|585.91|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2111.00||||2111.00|1899.9|2111|443.31 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|AETNA [1015]|AETNA ACO WILCO [101532]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|MULTIPLAN [1680]|HMA [168003]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2111.00||||2111.00||| 36047537|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY DRAIN REMOVE W/FLUORO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2111.00||||2111.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12486.00||||12486.00|8115.9|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|GEHA [1415]|GEHA [141500]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|CORESOURCE [1315]|CORESOURCE [131500]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|CHAMPVA [1240]|CHAMP VA [124000]|12486.00||||12486.00|9364.5|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12486.00||||12486.00|5987.04|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12486.00||||12486.00|12486|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12486.00||||12486.00|2622.06|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12486.00||||12486.00|5368.98|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|FMH BENEFIT SERVICES [1390]|FMH [139000]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MULTIPLAN [1680]|IHC HS [168011]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|FIRST HEALTH [1375]|QUALCHOICE [137513]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|HEALTHNET [1495]|HEALTHNET [149500]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|TRUSTMARK [2030]|STARMARK [203000]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|||12486.00||||12486.00|3745.8|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|UMR [2035]|UMR OPTIONS [203501]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12486.00||||12486.00|10985.17|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12486.00||||12486.00|6255.49|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12486.00||||12486.00|5319.04|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12486.00||||12486.00|4382.59|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12486.00||||12486.00|5368.98|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12486.00||||12486.00|7491.6|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12486.00||||12486.00|11237.4|12486|2622.06 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MULTIPLAN [1680]|HMA [168003]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|AETNA [1015]|AETNA ACO WILCO [101532]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12486.00||||12486.00||| 36047538|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BIL DUCT EXIST ACC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12486.00||||12486.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13111.00||||13111.00|6568.61|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13111.00||||13111.00|4601.96|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13111.00||||13111.00|5637.73|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13111.00||||13111.00|10985.17|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13111.00||||13111.00|7866.6|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|TRUSTMARK [2030]|STARMARK [203000]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|HEALTHNET [1495]|HEALTHNET [149500]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13111.00||||13111.00|5637.73|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|UMR [2035]|UMR OPTIONS [203501]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13111.00||||13111.00|2753.31|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13111.00||||13111.00|13111|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13111.00||||13111.00|8522.15|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13111.00||||13111.00|6286.72|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|||13111.00||||13111.00|3933.3|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13111.00||||13111.00|5585.29|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|CHAMPVA [1240]|CHAMP VA [124000]|13111.00||||13111.00|9833.25|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|CORESOURCE [1315]|CORESOURCE [131500]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|GEHA [1415]|GEHA [141500]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MULTIPLAN [1680]|IHC HS [168011]|13111.00||||13111.00|11799.9|13111|2753.31 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|AETNA [1015]|AETNA ACO WILCO [101532]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13111.00||||13111.00||| 36047540|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE STENT BILI NEW W/BILCATH|MULTIPLAN [1680]|HMA [168003]|13111.00||||13111.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|GEHA [1415]|GEHA [141500]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|CORESOURCE [1315]|CORESOURCE [131500]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|||585.00||||585.00|175.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|585.00||||585.00|280.51|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|585.00||||585.00|380.25|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|585.00||||585.00|585|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|FMH BENEFIT SERVICES [1390]|FMH [139000]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MULTIPLAN [1680]|IHC HS [168011]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|FIRST HEALTH [1375]|QUALCHOICE [137513]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|585.00||||585.00|122.85|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|HEALTHNET [1495]|HEALTHNET [149500]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|TRUSTMARK [2030]|STARMARK [203000]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|UMR [2035]|UMR OPTIONS [203501]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|585.00||||585.00|251.55|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|CHAMPVA [1240]|CHAMP VA [124000]|585.00||||585.00|438.75|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|585.00||||585.00|351|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|585.00||||585.00|251.55|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|585.00||||585.00|526.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|585.00||||585.00|249.21|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|585.00||||585.00|205.34|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|585.00||||585.00|293.09|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|585.00||||585.00|292.5|585|122.85 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MULTIPLAN [1680]|HMA [168003]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|AETNA [1015]|AETNA ACO WILCO [101532]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|585.00||||585.00||| 36047543|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY BX ENDOLUMINAL ALL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|585.00||||585.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7332.00||||7332.00|3152.76|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7332.00||||7332.00|3673.33|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7332.00||||7332.00|2573.53|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7332.00||||7332.00|3123.43|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7332.00||||7332.00|4399.2|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|TRUSTMARK [2030]|STARMARK [203000]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|HEALTHNET [1495]|HEALTHNET [149500]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7332.00||||7332.00|3152.76|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MULTIPLAN [1680]|IHC HS [168011]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|UMR [2035]|UMR OPTIONS [203501]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7332.00||||7332.00|1539.72|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7332.00||||7332.00|7332|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7332.00||||7332.00|7044.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7332.00||||7332.00|4765.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7332.00||||7332.00|3515.69|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|||7332.00||||7332.00|2199.6|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|GEHA [1415]|GEHA [141500]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|CORESOURCE [1315]|CORESOURCE [131500]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|CHAMPVA [1240]|CHAMP VA [124000]|7332.00||||7332.00|5499|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7332.00||||7332.00|6598.8|7332|1539.72 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|AETNA [1015]|AETNA ACO WILCO [101532]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|MULTIPLAN [1680]|HMA [168003]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7332.00||||7332.00||| 36047555|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BILIARY ENDSC W/DILT W/O STENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7332.00||||7332.00||| 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|CORESOURCE [1315]|CORESOURCE [131500]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5709.00||||5709.00|1878.3|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|CHAMPVA [1240]|CHAMP VA [124000]|5709.00||||5709.00|4281.75|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5709.00||||5709.00|790.68|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|GEHA [1415]|GEHA [141500]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5709.00||||5709.00|1306.55|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5709.00||||5709.00|1306.55|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5709.00||||5709.00|859.62|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5709.00||||5709.00|2737.47|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5709.00||||5709.00|3710.85|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5709.00||||5709.00|5709|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5709.00||||5709.00|1198.89|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|UMR [2035]|UMR OPTIONS [203501]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5709.00||||5709.00|982.82|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5709.00||||5709.00|2454.87|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5709.00||||5709.00|1306.55|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|MULTIPLAN [1680]|IHC HS [168011]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5709.00||||5709.00|1878.3|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|MULTIPLAN [1680]|HMA [168003]|5709.00||||5709.00|1959.83|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5709.00||||5709.00|1306.55|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5709.00||||5709.00|1306.55|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5709.00||||5709.00|1306.55|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5709.00||||5709.00|1306.55|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5709.00||||5709.00|1332.68|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|HEALTHNET [1495]|HEALTHNET [149500]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|TRUSTMARK [2030]|STARMARK [203000]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|||5709.00||||5709.00|1712.7|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE 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[289500]|5709.00||||5709.00|1437.21|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5709.00||||5709.00|859.62|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5709.00||||5709.00|5138.1|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5709.00||||5709.00|3425.4|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5709.00||||5709.00|1371.88|5709|790.68 36048102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY PANCREAS NEEDLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5709.00||||5709.00|3287.78|5709|790.68 36048102|EAP|0360 - OPERATING ROOM 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- OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5906.00||||5906.00|2515.96|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5906.00||||5906.00|785.51|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5906.00||||5906.00|1820.3|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5906.00||||5906.00|489.37|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5906.00||||5906.00|822.91|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|TRUSTMARK [2030]|STARMARK [203000]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MULTIPLAN [1680]|HMA [168003]|5906.00||||5906.00|1122.16|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5906.00||||5906.00|763.07|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5906.00||||5906.00|559.5|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5906.00||||5906.00|2539.58|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|UMR [2035]|UMR OPTIONS [203501]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5906.00||||5906.00|1092.23|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH 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PARACENTESIS W/IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MULTIPLAN [1680]|IHC HS [168011]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5906.00||||5906.00|3838.9|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5906.00||||5906.00|2831.93|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5906.00||||5906.00|3543.6|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|||5906.00||||5906.00|1771.8|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5906.00||||5906.00|489.37|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5906.00||||5906.00|2958.91|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5906.00||||5906.00|748.1|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5906.00||||5906.00|450.12|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|5906.00||||5906.00|4429.5|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|GEHA [1415]|GEHA [141500]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5906.00||||5906.00|1075.47|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5906.00||||5906.00|508.64|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5906.00||||5906.00|5315.4|5906|450.12 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5906.00||||5906.00||| 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|5906.00||||5906.00||| 36049083|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABD PARACENTESIS W/IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5906.00||||5906.00||| 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|CORESOURCE [1315]|CORESOURCE [131500]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2887.00||||2887.00|1878.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2887.00||||2887.00|790.68|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|GEHA [1415]|GEHA [141500]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2887.00||||2887.00|859.62|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|||2887.00||||2887.00|866.1|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2887.00||||2887.00|1384.32|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2887.00||||2887.00|2887|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2887.00||||2887.00|606.27|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2887.00||||2887.00|1907.56|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2887.00||||2887.00|1332.68|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2887.00||||2887.00|1241.41|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MULTIPLAN [1680]|IHC HS [168011]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2887.00||||2887.00|1878.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MULTIPLAN [1680]|HMA [168003]|2887.00||||2887.00|1959.83|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|HEALTHNET [1495]|HEALTHNET [149500]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|TRUSTMARK [2030]|STARMARK [203000]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2887.00||||2887.00|1876.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2887.00||||2887.00|982.82|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|UMR [2035]|UMR OPTIONS [203501]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2887.00||||2887.00|830.21|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|CHAMPVA [1240]|CHAMP VA [124000]|2887.00||||2887.00|2165.25|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2887.00||||2887.00|1437.21|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2887.00||||2887.00|859.62|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2887.00||||2887.00|1732.2|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2887.00||||2887.00|893.47|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2887.00||||2887.00|1013.34|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2887.00||||2887.00|2887|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2887.00||||2887.00|1306.55|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2887.00||||2887.00|1437.21|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2887.00||||2887.00|2598.3|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2887.00||||2887.00|1446.39|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2887.00||||2887.00|1241.41|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2887.00||||2887.00|1229.86|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2887.00||||2887.00|1371.88|2887|606.27 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2887.00||||2887.00||| 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|AETNA [1015]|AETNA ACO WILCO [101532]|2887.00||||2887.00||| 36049180|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY ABDOMINAL MASS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2887.00||||2887.00||| 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3789.00||||3789.00|1200.2|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3789.00||||3789.00|638.72|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3789.00||||3789.00|1629.27|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3789.00||||3789.00|1898.29|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3789.00||||3789.00|1329.94|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3789.00||||3789.00|609.69|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3789.00||||3789.00|2273.4|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3789.00||||3789.00|638.72|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3789.00||||3789.00|834.75|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3789.00||||3789.00|1629.27|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3789.00||||3789.00|592.27|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|UMR [2035]|UMR OPTIONS [203501]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3789.00||||3789.00|1420.82|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3789.00||||3789.00|847.76|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|TRUSTMARK [2030]|STARMARK [203000]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3789.00||||3789.00|795.69|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3789.00||||3789.00|3789|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MULTIPLAN [1680]|HMA [168003]|3789.00||||3789.00|870.99|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3789.00||||3789.00|2462.85|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3789.00||||3789.00|1242.72|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MULTIPLAN [1680]|IHC HS [168011]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3789.00||||3789.00|1816.83|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|||3789.00||||3789.00|1136.7|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3789.00||||3789.00|1614.11|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3789.00||||3789.00|1242.72|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3789.00||||3789.00|1384.76|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|HEALTHNET [1495]|HEALTHNET [149500]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|CORESOURCE [1315]|CORESOURCE [131500]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|GEHA [1415]|GEHA [141500]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3789.00||||3789.00|1291.65|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3789.00||||3789.00|834.75|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|CHAMPVA [1240]|CHAMP VA [124000]|3789.00||||3789.00|2841.75|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3789.00||||3789.00|1143.05|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3789.00||||3789.00|580.66|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3789.00||||3789.00|3410.1|3789|580.66 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3789.00||||3789.00||| 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|AETNA [1015]|AETNA ACO WILCO [101532]|3789.00||||3789.00||| 36049185|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SCLEROTX OF FLUID COLLECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3789.00||||3789.00||| 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4030.00||||4030.00|1496.85|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4030.00||||4030.00|1932.39|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4030.00||||4030.00|2619.5|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4030.00||||4030.00|4030|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4030.00||||4030.00|846.3|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|UMR [2035]|UMR OPTIONS [203501]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4030.00||||4030.00|1332.68|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4030.00||||4030.00|1711.37|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|FIRST HEALTH [1375]|QUALCHOICE [137513]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|FMH BENEFIT SERVICES [1390]|FMH [139000]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MULTIPLAN [1680]|IHC HS [168011]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4030.00||||4030.00|1878.3|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4030.00||||4030.00|1732.9|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|HEALTHNET [1495]|HEALTHNET [149500]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|TRUSTMARK [2030]|STARMARK [203000]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4030.00||||4030.00|1907.56|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4030.00||||4030.00|1445.64|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|||4030.00||||4030.00|1209|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MULTIPLAN [1680]|HMA [168003]|4030.00||||4030.00|1959.83|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4030.00||||4030.00|1437.21|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4030.00||||4030.00|1496.85|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4030.00||||4030.00|1732.9|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4030.00||||4030.00|3287.78|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4030.00||||4030.00|1437.21|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4030.00||||4030.00|1716.78|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4030.00||||4030.00|1306.55|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4030.00||||4030.00|1414.53|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4030.00||||4030.00|2019.03|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4030.00||||4030.00|1371.88|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4030.00||||4030.00|2418|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|GEHA [1415]|GEHA [141500]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4030.00||||4030.00|1555.79|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|CORESOURCE [1315]|CORESOURCE [131500]|4030.00||||4030.00|3627|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4030.00||||4030.00|1878.3|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|CHAMPVA [1240]|CHAMP VA [124000]|4030.00||||4030.00|3022.5|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4030.00||||4030.00|1376.8|4030|846.3 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4030.00||||4030.00||| 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|AETNA [1015]|AETNA ACO WILCO [101532]|4030.00||||4030.00||| 36049405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID COLXN VISC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4030.00||||4030.00||| 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4029.00||||4029.00|1437.21|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4029.00||||4029.00|3287.78|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4029.00||||4029.00|1732.47|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4029.00||||4029.00|2018.53|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4029.00||||4029.00|1716.35|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4029.00||||4029.00|1414.18|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4029.00||||4029.00|1371.88|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4029.00||||4029.00|1496.85|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4029.00||||4029.00|1437.21|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|TRUSTMARK [2030]|STARMARK [203000]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|HEALTHNET [1495]|HEALTHNET [149500]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4029.00||||4029.00|1878.3|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MULTIPLAN [1680]|HMA [168003]|4029.00||||4029.00|1959.83|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|FMH BENEFIT SERVICES [1390]|FMH [139000]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|FIRST HEALTH [1375]|QUALCHOICE [137513]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MULTIPLAN [1680]|IHC HS [168011]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4029.00||||4029.00|1732.47|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4029.00||||4029.00|1711.37|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4029.00||||4029.00|1332.68|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|UMR [2035]|UMR OPTIONS [203501]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4029.00||||4029.00|1907.56|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4029.00||||4029.00|1445.64|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4029.00||||4029.00|846.09|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4029.00||||4029.00|2417.4|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4029.00||||4029.00|4029|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4029.00||||4029.00|2618.85|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4029.00||||4029.00|1931.91|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|||4029.00||||4029.00|1208.7|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4029.00||||4029.00|1496.85|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4029.00||||4029.00|1306.55|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4029.00||||4029.00|1376.8|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|CHAMPVA [1240]|CHAMP VA [124000]|4029.00||||4029.00|3021.75|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4029.00||||4029.00|1878.3|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|CORESOURCE [1315]|CORESOURCE [131500]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4029.00||||4029.00|1555.79|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|GEHA [1415]|GEHA [141500]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4029.00||||4029.00|3626.1|4029|846.09 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4029.00||||4029.00||| 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|AETNA [1015]|AETNA ACO WILCO [101532]|4029.00||||4029.00||| 36049406|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH DRAIN PERITONEAL/RETROPER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4029.00||||4029.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|CORESOURCE [1315]|CORESOURCE [131500]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|||3920.00||||3920.00|1176|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3920.00||||3920.00|1879.64|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3920.00||||3920.00|3920|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|UMR [2035]|UMR OPTIONS [203501]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3920.00||||3920.00|1685.6|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|FIRST HEALTH [1375]|QUALCHOICE [137513]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|FMH BENEFIT SERVICES [1390]|FMH [139000]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MULTIPLAN [1680]|IHC HS [168011]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3920.00||||3920.00|823.2|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|HEALTHNET [1495]|HEALTHNET [149500]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3920.00||||3920.00|2548|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|TRUSTMARK [2030]|STARMARK [203000]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|CHAMPVA [1240]|CHAMP VA [124000]|3920.00||||3920.00|2940|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|GEHA [1415]|GEHA [141500]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3920.00||||3920.00|2352|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3920.00||||3920.00|1685.6|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3920.00||||3920.00|1963.92|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3920.00||||3920.00|1375.92|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3920.00||||3920.00|1669.92|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3920.00||||3920.00|3287.78|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3920.00||||3920.00|3528|3920|823.2 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MULTIPLAN [1680]|HMA [168003]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|AETNA [1015]|AETNA ACO WILCO [101532]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3920.00||||3920.00||| 36049407|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMAGE CATH FLUID TRNS/VGNL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3920.00||||3920.00||| 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7677.00||||7677.00|3255.69|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7677.00||||7677.00|3301.11|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7677.00||||7677.00|3846.18|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7677.00||||7677.00|2694.63|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7677.00||||7677.00|3107.71|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7677.00||||7677.00|4606.2|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7677.00||||7677.00|2756.8|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7677.00||||7677.00|3255.69|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7677.00||||7677.00|2662.49|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|HEALTHNET [1495]|HEALTHNET [149500]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MULTIPLAN [1680]|IHC HS [168011]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7677.00||||7677.00|4254.9|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MULTIPLAN [1680]|HMA [168003]|7677.00||||7677.00|4439.58|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|FMH BENEFIT SERVICES [1390]|FMH [139000]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|FIRST HEALTH [1375]|QUALCHOICE [137513]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7677.00||||7677.00|3301.11|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7677.00||||7677.00|3151.89|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7677.00||||7677.00|3018.92|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|TRUSTMARK [2030]|STARMARK [203000]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|UMR [2035]|UMR OPTIONS [203501]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7677.00||||7677.00|4321.19|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7677.00||||7677.00|1612.17|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7677.00||||7677.00|7677|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7677.00||||7677.00|4990.05|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7677.00||||7677.00|3270.4|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7677.00||||7677.00|3681.12|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|||7677.00||||7677.00|2303.1|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7677.00||||7677.00|7044.8|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7677.00||||7677.00|2756.8|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7677.00||||7677.00|2959.72|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7677.00||||7677.00|2535.71|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|CHAMPVA [1240]|CHAMP VA [124000]|7677.00||||7677.00|5757.75|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7677.00||||7677.00|4254.9|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|CORESOURCE [1315]|CORESOURCE [131500]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7677.00||||7677.00|2865.35|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|GEHA [1415]|GEHA [141500]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7677.00||||7677.00|6909.3|7677|1612.17 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|AETNA [1015]|AETNA ACO WILCO [101532]|7677.00||||7677.00||| 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7677.00||||7677.00||| 36049418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INS TUN INTRAPER CATH W/O PORT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7677.00||||7677.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|GEHA [1415]|GEHA [141500]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7618.00||||7618.00|2160.25|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|CHAMPVA [1240]|CHAMP VA [124000]|7618.00||||7618.00|5713.5|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7618.00||||7618.00|1911.77|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7618.00||||7618.00|2078.41|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|||7618.00||||7618.00|2285.4|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7618.00||||7618.00|3652.83|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7618.00||||7618.00|4951.7|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7618.00||||7618.00|7618|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7618.00||||7618.00|1599.78|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|UMR [2035]|UMR OPTIONS [203501]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7618.00||||7618.00|2376.27|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7618.00||||7618.00|3275.74|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|FIRST HEALTH [1375]|QUALCHOICE [137513]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|FMH BENEFIT SERVICES [1390]|FMH [139000]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MULTIPLAN [1680]|IHC HS [168011]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|HEALTHNET [1495]|HEALTHNET [149500]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|TRUSTMARK [2030]|STARMARK [203000]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7618.00||||7618.00|2007.41|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|CORESOURCE [1315]|CORESOURCE [131500]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7618.00||||7618.00|2078.41|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7618.00||||7618.00|4570.8|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7618.00||||7618.00|3275.74|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7618.00||||7618.00|3816.62|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7618.00||||7618.00|2673.92|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7618.00||||7618.00|3245.27|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7618.00||||7618.00|6313.87|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7618.00||||7618.00|6856.2|7618|1599.78 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MULTIPLAN [1680]|HMA [168003]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|AETNA [1015]|AETNA ACO WILCO [101532]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7618.00||||7618.00||| 36049422|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVAL TUNNEL PERITO CATHETER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7618.00||||7618.00||| 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3205.00||||3205.00|1630.7|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3205.00||||3205.00|3205|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3205.00||||3205.00|1378.15|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3205.00||||3205.00|1365.33|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3205.00||||3205.00|1124.96|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3205.00||||3205.00|1556.58|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3205.00||||3205.00|1361.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3205.00||||3205.00|1630.7|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|TRUSTMARK [2030]|STARMARK [203000]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3205.00||||3205.00|2131.18|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MULTIPLAN [1680]|HMA [168003]|3205.00||||3205.00|2223.68|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MULTIPLAN [1680]|IHC HS [168011]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3205.00||||3205.00|1378.15|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3205.00||||3205.00|1556.62|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3205.00||||3205.00|1512.11|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|HEALTHNET [1495]|HEALTHNET [149500]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|UMR [2035]|UMR OPTIONS [203501]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3205.00||||3205.00|2164.39|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3205.00||||3205.00|673.05|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3205.00||||3205.00|1314.91|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3205.00||||3205.00|1923|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3205.00||||3205.00|3205|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3205.00||||3205.00|2083.25|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3205.00||||3205.00|1536.8|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|||3205.00||||3205.00|961.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3205.00||||3205.00|1361.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3205.00||||3205.00|1605.71|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3205.00||||3205.00|1482.46|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3205.00||||3205.00|1252.3|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|CHAMPVA [1240]|CHAMP VA [124000]|3205.00||||3205.00|2403.75|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3205.00||||3205.00|2131.18|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|CORESOURCE [1315]|CORESOURCE [131500]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3205.00||||3205.00|1415.11|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|GEHA [1415]|GEHA [141500]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3205.00||||3205.00|2884.5|3205|673.05 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3205.00||||3205.00||| 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|AETNA [1015]|AETNA ACO WILCO [101532]|3205.00||||3205.00||| 36049423|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE ABSCESS/CYST DRAINAGE CATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3205.00||||3205.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|CORESOURCE [1315]|CORESOURCE [131500]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|CHAMPVA [1240]|CHAMP VA [124000]|917.00||||917.00|687.75|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|||917.00||||917.00|275.1|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|917.00||||917.00|439.7|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|917.00||||917.00|917|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|917.00||||917.00|192.57|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|917.00||||917.00|394.31|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|UMR [2035]|UMR OPTIONS [203501]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MULTIPLAN [1680]|IHC HS [168011]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|917.00||||917.00|596.05|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|HEALTHNET [1495]|HEALTHNET [149500]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|TRUSTMARK [2030]|STARMARK [203000]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|917.00||||917.00|550.2|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|GEHA [1415]|GEHA [141500]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|917.00||||917.00|394.31|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|917.00||||917.00|459.42|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|917.00||||917.00|321.87|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|917.00||||917.00|390.64|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|917.00||||917.00|458.5|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|917.00||||917.00|825.3|917|192.57 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MULTIPLAN [1680]|HMA [168003]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|AETNA [1015]|AETNA ACO WILCO [101532]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|917.00||||917.00||| 36049424|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST VIA CATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|917.00||||917.00||| 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3450.00||||3450.00|1630.7|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3450.00||||3450.00|1483.5|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3450.00||||3450.00|1728.45|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3450.00||||3450.00|1210.95|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3450.00||||3450.00|1469.7|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3450.00||||3450.00|1556.58|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3450.00||||3450.00|2070|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3450.00||||3450.00|1630.7|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3450.00||||3450.00|751.17|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|HEALTHNET [1495]|HEALTHNET [149500]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MULTIPLAN [1680]|IHC HS [168011]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3450.00||||3450.00|2131.18|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MULTIPLAN [1680]|HMA [168003]|3450.00||||3450.00|2223.68|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|FMH BENEFIT SERVICES [1390]|FMH [139000]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|FIRST HEALTH [1375]|QUALCHOICE [137513]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3450.00||||3450.00|1483.5|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3450.00||||3450.00|889.23|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3450.00||||3450.00|1512.11|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|TRUSTMARK [2030]|STARMARK [203000]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|UMR [2035]|UMR OPTIONS [203501]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3450.00||||3450.00|2164.39|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3450.00||||3450.00|724.5|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3450.00||||3450.00|777.77|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3450.00||||3450.00|3450|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3450.00||||3450.00|2242.5|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3450.00||||3450.00|1654.28|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|||3450.00||||3450.00|1035|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3450.00||||3450.00|3450|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3450.00||||3450.00|777.77|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3450.00||||3450.00|1482.46|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3450.00||||3450.00|715.4|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|CHAMPVA [1240]|CHAMP VA [124000]|3450.00||||3450.00|2587.5|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3450.00||||3450.00|2131.18|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|CORESOURCE [1315]|CORESOURCE [131500]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3450.00||||3450.00|808.39|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|GEHA [1415]|GEHA [141500]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3450.00||||3450.00|3105|3450|715.4 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3450.00||||3450.00||| 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|AETNA [1015]|AETNA ACO WILCO [101532]|3450.00||||3450.00||| 36049440|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT GASTRO TUBE W/ FLUORO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3450.00||||3450.00||| 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|GEHA [1415]|GEHA [141500]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2666.00||||2666.00|808.39|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2666.00||||2666.00|2131.18|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|CHAMPVA [1240]|CHAMP VA [124000]|2666.00||||2666.00|1999.5|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2666.00||||2666.00|715.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2666.00||||2666.00|777.77|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2666.00||||2666.00|1278.35|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2666.00||||2666.00|1732.9|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2666.00||||2666.00|2666|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2666.00||||2666.00|559.86|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2666.00||||2666.00|2164.39|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|UMR [2035]|UMR OPTIONS [203501]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2666.00||||2666.00|1512.11|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2666.00||||2666.00|889.23|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2666.00||||2666.00|1146.38|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|FIRST HEALTH [1375]|QUALCHOICE [137513]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|FMH BENEFIT SERVICES [1390]|FMH [139000]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MULTIPLAN [1680]|IHC HS [168011]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2666.00||||2666.00|2131.18|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MULTIPLAN [1680]|HMA [168003]|2666.00||||2666.00|2223.68|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|||2666.00||||2666.00|799.8|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|HEALTHNET [1495]|HEALTHNET [149500]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|TRUSTMARK [2030]|STARMARK [203000]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2666.00||||2666.00|751.17|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2666.00||||2666.00|1630.7|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2666.00||||2666.00|777.77|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|CORESOURCE [1315]|CORESOURCE [131500]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2666.00||||2666.00|1599.6|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2666.00||||2666.00|1556.58|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2666.00||||2666.00|1146.38|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2666.00||||2666.00|1335.67|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2666.00||||2666.00|935.77|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2666.00||||2666.00|1135.72|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2666.00||||2666.00|2666|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2666.00||||2666.00|1482.46|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2666.00||||2666.00|1630.7|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2666.00||||2666.00|2399.4|2666|559.86 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2666.00||||2666.00||| 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|AETNA [1015]|AETNA ACO WILCO [101532]|2666.00||||2666.00||| 36049441|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2666.00||||2666.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1969.00||||1969.00|1969|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1969.00||||1969.00|846.67|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1969.00||||1969.00|691.12|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1969.00||||1969.00|838.79|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|TRUSTMARK [2030]|STARMARK [203000]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|HEALTHNET [1495]|HEALTHNET [149500]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MULTIPLAN [1680]|IHC HS [168011]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1969.00||||1969.00|846.67|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|UMR [2035]|UMR OPTIONS [203501]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1969.00||||1969.00|413.49|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1969.00||||1969.00|1969|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1969.00||||1969.00|1279.85|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1969.00||||1969.00|1181.4|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1969.00||||1969.00|986.47|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1969.00||||1969.00|944.14|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|||1969.00||||1969.00|590.7|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|CHAMPVA [1240]|CHAMP VA [124000]|1969.00||||1969.00|1476.75|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|CORESOURCE [1315]|CORESOURCE [131500]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|GEHA [1415]|GEHA [141500]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1969.00||||1969.00|1772.1|1969|413.49 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|AETNA [1015]|AETNA ACO WILCO [101532]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|MULTIPLAN [1680]|HMA [168003]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1969.00||||1969.00||| 36049446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CONVRT GASTROTUBE TO GASTRO JE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1969.00||||1969.00||| 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|GEHA [1415]|GEHA [141500]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2666.00||||2666.00|589.16|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|CORESOURCE [1315]|CORESOURCE [131500]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2666.00||||2666.00|1075.47|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2666.00||||2666.00|521.38|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|||2666.00||||2666.00|799.8|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2666.00||||2666.00|1278.35|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2666.00||||2666.00|1732.9|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2666.00||||2666.00|2666|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2666.00||||2666.00|1092.23|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2666.00||||2666.00|648.08|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2666.00||||2666.00|1146.38|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|FIRST HEALTH [1375]|QUALCHOICE [137513]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|FMH BENEFIT SERVICES [1390]|FMH [139000]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2666.00||||2666.00|763.07|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|UMR [2035]|UMR OPTIONS [203501]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2666.00||||2666.00|559.86|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MULTIPLAN [1680]|IHC HS [168011]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2666.00||||2666.00|1075.47|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MULTIPLAN [1680]|HMA [168003]|2666.00||||2666.00|1122.16|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|HEALTHNET [1495]|HEALTHNET [149500]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2666.00||||2666.00|566.84|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|TRUSTMARK [2030]|STARMARK [203000]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2666.00||||2666.00|547.44|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|CHAMPVA [1240]|CHAMP VA [124000]|2666.00||||2666.00|1999.5|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2666.00||||2666.00|822.91|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2666.00||||2666.00|566.84|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2666.00||||2666.00|1599.6|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2666.00||||2666.00|785.51|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2666.00||||2666.00|1146.38|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2666.00||||2666.00|1335.67|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2666.00||||2666.00|935.77|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2666.00||||2666.00|1135.72|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2666.00||||2666.00|1820.3|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2666.00||||2666.00|748.1|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2666.00||||2666.00|822.91|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2666.00||||2666.00|2399.4|2666|521.38 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2666.00||||2666.00||| 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|AETNA [1015]|AETNA ACO WILCO [101532]|2666.00||||2666.00||| 36049450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACEMENT GASTROSTOMY FLUORO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2666.00||||2666.00||| 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1309.00||||1309.00|822.91|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1309.00||||1309.00|1309|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1309.00||||1309.00|562.87|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1309.00||||1309.00|655.81|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1309.00||||1309.00|459.46|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1309.00||||1309.00|785.51|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1309.00||||1309.00|785.4|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1309.00||||1309.00|822.91|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1309.00||||1309.00|547.44|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|TRUSTMARK [2030]|STARMARK [203000]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|HEALTHNET [1495]|HEALTHNET [149500]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MULTIPLAN [1680]|IHC HS [168011]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1309.00||||1309.00|1075.47|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MULTIPLAN [1680]|HMA [168003]|1309.00||||1309.00|1122.16|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1309.00||||1309.00|562.87|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1309.00||||1309.00|648.08|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1309.00||||1309.00|763.07|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|UMR [2035]|UMR OPTIONS [203501]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1309.00||||1309.00|1092.23|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1309.00||||1309.00|274.89|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1309.00||||1309.00|1309|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1309.00||||1309.00|566.84|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1309.00||||1309.00|557.63|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1309.00||||1309.00|850.85|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1309.00||||1309.00|627.67|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|||1309.00||||1309.00|392.7|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1309.00||||1309.00|566.84|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1309.00||||1309.00|748.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1309.00||||1309.00|521.38|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|CHAMPVA [1240]|CHAMP VA [124000]|1309.00||||1309.00|981.75|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1309.00||||1309.00|1075.47|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|CORESOURCE [1315]|CORESOURCE [131500]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1309.00||||1309.00|589.16|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|GEHA [1415]|GEHA [141500]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1309.00||||1309.00|1178.1|1309|274.89 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1309.00||||1309.00||| 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|AETNA [1015]|AETNA ACO WILCO [101532]|1309.00||||1309.00||| 36049451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLACE DUOD/JEJ TUBE PERC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1309.00||||1309.00||| 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|GEHA [1415]|GEHA [141500]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1361.00||||1361.00|589.16|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1361.00||||1361.00|1075.47|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|CHAMPVA [1240]|CHAMP VA [124000]|1361.00||||1361.00|1020.75|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1361.00||||1361.00|521.38|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1361.00||||1361.00|566.84|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1361.00||||1361.00|652.6|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1361.00||||1361.00|884.65|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1361.00||||1361.00|1361|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1361.00||||1361.00|285.81|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1361.00||||1361.00|1092.23|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|UMR [2035]|UMR OPTIONS [203501]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1361.00||||1361.00|763.07|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1361.00||||1361.00|648.08|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1361.00||||1361.00|585.23|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|FIRST HEALTH [1375]|QUALCHOICE [137513]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|FMH BENEFIT SERVICES [1390]|FMH [139000]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MULTIPLAN [1680]|IHC HS [168011]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1361.00||||1361.00|1075.47|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MULTIPLAN [1680]|HMA [168003]|1361.00||||1361.00|1122.16|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|||1361.00||||1361.00|408.3|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|HEALTHNET [1495]|HEALTHNET [149500]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|TRUSTMARK [2030]|STARMARK [203000]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1361.00||||1361.00|547.44|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|CORESOURCE [1315]|CORESOURCE [131500]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1361.00||||1361.00|822.91|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1361.00||||1361.00|566.84|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1361.00||||1361.00|816.6|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1361.00||||1361.00|785.51|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1361.00||||1361.00|585.23|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1361.00||||1361.00|681.86|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1361.00||||1361.00|477.71|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1361.00||||1361.00|579.79|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1361.00||||1361.00|1361|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1361.00||||1361.00|748.1|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1361.00||||1361.00|822.91|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1361.00||||1361.00|1224.9|1361|285.81 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1361.00||||1361.00||| 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|AETNA [1015]|AETNA ACO WILCO [101532]|1361.00||||1361.00||| 36049452|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REPLAEMENT GJ TUBE FLUORO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1361.00||||1361.00||| 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1153.00||||1153.00|822.91|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1153.00||||1153.00|1153|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1153.00||||1153.00|495.79|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1153.00||||1153.00|491.18|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1153.00||||1153.00|404.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1153.00||||1153.00|785.51|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1153.00||||1153.00|691.8|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1153.00||||1153.00|566.84|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1153.00||||1153.00|822.91|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|TRUSTMARK [2030]|STARMARK [203000]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MULTIPLAN [1680]|IHC HS [168011]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1153.00||||1153.00|1075.47|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MULTIPLAN [1680]|HMA [168003]|1153.00||||1153.00|1122.16|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1153.00||||1153.00|495.79|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1153.00||||1153.00|648.08|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1153.00||||1153.00|763.07|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|HEALTHNET [1495]|HEALTHNET [149500]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|UMR [2035]|UMR OPTIONS [203501]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1153.00||||1153.00|1092.23|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1153.00||||1153.00|242.13|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1153.00||||1153.00|547.44|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1153.00||||1153.00|1153|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1153.00||||1153.00|749.45|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1153.00||||1153.00|577.65|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1153.00||||1153.00|552.86|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|||1153.00||||1153.00|345.9|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1153.00||||1153.00|566.84|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1153.00||||1153.00|748.1|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1153.00||||1153.00|521.38|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|CHAMPVA [1240]|CHAMP VA [124000]|1153.00||||1153.00|864.75|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1153.00||||1153.00|1075.47|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|CORESOURCE [1315]|CORESOURCE [131500]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1153.00||||1153.00|589.16|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|GEHA [1415]|GEHA [141500]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1153.00||||1153.00|1037.7|1153|242.13 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1153.00||||1153.00||| 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|1153.00||||1153.00||| 36049460|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC MECH REMOVAL OBST G TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1153.00||||1153.00||| 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|840.00||||840.00|206.95|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|CORESOURCE [1315]|CORESOURCE [131500]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|840.00||||840.00|318.9|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|840.00||||840.00|183.15|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|840.00||||840.00|199.11|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|||840.00||||840.00|252|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|840.00||||840.00|402.78|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|840.00||||840.00|840|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|840.00||||840.00|323.87|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|840.00||||840.00|226.26|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|840.00||||840.00|227.64|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|840.00||||840.00|361.2|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|FIRST HEALTH [1375]|QUALCHOICE [137513]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|FMH BENEFIT SERVICES [1390]|FMH [139000]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|UMR [2035]|UMR OPTIONS [203501]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MULTIPLAN [1680]|IHC HS [168011]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|840.00||||840.00|318.9|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MULTIPLAN [1680]|HMA [168003]|840.00||||840.00|332.74|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|840.00||||840.00|176.4|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|840.00||||840.00|546|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|HEALTHNET [1495]|HEALTHNET [149500]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|TRUSTMARK [2030]|STARMARK [203000]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|840.00||||840.00|192.32|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|CHAMPVA [1240]|CHAMP VA [124000]|840.00||||840.00|630|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|840.00||||840.00|244.01|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|840.00||||840.00|199.11|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|840.00||||840.00|504|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|GEHA [1415]|GEHA [141500]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|840.00||||840.00|232.92|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|840.00||||840.00|361.2|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|840.00||||840.00|420.84|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|840.00||||840.00|294.84|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|840.00||||840.00|357.84|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|840.00||||840.00|551.1|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|840.00||||840.00|221.83|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|840.00||||840.00|244.01|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|840.00||||840.00|756|840|176.4 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|840.00||||840.00||| 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|AETNA [1015]|AETNA ACO WILCO [101532]|840.00||||840.00||| 36049465|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CONTRAST EXISTING TUBE GI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|840.00||||840.00||| 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5062.00||||5062.00|1437.21|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5062.00||||5062.00|2176.66|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5062.00||||5062.00|2536.06|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5062.00||||5062.00|1776.76|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5062.00||||5062.00|1371.88|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5062.00||||5062.00|3037.2|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5062.00||||5062.00|1437.21|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5062.00||||5062.00|830.21|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|HEALTHNET [1495]|HEALTHNET [149500]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MULTIPLAN [1680]|IHC HS [168011]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5062.00||||5062.00|1878.3|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5062.00||||5062.00|2176.66|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MULTIPLAN [1680]|HMA [168003]|5062.00||||5062.00|1959.83|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5062.00||||5062.00|982.82|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5062.00||||5062.00|1332.68|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|TRUSTMARK [2030]|STARMARK [203000]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|UMR [2035]|UMR OPTIONS [203501]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5062.00||||5062.00|1907.56|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5062.00||||5062.00|1063.02|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5062.00||||5062.00|859.62|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5062.00||||5062.00|5062|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5062.00||||5062.00|3290.3|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5062.00||||5062.00|2427.23|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|||5062.00||||5062.00|1518.6|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5062.00||||5062.00|2156.41|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5062.00||||5062.00|3287.78|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5062.00||||5062.00|859.62|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5062.00||||5062.00|1306.55|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5062.00||||5062.00|790.68|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|CHAMPVA [1240]|CHAMP VA [124000]|5062.00||||5062.00|3796.5|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5062.00||||5062.00|1878.3|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|CORESOURCE [1315]|CORESOURCE [131500]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5062.00||||5062.00|893.47|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|GEHA [1415]|GEHA [141500]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5062.00||||5062.00|4555.8|5062|790.68 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5062.00||||5062.00||| 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|AETNA [1015]|AETNA ACO WILCO [101532]|5062.00||||5062.00||| 36050200|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY RENAL TROCAR/NEEDLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5062.00||||5062.00||| 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|GEHA [1415]|GEHA [141500]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4329.00||||4329.00|1415.11|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|CORESOURCE [1315]|CORESOURCE [131500]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4329.00||||4329.00|2424.23|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|CHAMPVA [1240]|CHAMP VA [124000]|4329.00||||4329.00|3246.75|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4329.00||||4329.00|1252.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4329.00||||4329.00|1361.5|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4329.00||||4329.00|2075.76|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4329.00||||4329.00|2813.85|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4329.00||||4329.00|4329|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4329.00||||4329.00|909.09|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|UMR [2035]|UMR OPTIONS [203501]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4329.00||||4329.00|1720.03|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4329.00||||4329.00|1556.62|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4329.00||||4329.00|1861.47|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MULTIPLAN [1680]|IHC HS [168011]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4329.00||||4329.00|2462|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4329.00||||4329.00|2424.23|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MULTIPLAN [1680]|HMA [168003]|4329.00||||4329.00|2529.45|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|||4329.00||||4329.00|1298.7|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|HEALTHNET [1495]|HEALTHNET [149500]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|TRUSTMARK [2030]|STARMARK [203000]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4329.00||||4329.00|1314.91|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4329.00||||4329.00|1854.93|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4329.00||||4329.00|1361.5|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4329.00||||4329.00|2597.4|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4329.00||||4329.00|1770.62|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4329.00||||4329.00|1861.47|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4329.00||||4329.00|2168.83|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4329.00||||4329.00|1519.48|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4329.00||||4329.00|1844.15|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4329.00||||4329.00|4158.42|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4329.00||||4329.00|1686.3|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4329.00||||4329.00|1854.93|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4329.00||||4329.00|3896.1|4329|909.09 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4329.00||||4329.00||| 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|AETNA [1015]|AETNA ACO WILCO [101532]|4329.00||||4329.00||| 36050387|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE NEPHROURETERAL CATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4329.00||||4329.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2378.00||||2378.00|1343.91|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2378.00||||2378.00|1022.54|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2378.00||||2378.00|1191.38|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2378.00||||2378.00|1013.03|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2378.00||||2378.00|834.68|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2378.00||||2378.00|634.43|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|TRUSTMARK [2030]|STARMARK [203000]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|HEALTHNET [1495]|HEALTHNET [149500]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|FMH BENEFIT SERVICES [1390]|FMH [139000]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|FIRST HEALTH [1375]|QUALCHOICE [137513]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MULTIPLAN [1680]|IHC HS [168011]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2378.00||||2378.00|1022.54|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2378.00||||2378.00|725.35|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|UMR [2035]|UMR OPTIONS [203501]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2378.00||||2378.00|612.76|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2378.00||||2378.00|499.38|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2378.00||||2378.00|1426.8|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2378.00||||2378.00|2378|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2378.00||||2378.00|1545.7|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2378.00||||2378.00|1140.25|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|||2378.00||||2378.00|713.4|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2378.00||||2378.00|634.43|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2378.00||||2378.00|583.56|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|CHAMPVA [1240]|CHAMP VA [124000]|2378.00||||2378.00|1783.5|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|CORESOURCE [1315]|CORESOURCE [131500]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2378.00||||2378.00|659.41|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|GEHA [1415]|GEHA [141500]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2378.00||||2378.00|2140.2|2378|499.38 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|AETNA [1015]|AETNA ACO WILCO [101532]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|MULTIPLAN [1680]|HMA [168003]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2378.00||||2378.00||| 36050389|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE RENAL TUBE W/FLUORO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2378.00||||2378.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|CORESOURCE [1315]|CORESOURCE [131500]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|||3103.00||||3103.00|930.9|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3103.00||||3103.00|1487.89|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3103.00||||3103.00|3103|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|UMR [2035]|UMR OPTIONS [203501]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3103.00||||3103.00|1334.29|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MULTIPLAN [1680]|IHC HS [168011]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3103.00||||3103.00|651.63|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|HEALTHNET [1495]|HEALTHNET [149500]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3103.00||||3103.00|2016.95|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|TRUSTMARK [2030]|STARMARK [203000]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|CHAMPVA [1240]|CHAMP VA [124000]|3103.00||||3103.00|2327.25|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3103.00||||3103.00|1861.8|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3103.00||||3103.00|1334.29|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3103.00||||3103.00|1554.6|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3103.00||||3103.00|1089.15|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|GEHA [1415]|GEHA [141500]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3103.00||||3103.00|1321.88|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3103.00||||3103.00|1384.76|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3103.00||||3103.00|2792.7|3103|651.63 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MULTIPLAN [1680]|HMA [168003]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|AETNA [1015]|AETNA ACO WILCO [101532]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3103.00||||3103.00||| 36050390|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASP/INJ RENAL CYST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3103.00||||3103.00||| 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4330.00||||4330.00|582.73|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4330.00||||4330.00|1861.9|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4330.00||||4330.00|2169.33|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4330.00||||4330.00|1519.83|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4330.00||||4330.00|556.24|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4330.00||||4330.00|2598|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4330.00||||4330.00|691.93|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4330.00||||4330.00|582.73|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4330.00||||4330.00|668.3|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|HEALTHNET [1495]|HEALTHNET [149500]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MULTIPLAN [1680]|IHC HS [168011]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4330.00||||4330.00|761.57|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MULTIPLAN [1680]|HMA [168003]|4330.00||||4330.00|794.63|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|FMH BENEFIT SERVICES [1390]|FMH [139000]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|FIRST HEALTH [1375]|QUALCHOICE [137513]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4330.00||||4330.00|1861.9|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4330.00||||4330.00|791.09|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4330.00||||4330.00|540.35|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|TRUSTMARK [2030]|STARMARK [203000]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|UMR [2035]|UMR OPTIONS [203501]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4330.00||||4330.00|773.44|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4330.00||||4330.00|909.3|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4330.00||||4330.00|4330|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4330.00||||4330.00|2814.5|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4330.00||||4330.00|1844.58|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4330.00||||4330.00|2076.24|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|||4330.00||||4330.00|1299|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4330.00||||4330.00|1343.91|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4330.00||||4330.00|691.93|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4330.00||||4330.00|529.75|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4330.00||||4330.00|636.46|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|CHAMPVA [1240]|CHAMP VA [124000]|4330.00||||4330.00|3247.5|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4330.00||||4330.00|761.57|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|CORESOURCE [1315]|CORESOURCE [131500]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4330.00||||4330.00|719.17|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|GEHA [1415]|GEHA [141500]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4330.00||||4330.00|3897|4330|529.75 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|AETNA [1015]|AETNA ACO WILCO [101532]|4330.00||||4330.00||| 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4330.00||||4330.00||| 36050430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHRO & URTRGRAM NEW ACC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4330.00||||4330.00||| 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|GEHA [1415]|GEHA [141500]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4330.00||||4330.00|719.17|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4330.00||||4330.00|761.57|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|CHAMPVA [1240]|CHAMP VA [124000]|4330.00||||4330.00|3247.5|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4330.00||||4330.00|636.46|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4330.00||||4330.00|691.93|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|||4330.00||||4330.00|1299|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4330.00||||4330.00|2076.24|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4330.00||||4330.00|2814.5|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4330.00||||4330.00|4330|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4330.00||||4330.00|909.3|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|UMR [2035]|UMR OPTIONS [203501]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4330.00||||4330.00|540.35|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4330.00||||4330.00|791.09|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4330.00||||4330.00|1861.9|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|FIRST HEALTH [1375]|QUALCHOICE [137513]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|FMH BENEFIT SERVICES [1390]|FMH [139000]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4330.00||||4330.00|773.44|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MULTIPLAN [1680]|IHC HS [168011]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4330.00||||4330.00|761.57|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MULTIPLAN [1680]|HMA [168003]|4330.00||||4330.00|794.63|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|HEALTHNET [1495]|HEALTHNET [149500]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|TRUSTMARK [2030]|STARMARK [203000]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4330.00||||4330.00|668.3|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|CORESOURCE [1315]|CORESOURCE [131500]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4330.00||||4330.00|582.73|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4330.00||||4330.00|691.93|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4330.00||||4330.00|2598|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4330.00||||4330.00|556.24|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4330.00||||4330.00|1861.9|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4330.00||||4330.00|2169.33|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4330.00||||4330.00|1519.83|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4330.00||||4330.00|1844.58|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4330.00||||4330.00|1343.91|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4330.00||||4330.00|529.75|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4330.00||||4330.00|582.73|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4330.00||||4330.00|3897|4330|529.75 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4330.00||||4330.00||| 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|AETNA [1015]|AETNA ACO WILCO [101532]|4330.00||||4330.00||| 36050431|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NEPHROSTGRM/URETERGRM EXISTING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4330.00||||4330.00||| 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7962.00||||7962.00|1854.93|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7962.00||||7962.00|4158.42|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7962.00||||7962.00|3423.66|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7962.00||||7962.00|3391.81|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7962.00||||7962.00|2794.66|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7962.00||||7962.00|1770.62|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7962.00||||7962.00|1987.37|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7962.00||||7962.00|1854.93|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|TRUSTMARK [2030]|STARMARK [203000]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7962.00||||7962.00|2424.23|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MULTIPLAN [1680]|HMA [168003]|7962.00||||7962.00|2529.45|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|FMH BENEFIT SERVICES [1390]|FMH [139000]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|FIRST HEALTH [1375]|QUALCHOICE [137513]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7962.00||||7962.00|3423.66|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7962.00||||7962.00|2272.18|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7962.00||||7962.00|1720.03|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MULTIPLAN [1680]|IHC HS [168011]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|HEALTHNET [1495]|HEALTHNET [149500]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|UMR [2035]|UMR OPTIONS [203501]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7962.00||||7962.00|2462|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7962.00||||7962.00|1672.02|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7962.00||||7962.00|1919.38|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7962.00||||7962.00|4777.2|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7962.00||||7962.00|7962|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7962.00||||7962.00|5175.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7962.00||||7962.00|3988.96|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7962.00||||7962.00|3817.78|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|||7962.00||||7962.00|2388.6|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7962.00||||7962.00|1987.37|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7962.00||||7962.00|1686.3|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7962.00||||7962.00|1827.99|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|CHAMPVA [1240]|CHAMP VA [124000]|7962.00||||7962.00|5971.5|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7962.00||||7962.00|2424.23|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|CORESOURCE [1315]|CORESOURCE [131500]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7962.00||||7962.00|2065.62|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|GEHA [1415]|GEHA [141500]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7962.00||||7962.00|7165.8|7962|1672.02 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7962.00||||7962.00||| 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|AETNA [1015]|AETNA ACO WILCO [101532]|7962.00||||7962.00||| 36050432|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROSTOMY CATHETER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7962.00||||7962.00||| 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7962.00||||7962.00|2065.62|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|CORESOURCE [1315]|CORESOURCE [131500]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7962.00||||7962.00|4130.64|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|CHAMPVA [1240]|CHAMP VA [124000]|7962.00||||7962.00|5971.5|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7962.00||||7962.00|1827.99|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|||7962.00||||7962.00|2388.6|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7962.00||||7962.00|3817.78|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7962.00||||7962.00|7962|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7962.00||||7962.00|1672.02|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7962.00||||7962.00|4195|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7962.00||||7962.00|2272.18|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7962.00||||7962.00|3423.66|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7962.00||||7962.00|2930.75|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|FIRST HEALTH [1375]|QUALCHOICE [137513]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|FMH BENEFIT SERVICES [1390]|FMH [139000]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|UMR [2035]|UMR OPTIONS [203501]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MULTIPLAN [1680]|IHC HS [168011]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7962.00||||7962.00|4130.64|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MULTIPLAN [1680]|HMA [168003]|7962.00||||7962.00|4309.93|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7962.00||||7962.00|5175.3|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|HEALTHNET [1495]|HEALTHNET [149500]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7962.00||||7962.00|1987.37|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|TRUSTMARK [2030]|STARMARK [203000]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7962.00||||7962.00|1919.38|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7962.00||||7962.00|3160.62|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7962.00||||7962.00|1987.37|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7962.00||||7962.00|4777.2|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|GEHA [1415]|GEHA [141500]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7962.00||||7962.00|3016.95|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7962.00||||7962.00|3423.66|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7962.00||||7962.00|3988.96|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7962.00||||7962.00|2794.66|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7962.00||||7962.00|3391.81|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7962.00||||7962.00|4158.42|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7962.00||||7962.00|2873.29|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7962.00||||7962.00|3160.62|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7962.00||||7962.00|7165.8|7962|1672.02 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7962.00||||7962.00||| 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|AETNA [1015]|AETNA ACO WILCO [101532]|7962.00||||7962.00||| 36050433|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE NEPHROURETERAL CATH PERQ NEW ACCESS RS&I|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7962.00||||7962.00||| 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6210.00||||6210.00|1854.93|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6210.00||||6210.00|4158.42|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6210.00||||6210.00|2670.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6210.00||||6210.00|3111.21|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6210.00||||6210.00|2179.71|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6210.00||||6210.00|2645.46|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6210.00||||6210.00|1770.62|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6210.00||||6210.00|3726|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6210.00||||6210.00|1854.93|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6210.00||||6210.00|668.26|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|HEALTHNET [1495]|HEALTHNET [149500]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MULTIPLAN [1680]|IHC HS [168011]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6210.00||||6210.00|2424.23|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MULTIPLAN [1680]|HMA [168003]|6210.00||||6210.00|2529.45|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6210.00||||6210.00|2670.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6210.00||||6210.00|791.09|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6210.00||||6210.00|1720.03|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|TRUSTMARK [2030]|STARMARK [203000]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|UMR [2035]|UMR OPTIONS [203501]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6210.00||||6210.00|2462|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6210.00||||6210.00|691.93|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6210.00||||6210.00|1304.1|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6210.00||||6210.00|6210|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6210.00||||6210.00|4036.5|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6210.00||||6210.00|2977.7|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|||6210.00||||6210.00|1863|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6210.00||||6210.00|691.93|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6210.00||||6210.00|1686.3|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6210.00||||6210.00|636.44|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|CHAMPVA [1240]|CHAMP VA [124000]|6210.00||||6210.00|4657.5|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6210.00||||6210.00|2424.23|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|CORESOURCE [1315]|CORESOURCE [131500]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6210.00||||6210.00|719.17|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|GEHA [1415]|GEHA [141500]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6210.00||||6210.00|5589|6210|636.44 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6210.00||||6210.00||| 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|AETNA [1015]|AETNA ACO WILCO [101532]|6210.00||||6210.00||| 36050435|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EXCHANGE NEPHROSTOMY CATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6210.00||||6210.00||| 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|GEHA [1415]|GEHA [141500]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12986.00||||12986.00|2385.57|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12986.00||||12986.00|2424.23|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|CHAMPVA [1240]|CHAMP VA [124000]|12986.00||||12986.00|9739.5|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12986.00||||12986.00|2295.2|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12986.00||||12986.00|6226.79|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12986.00||||12986.00|8440.9|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12986.00||||12986.00|2727.06|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|UMR [2035]|UMR OPTIONS [203501]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12986.00||||12986.00|2624.13|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12986.00||||12986.00|1720.03|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12986.00||||12986.00|5583.98|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|FIRST HEALTH [1375]|QUALCHOICE [137513]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|FMH BENEFIT SERVICES [1390]|FMH [139000]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|HEALTHNET [1495]|HEALTHNET [149500]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12986.00||||12986.00|2462|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12986.00||||12986.00|12986|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MULTIPLAN [1680]|IHC HS [168011]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12986.00||||12986.00|2424.23|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MULTIPLAN [1680]|HMA [168003]|12986.00||||12986.00|2529.45|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|TRUSTMARK [2030]|STARMARK [203000]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|||12986.00||||12986.00|3895.8|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12986.00||||12986.00|1854.93|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|CORESOURCE [1315]|CORESOURCE [131500]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12986.00||||12986.00|2295.2|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12986.00||||12986.00|5583.98|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12986.00||||12986.00|6505.99|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12986.00||||12986.00|4558.09|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12986.00||||12986.00|5532.04|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12986.00||||12986.00|7791.6|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12986.00||||12986.00|1770.62|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12986.00||||12986.00|4158.42|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12986.00||||12986.00|1854.93|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12986.00||||12986.00|1686.3|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12986.00||||12986.00|11687.4|12986|1686.3 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12986.00||||12986.00||| 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12986.00||||12986.00||| 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|AETNA [1015]|AETNA ACO WILCO [101532]|12986.00||||12986.00||| 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12986.00||||12986.00||| 36050436|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12986.00||||12986.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14284.00||||14284.00|6995.9|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14284.00||||14284.00|6142.12|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14284.00||||14284.00|7156.28|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14284.00||||14284.00|5013.68|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|TRUSTMARK [2030]|STARMARK [203000]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MULTIPLAN [1680]|IHC HS [168011]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|HEALTHNET [1495]|HEALTHNET [149500]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|FMH BENEFIT SERVICES [1390]|FMH [139000]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|FIRST HEALTH [1375]|QUALCHOICE [137513]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14284.00||||14284.00|6142.12|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|UMR [2035]|UMR OPTIONS [203501]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14284.00||||14284.00|2999.64|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14284.00||||14284.00|14284|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14284.00||||14284.00|9284.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14284.00||||14284.00|6084.98|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14284.00||||14284.00|8570.4|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14284.00||||14284.00|6849.18|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|||14284.00||||14284.00|4285.2|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|CHAMPVA [1240]|CHAMP VA [124000]|14284.00||||14284.00|10713|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|CORESOURCE [1315]|CORESOURCE [131500]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|GEHA [1415]|GEHA [141500]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14284.00||||14284.00|12855.6|14284|2999.64 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|AETNA [1015]|AETNA ACO WILCO [101532]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MULTIPLAN [1680]|HMA [168003]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14284.00||||14284.00||| 36050437|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14284.00||||14284.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|GEHA [1415]|GEHA [141500]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|CORESOURCE [1315]|CORESOURCE [131500]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|||705.00||||705.00|211.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|705.00||||705.00|338.05|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|705.00||||705.00|458.25|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|705.00||||705.00|705|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|705.00||||705.00|303.15|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|FIRST HEALTH [1375]|QUALCHOICE [137513]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|FMH BENEFIT SERVICES [1390]|FMH [139000]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|UMR [2035]|UMR OPTIONS [203501]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|705.00||||705.00|148.05|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MULTIPLAN [1680]|IHC HS [168011]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|HEALTHNET [1495]|HEALTHNET [149500]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|TRUSTMARK [2030]|STARMARK [203000]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|CHAMPVA [1240]|CHAMP VA [124000]|705.00||||705.00|528.75|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|705.00||||705.00|423|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|705.00||||705.00|303.15|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|705.00||||705.00|353.21|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|705.00||||705.00|247.46|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|705.00||||705.00|300.33|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|705.00||||705.00|352.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|705.00||||705.00|634.5|705|148.05 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MULTIPLAN [1680]|HMA [168003]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|AETNA [1015]|AETNA ACO WILCO [101532]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|705.00||||705.00||| 36050684|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ URETER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|705.00||||705.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|576.00||||576.00|288|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|576.00||||576.00|247.68|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|576.00||||576.00|288.58|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|576.00||||576.00|245.38|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|576.00||||576.00|345.6|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|TRUSTMARK [2030]|STARMARK [203000]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|HEALTHNET [1495]|HEALTHNET [149500]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MULTIPLAN [1680]|IHC HS [168011]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|FMH BENEFIT SERVICES [1390]|FMH [139000]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|FIRST HEALTH [1375]|QUALCHOICE [137513]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|576.00||||576.00|247.68|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|UMR [2035]|UMR OPTIONS [203501]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|576.00||||576.00|120.96|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|576.00||||576.00|576|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|576.00||||576.00|202.18|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|576.00||||576.00|374.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|576.00||||576.00|276.19|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|||576.00||||576.00|172.8|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|CHAMPVA [1240]|CHAMP VA [124000]|576.00||||576.00|432|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|CORESOURCE [1315]|CORESOURCE [131500]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|GEHA [1415]|GEHA [141500]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|576.00||||576.00|518.4|576|120.96 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|AETNA [1015]|AETNA ACO WILCO [101532]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|MULTIPLAN [1680]|HMA [168003]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|576.00||||576.00||| 36050690|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ILEAL CONDUIT/URETEROPY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|576.00||||576.00||| 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|GEHA [1415]|GEHA [141500]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|8987.00||||8987.00|3076.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|8987.00||||8987.00|4130.64|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|CHAMPVA [1240]|CHAMP VA [124000]|8987.00||||8987.00|6740.25|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|8987.00||||8987.00|2722.39|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|8987.00||||8987.00|2959.76|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8987.00||||8987.00|4309.27|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|8987.00||||8987.00|5841.55|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|8987.00||||8987.00|1887.27|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|8987.00||||8987.00|4195|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|UMR [2035]|UMR OPTIONS [203501]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8987.00||||8987.00|2930.75|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|8987.00||||8987.00|3383.93|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8987.00||||8987.00|3864.41|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|FIRST HEALTH [1375]|QUALCHOICE [137513]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|FMH BENEFIT SERVICES [1390]|FMH [139000]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MULTIPLAN [1680]|IHC HS [168011]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|8987.00||||8987.00|4130.64|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MULTIPLAN [1680]|HMA [168003]|8987.00||||8987.00|4309.93|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|8987.00||||8987.00|8987|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|||8987.00||||8987.00|2696.1|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|HEALTHNET [1495]|HEALTHNET [149500]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|TRUSTMARK [2030]|STARMARK [203000]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|8987.00||||8987.00|2858.5|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|CORESOURCE [1315]|CORESOURCE [131500]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|8987.00||||8987.00|3160.62|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|8987.00||||8987.00|2959.76|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8987.00||||8987.00|5392.2|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8987.00||||8987.00|3016.95|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|8987.00||||8987.00|3864.41|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|8987.00||||8987.00|4502.49|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|8987.00||||8987.00|3154.44|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|8987.00||||8987.00|3828.46|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|8987.00||||8987.00|4158.42|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8987.00||||8987.00|2873.29|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|8987.00||||8987.00|8088.3|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|8987.00||||8987.00|3160.62|8987|1887.27 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|8987.00||||8987.00||| 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|AETNA [1015]|AETNA ACO WILCO [101532]|8987.00||||8987.00||| 36050693|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETER STENT VIA NEPHRO TRACT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8987.00||||8987.00||| 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11343.00||||11343.00|1854.93|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11343.00||||11343.00|4158.42|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11343.00||||11343.00|4877.49|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11343.00||||11343.00|3981.39|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11343.00||||11343.00|4832.12|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11343.00||||11343.00|1770.62|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11343.00||||11343.00|6805.8|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11343.00||||11343.00|1780.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11343.00||||11343.00|1854.93|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|TRUSTMARK [2030]|STARMARK [203000]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|HEALTHNET [1495]|HEALTHNET [149500]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MULTIPLAN [1680]|IHC HS [168011]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11343.00||||11343.00|2424.23|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MULTIPLAN [1680]|HMA [168003]|11343.00||||11343.00|2529.45|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11343.00||||11343.00|4877.49|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11343.00||||11343.00|2035.9|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11343.00||||11343.00|1720.03|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|UMR [2035]|UMR OPTIONS [203501]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11343.00||||11343.00|2462|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11343.00||||11343.00|2382.03|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11343.00||||11343.00|1719.78|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11343.00||||11343.00|11343|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11343.00||||11343.00|7372.95|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11343.00||||11343.00|5682.84|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11343.00||||11343.00|5438.97|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|||11343.00||||11343.00|3402.9|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11343.00||||11343.00|1780.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11343.00||||11343.00|1686.3|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11343.00||||11343.00|1637.89|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|CHAMPVA [1240]|CHAMP VA [124000]|11343.00||||11343.00|8507.25|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11343.00||||11343.00|2424.23|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|CORESOURCE [1315]|CORESOURCE [131500]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11343.00||||11343.00|1850.82|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|GEHA [1415]|GEHA [141500]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11343.00||||11343.00|10208.7|11343|1637.89 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|AETNA [1015]|AETNA ACO WILCO [101532]|11343.00||||11343.00||| 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11343.00||||11343.00||| 36051102|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PLACE SUPRAPUBIC CATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11343.00||||11343.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1416.00||||1416.00|608.88|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MULTIPLAN [1680]|IHC HS [168011]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|HEALTHNET [1495]|HEALTHNET [149500]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|TRUSTMARK [2030]|STARMARK [203000]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1416.00||||1416.00|849.6|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|UMR [2035]|UMR OPTIONS [203501]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1416.00||||1416.00|608.88|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1416.00||||1416.00|709.42|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1416.00||||1416.00|497.02|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1416.00||||1416.00|603.22|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1416.00||||1416.00|708|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|GEHA [1415]|GEHA [141500]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1416.00||||1416.00|297.36|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|CHAMPVA [1240]|CHAMP VA [124000]|1416.00||||1416.00|1062|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|CORESOURCE [1315]|CORESOURCE [131500]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|||1416.00||||1416.00|424.8|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1416.00||||1416.00|678.97|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1416.00||||1416.00|1416|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1416.00||||1416.00|920.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1416.00||||1416.00|1274.4|1416|297.36 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MULTIPLAN [1680]|HMA [168003]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|AETNA [1015]|AETNA ACO WILCO [101532]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1416.00||||1416.00||| 36051600|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ CYSTOGRAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1416.00||||1416.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|GEHA [1415]|GEHA [141500]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|588.00||||588.00|382.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|588.00||||588.00|294|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|588.00||||588.00|294.59|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|CORESOURCE [1315]|CORESOURCE [131500]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|588.00||||588.00|252.84|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|588.00||||588.00|206.39|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|588.00||||588.00|252.84|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|FIRST HEALTH [1375]|QUALCHOICE [137513]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|588.00||||588.00|250.49|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|588.00||||588.00|352.8|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|588.00||||588.00|123.48|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|||588.00||||588.00|176.4|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|588.00||||588.00|281.95|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|TRUSTMARK [2030]|STARMARK [203000]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|AETNA [1015]|COVENTRY HEALTHCARE [101502]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MULTIPLAN [1680]|IHC HS [168011]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|UMR [2035]|UMR OPTIONS [203501]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|HEALTHNET [1495]|HEALTHNET [149500]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|CHAMPVA [1240]|CHAMP VA [124000]|588.00||||588.00|441|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|FMH BENEFIT SERVICES [1390]|FMH [139000]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|588.00||||588.00|588|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|588.00||||588.00|529.2|588|123.48 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|AETNA [1015]|AETNA ACO WILCO [101532]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MULTIPLAN [1680]|HMA [168003]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|588.00||||588.00||| 36051610|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC URETHROCYSTOGRAM RETRO|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|588.00||||588.00||| 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|HEALTHNET [1495]|HEALTHNET [149500]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|917.00||||917.00|167.79|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|917.00||||917.00|173.73|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MULTIPLAN [1680]|HMA [168003]|917.00||||917.00|155.68|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|917.00||||917.00|149.2|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|917.00||||917.00|106.04|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|917.00||||917.00|254.52|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|TRUSTMARK [2030]|STARMARK [203000]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|917.00||||917.00|114.16|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|917.00||||917.00|180.57|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|917.00||||917.00|114.16|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MULTIPLAN [1680]|IHC HS [168011]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|917.00||||917.00|321.87|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|GEHA [1415]|GEHA [141500]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|917.00||||917.00|173.73|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|917.00||||917.00|149.2|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|FMH BENEFIT SERVICES [1390]|FMH [139000]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|917.00||||917.00|394.31|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|917.00||||917.00|390.64|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|917.00||||917.00|100.99|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|CHAMPVA [1240]|CHAMP VA [124000]|917.00||||917.00|687.75|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|917.00||||917.00|550.2|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|FIRST HEALTH [1375]|QUALCHOICE [137513]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|917.00||||917.00|192.57|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|917.00||||917.00|439.7|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|917.00||||917.00|394.31|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|917.00||||917.00|596.05|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|917.00||||917.00|917|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|917.00||||917.00|198.62|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|||917.00||||917.00|275.1|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|CORESOURCE [1315]|CORESOURCE [131500]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|UMR [2035]|UMR OPTIONS [203501]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|917.00||||917.00|459.42|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|917.00||||917.00|159.8|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|917.00||||917.00|825.3|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|917.00||||917.00|151.52|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|AETNA [1015]|AETNA ACO WILCO [101532]|917.00||||917.00|917|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|917.00||||917.00|105.86|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|917.00||||917.00|103.78|917|100.99 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|917.00||||917.00||| 36051702|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT CATH FOLEY BLADDER SMPL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|917.00||||917.00||| 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2049.00||||2049.00|553.15|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2049.00||||2049.00|881.07|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2049.00||||2049.00|245.95|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2049.00||||2049.00|245.95|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2049.00||||2049.00|1229.4|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2049.00||||2049.00|872.87|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MULTIPLAN [1680]|IHC HS [168011]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2049.00||||2049.00|228.07|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2049.00||||2049.00|1026.55|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2049.00||||2049.00|205.32|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2049.00||||2049.00|321.44|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|TRUSTMARK [2030]|STARMARK [203000]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MULTIPLAN [1680]|HMA [168003]|2049.00||||2049.00|335.39|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2049.00||||2049.00|881.07|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|||2049.00||||2049.00|614.7|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2049.00||||2049.00|326.45|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2049.00||||2049.00|2049|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2049.00||||2049.00|234.77|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|HEALTHNET [1495]|HEALTHNET [149500]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2049.00||||2049.00|179.58|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2049.00||||2049.00|186.65|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2049.00||||2049.00|982.5|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|GEHA [1415]|GEHA [141500]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2049.00||||2049.00|321.44|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2049.00||||2049.00|1331.85|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2049.00||||2049.00|179.58|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|UMR [2035]|UMR OPTIONS [203501]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|CHAMPVA [1240]|CHAMP VA [124000]|2049.00||||2049.00|1536.75|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|CORESOURCE [1315]|CORESOURCE [131500]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2049.00||||2049.00|165.18|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2049.00||||2049.00|173.43|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2049.00||||2049.00|719.2|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2049.00||||2049.00|1844.1|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2049.00||||2049.00|223.59|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2049.00||||2049.00|430.29|2049|165.18 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|AETNA [1015]|AETNA ACO WILCO [101532]|2049.00||||2049.00||| 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2049.00||||2049.00||| 36051705|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC SUPRAPUBIC CATHETER CHANGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2049.00||||2049.00||| 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2253.00||||2253.00|547.44|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MULTIPLAN [1680]|HMA [168003]|2253.00||||2253.00|794.63|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2253.00||||2253.00|1351.8|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|TRUSTMARK [2030]|STARMARK [203000]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2253.00||||2253.00|566.84|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2253.00||||2253.00|582.73|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2253.00||||2253.00|959.78|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|HEALTHNET [1495]|HEALTHNET [149500]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2253.00||||2253.00|1343.91|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2253.00||||2253.00|582.73|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2253.00||||2253.00|761.57|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2253.00||||2253.00|556.24|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2253.00||||2253.00|790.8|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MULTIPLAN [1680]|IHC HS [168011]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2253.00||||2253.00|968.79|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2253.00||||2253.00|1128.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2253.00||||2253.00|761.57|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2253.00||||2253.00|589.16|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|CORESOURCE [1315]|CORESOURCE [131500]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2253.00||||2253.00|1080.31|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|||2253.00||||2253.00|675.9|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2253.00||||2253.00|2253|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|CHAMPVA [1240]|CHAMP VA [124000]|2253.00||||2253.00|1689.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|FMH BENEFIT SERVICES [1390]|FMH [139000]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2253.00||||2253.00|473.13|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2253.00||||2253.00|521.38|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2253.00||||2253.00|773.44|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|FIRST HEALTH [1375]|QUALCHOICE [137513]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|GEHA [1415]|GEHA [141500]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2253.00||||2253.00|540.35|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|UMR [2035]|UMR OPTIONS [203501]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2253.00||||2253.00|968.79|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2253.00||||2253.00|566.84|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2253.00||||2253.00|648.08|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2253.00||||2253.00|1464.45|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2253.00||||2253.00|529.75|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2253.00||||2253.00|2027.7|2253|473.13 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|AETNA [1015]|AETNA ACO WILCO [101532]|2253.00||||2253.00||| 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2253.00||||2253.00||| 36051710|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHANGE CYSTOSTOMY TUBE COMPLEX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2253.00||||2253.00||| 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248.00||||248.00|133.61|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|TRUSTMARK [2030]|STARMARK [203000]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248.00||||248.00|69.06|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248.00||||248.00|54.98|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248.00||||248.00|57.6|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|248.00||||248.00|124.25|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248.00||||248.00|57.6|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MULTIPLAN [1680]|HMA [168003]|248.00||||248.00|78.55|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|248.00||||248.00|75.28|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|HEALTHNET [1495]|HEALTHNET [149500]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MULTIPLAN [1680]|IHC HS [168011]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248.00||||248.00|53.41|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|248.00||||248.00|78.96|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|||248.00||||248.00|74.4|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248.00||||248.00|148.8|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248.00||||248.00|69.06|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248.00||||248.00|248|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248.00||||248.00|161.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248.00||||248.00|66.71|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|UMR [2035]|UMR OPTIONS [203501]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|GEHA [1415]|GEHA [141500]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248.00||||248.00|52.08|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|248.00||||248.00|105.65|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248.00||||248.00|87.05|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248.00||||248.00|63.53|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|248.00||||248.00|75.28|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248.00||||248.00|106.64|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|CHAMPVA [1240]|CHAMP VA [124000]|248.00||||248.00|186|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|248.00||||248.00|71.78|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248.00||||248.00|118.92|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|248.00||||248.00|52.36|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248.00||||248.00|106.64|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|CORESOURCE [1315]|CORESOURCE [131500]|248.00||||248.00|223.2|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248.00||||248.00|76.45|248|52.08 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|AETNA [1015]|AETNA ACO WILCO [101532]|248.00||||248.00||| 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|248.00||||248.00||| 36051798|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC POST VOID BLADDER SCAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|248.00||||248.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|CORESOURCE [1315]|CORESOURCE [131500]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4820.00||||4820.00|4820|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4820.00||||4820.00|3133|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4820.00||||4820.00|2311.19|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|UMR [2035]|UMR OPTIONS [203501]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4820.00||||4820.00|2072.6|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|GEHA [1415]|GEHA [141500]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4820.00||||4820.00|2053.32|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4820.00||||4820.00|2892|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4820.00||||4820.00|2072.6|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MULTIPLAN [1680]|IHC HS [168011]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4820.00||||4820.00|2414.82|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|||4820.00||||4820.00|1446|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4820.00||||4820.00|1012.2|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|HEALTHNET [1495]|HEALTHNET [149500]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4820.00||||4820.00|1691.82|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4820.00||||4820.00|4158.42|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|TRUSTMARK [2030]|STARMARK [203000]|4820.00||||4820.00|4338|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|CHAMPVA [1240]|CHAMP VA [124000]|4820.00||||4820.00|3615|4820|1012.2 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MULTIPLAN [1680]|HMA [168003]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|AETNA [1015]|AETNA ACO WILCO [101532]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4820.00||||4820.00||| 36055700|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY(S) PROSTATE NDL/PUNCH ANY APPROACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4820.00||||4820.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784.00||||784.00|392|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784.00||||784.00|337.12|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|TRUSTMARK [2030]|STARMARK [203000]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784.00||||784.00|275.18|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|784.00||||784.00|392.78|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784.00||||784.00|470.4|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|784.00||||784.00|333.98|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|FIRST HEALTH [1375]|QUALCHOICE [137513]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|HEALTHNET [1495]|HEALTHNET [149500]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MULTIPLAN [1680]|IHC HS [168011]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|FMH BENEFIT SERVICES [1390]|FMH [139000]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784.00||||784.00|784|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784.00||||784.00|509.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|||784.00||||784.00|235.2|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784.00||||784.00|164.64|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784.00||||784.00|337.12|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|CORESOURCE [1315]|CORESOURCE [131500]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|CHAMPVA [1240]|CHAMP VA [124000]|784.00||||784.00|588|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784.00||||784.00|375.93|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|UMR [2035]|UMR OPTIONS [203501]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|GEHA [1415]|GEHA [141500]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784.00||||784.00|705.6|784|164.64 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|AETNA [1015]|AETNA ACO WILCO [101532]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MULTIPLAN [1680]|HMA [168003]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|784.00||||784.00||| 36058340|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CATH & SALINE/CTRST SONOHYSTER/HYSTEROSALPI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784.00||||784.00||| 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1268.00||||1268.00|635.27|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1268.00||||1268.00|445.07|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1268.00||||1268.00|1268|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1268.00||||1268.00|638.72|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1268.00||||1268.00|540.17|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1268.00||||1268.00|609.69|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1268.00||||1268.00|545.24|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1268.00||||1268.00|408.99|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1268.00||||1268.00|394.99|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1268.00||||1268.00|760.8|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1268.00||||1268.00|638.72|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|GEHA [1415]|GEHA [141500]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1268.00||||1268.00|812.29|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|CORESOURCE [1315]|CORESOURCE [131500]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|||1268.00||||1268.00|380.4|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|CHAMPVA [1240]|CHAMP VA [124000]|1268.00||||1268.00|951|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1268.00||||1268.00|408.99|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1268.00||||1268.00|608.01|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1268.00||||1268.00|824.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1268.00||||1268.00|266.28|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1268.00||||1268.00|1268|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1268.00||||1268.00|847.76|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|UMR [2035]|UMR OPTIONS [203501]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1268.00||||1268.00|545.24|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1268.00||||1268.00|592.27|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1268.00||||1268.00|425.09|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1268.00||||1268.00|467.6|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|TRUSTMARK [2030]|STARMARK [203000]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1268.00||||1268.00|376.19|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MULTIPLAN [1680]|HMA [168003]|1268.00||||1268.00|870.99|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|HEALTHNET [1495]|HEALTHNET [149500]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1268.00||||1268.00|834.75|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1268.00||||1268.00|580.66|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|MULTIPLAN [1680]|IHC HS [168011]|1268.00||||1268.00|1141.2|1268|266.28 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1268.00||||1268.00||| 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|AETNA [1015]|AETNA ACO WILCO [101532]|1268.00||||1268.00||| 36060100|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC BIOPSY THYROID PERC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1268.00||||1268.00||| 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12738.00||||12738.00|10985.17|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12738.00||||12738.00|5061.22|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12738.00||||12738.00|5477.34|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12738.00||||12738.00|6381.74|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12738.00||||12738.00|5426.39|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12738.00||||12738.00|4831.17|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12738.00||||12738.00|7642.8|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|UMR [2035]|UMR OPTIONS [203501]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|TRUSTMARK [2030]|STARMARK [203000]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|HEALTHNET [1495]|HEALTHNET [149500]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MULTIPLAN [1680]|IHC HS [168011]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MULTIPLAN [1680]|HMA [168003]|12738.00||||12738.00|6901.66|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|FMH BENEFIT SERVICES [1390]|FMH [139000]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|FIRST HEALTH [1375]|QUALCHOICE [137513]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12738.00||||12738.00|6614.56|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|||12738.00||||12738.00|3821.4|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12738.00||||12738.00|5477.34|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12738.00||||12738.00|8279.7|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12738.00||||12738.00|4957.06|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12738.00||||12738.00|4693.13|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12738.00||||12738.00|12738|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12738.00||||12738.00|6717.62|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12738.00||||12738.00|2674.98|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12738.00||||12738.00|6107.87|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12738.00||||12738.00|4471.04|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12738.00||||12738.00|4335.7|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12738.00||||12738.00|5061.22|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12738.00||||12738.00|4187.37|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|CORESOURCE [1315]|CORESOURCE [131500]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|CHAMPVA [1240]|CHAMP VA [124000]|12738.00||||12738.00|9553.5|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12738.00||||12738.00|6614.56|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12738.00||||12738.00|4601.11|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12738.00||||12738.00|3987.98|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12738.00||||12738.00|4506.42|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12738.00||||12738.00|4335.7|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|GEHA [1415]|GEHA [141500]|12738.00||||12738.00|11464.2|12738|2674.98 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|AETNA [1015]|AETNA ACO WILCO [101532]|12738.00||||12738.00||| 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12738.00||||12738.00||| 36060699|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ABLATION PARATHYROIDGL ALCOHOL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12738.00||||12738.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|GEHA [1415]|GEHA [141500]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1933.00||||1933.00|926.87|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|CORESOURCE [1315]|CORESOURCE [131500]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1933.00||||1933.00|1933|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|HEALTHNET [1495]|HEALTHNET [149500]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|UMR [2035]|UMR OPTIONS [203501]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1933.00||||1933.00|831.19|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1933.00||||1933.00|405.93|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MULTIPLAN [1680]|IHC HS [168011]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|TRUSTMARK [2030]|STARMARK [203000]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|||1933.00||||1933.00|579.9|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|CHAMPVA [1240]|CHAMP VA [124000]|1933.00||||1933.00|1449.75|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1933.00||||1933.00|823.46|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1933.00||||1933.00|968.43|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1933.00||||1933.00|1431.31|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1933.00||||1933.00|678.48|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1933.00||||1933.00|831.19|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1933.00||||1933.00|1159.8|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1933.00||||1933.00|1739.7|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1933.00||||1933.00|1256.45|1933|405.93 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MULTIPLAN [1680]|HMA [168003]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|AETNA [1015]|AETNA ACO WILCO [101532]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1933.00||||1933.00||| 36061070|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR/INJECT CSF SHUNT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1933.00||||1933.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29419.00||||29419.00|23111.3|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29419.00||||29419.00|14738.92|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29419.00||||29419.00|10326.07|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29419.00||||29419.00|12532.49|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29419.00||||29419.00|17651.4|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|FMH BENEFIT SERVICES [1390]|FMH [139000]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MULTIPLAN [1680]|IHC HS [168011]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|HEALTHNET [1495]|HEALTHNET [149500]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|FIRST HEALTH [1375]|QUALCHOICE [137513]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|TRUSTMARK [2030]|STARMARK [203000]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29419.00||||29419.00|12650.17|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29419.00||||29419.00|19122.35|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29419.00||||29419.00|29419|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29419.00||||29419.00|6177.99|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|UMR [2035]|UMR OPTIONS [203501]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29419.00||||29419.00|14106.41|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|GEHA [1415]|GEHA [141500]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|CHAMPVA [1240]|CHAMP VA [124000]|29419.00||||29419.00|22064.25|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29419.00||||29419.00|12650.17|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|||29419.00||||29419.00|8825.7|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|CORESOURCE [1315]|CORESOURCE [131500]|29419.00||||29419.00|26477.1|29419|6177.99 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MULTIPLAN [1680]|HMA [168003]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|AETNA [1015]|AETNA ACO WILCO [101532]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29419.00||||29419.00||| 36061626|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TRNSCATH OCCLUS/EMBOLZ NON-CNS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29419.00||||29419.00||| 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|CHAMPVA [1240]|CHAMP VA [124000]|1712.00||||1712.00|1284|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|CORESOURCE [1315]|CORESOURCE [131500]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|GEHA [1415]|GEHA [141500]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1712.00||||1712.00|834.75|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|||1712.00||||1712.00|513.6|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1712.00||||1712.00|425.09|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1712.00||||1712.00|408.99|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MULTIPLAN [1680]|HMA [168003]|1712.00||||1712.00|870.99|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1712.00||||1712.00|1112.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1712.00||||1712.00|359.52|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|FMH BENEFIT SERVICES [1390]|FMH [139000]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1712.00||||1712.00|847.76|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1712.00||||1712.00|592.27|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1712.00||||1712.00|736.16|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|FIRST HEALTH [1375]|QUALCHOICE [137513]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1712.00||||1712.00|467.6|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1712.00||||1712.00|834.75|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MULTIPLAN [1680]|IHC HS [168011]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|HEALTHNET [1495]|HEALTHNET [149500]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|TRUSTMARK [2030]|STARMARK [203000]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1712.00||||1712.00|1712|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1712.00||||1712.00|1027.2|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1712.00||||1712.00|609.69|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1712.00||||1712.00|1384.76|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1712.00||||1712.00|600.91|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1712.00||||1712.00|376.19|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1712.00||||1712.00|736.16|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1712.00||||1712.00|820.9|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1712.00||||1712.00|408.99|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1712.00||||1712.00|638.72|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1712.00||||1712.00|638.72|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1712.00||||1712.00|857.71|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|UMR [2035]|UMR OPTIONS [203501]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1712.00||||1712.00|394.99|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1712.00||||1712.00|729.31|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1712.00||||1712.00|1540.8|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1712.00||||1712.00|580.66|1712|359.52 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1712.00||||1712.00||| 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|AETNA [1015]|AETNA ACO WILCO [101532]|1712.00||||1712.00||| 36062267|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC ASPIR PULPOS/INTERVERT DISC/PVRT TISS DIAG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1712.00||||1712.00||| 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3571.00||||3571.00|1431.31|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3571.00||||3571.00|1789.07|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3571.00||||3571.00|654.47|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3571.00||||3571.00|1253.42|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3571.00||||3571.00|624.72|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|UMR [2035]|UMR OPTIONS [203501]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3571.00||||3571.00|2321.15|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|HEALTHNET [1495]|HEALTHNET [149500]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MULTIPLAN [1680]|IHC HS [168011]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3571.00||||3571.00|855.33|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3571.00||||3571.00|1535.53|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MULTIPLAN [1680]|HMA [168003]|3571.00||||3571.00|892.45|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3571.00||||3571.00|378.42|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3571.00||||3571.00|606.87|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3571.00||||3571.00|3571|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3571.00||||3571.00|868.66|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3571.00||||3571.00|749.91|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|TRUSTMARK [2030]|STARMARK [203000]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3571.00||||3571.00|1535.53|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|GEHA [1415]|GEHA [141500]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3571.00||||3571.00|855.33|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3571.00||||3571.00|304.44|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|CORESOURCE [1315]|CORESOURCE [131500]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3571.00||||3571.00|344.02|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3571.00||||3571.00|330.99|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3571.00||||3571.00|319.66|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3571.00||||3571.00|654.47|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3571.00||||3571.00|330.99|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3571.00||||3571.00|3213.9|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|CHAMPVA [1240]|CHAMP VA [124000]|3571.00||||3571.00|2678.25|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3571.00||||3571.00|1521.25|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|||3571.00||||3571.00|1071.3|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3571.00||||3571.00|1712.29|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3571.00||||3571.00|594.97|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3571.00||||3571.00|2142.6|3571|304.44 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3571.00||||3571.00||| 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3571.00||||3571.00||| 36062270|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUNCTURE SPINAL LUMBAR DIAGNOSTIC|AETNA [1015]|AETNA ACO WILCO [101532]|3571.00||||3571.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|CORESOURCE [1315]|CORESOURCE [131500]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|||1155.00||||1155.00|346.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|GEHA [1415]|GEHA [141500]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|CHAMPVA [1240]|CHAMP VA [124000]|1155.00||||1155.00|866.25|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1155.00||||1155.00|1155|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|HEALTHNET [1495]|HEALTHNET [149500]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1155.00||||1155.00|242.55|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|UMR [2035]|UMR OPTIONS [203501]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1155.00||||1155.00|496.65|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MULTIPLAN [1680]|IHC HS [168011]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|TRUSTMARK [2030]|STARMARK [203000]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1155.00||||1155.00|693|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1155.00||||1155.00|578.66|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1155.00||||1155.00|1155|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1155.00||||1155.00|492.03|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1155.00||||1155.00|405.41|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1155.00||||1155.00|553.82|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1155.00||||1155.00|1039.5|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1155.00||||1155.00|750.75|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1155.00||||1155.00|496.65|1155|242.55 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MULTIPLAN [1680]|HMA [168003]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|AETNA [1015]|AETNA ACO WILCO [101532]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1155.00||||1155.00||| 36062272|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC LUMBAR PUNCTURE THERAPUETIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1155.00||||1155.00||| 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5570.00||||5570.00|2372.82|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5570.00||||5570.00|624.72|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5570.00||||5570.00|3342|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5570.00||||5570.00|330.99|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5570.00||||5570.00|319.66|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MULTIPLAN [1680]|IHC HS [168011]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5570.00||||5570.00|855.33|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5570.00||||5570.00|2395.1|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|HEALTHNET [1495]|HEALTHNET [149500]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5570.00||||5570.00|5570|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MULTIPLAN [1680]|HMA [168003]|5570.00||||5570.00|892.45|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5570.00||||5570.00|868.66|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5570.00||||5570.00|1169.7|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5570.00||||5570.00|2670.82|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|CORESOURCE [1315]|CORESOURCE [131500]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|CHAMPVA [1240]|CHAMP VA [124000]|5570.00||||5570.00|4177.5|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5570.00||||5570.00|855.33|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5570.00||||5570.00|344.02|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5570.00||||5570.00|304.44|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|UMR [2035]|UMR OPTIONS [203501]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5570.00||||5570.00|330.99|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|GEHA [1415]|GEHA [141500]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|TRUSTMARK [2030]|STARMARK [203000]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5570.00||||5570.00|606.87|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5570.00||||5570.00|2790.57|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|||5570.00||||5570.00|1671|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5570.00||||5570.00|3620.5|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5570.00||||5570.00|654.47|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5570.00||||5570.00|378.42|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5570.00||||5570.00|5013|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5570.00||||5570.00|654.47|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5570.00||||5570.00|594.97|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5570.00||||5570.00|1431.31|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5570.00||||5570.00|1955.07|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5570.00||||5570.00|2395.1|5570|304.44 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|5570.00||||5570.00||| 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5570.00||||5570.00||| 36062273|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL BLD/CLOT PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5570.00||||5570.00||| 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4669.00||||4669.00|855.33|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|GEHA [1415]|GEHA [141500]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|CORESOURCE [1315]|CORESOURCE [131500]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|CHAMPVA [1240]|CHAMP VA [124000]|4669.00||||4669.00|3501.75|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4669.00||||4669.00|615.21|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4669.00||||4669.00|668.84|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4669.00||||4669.00|2238.79|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4669.00||||4669.00|3034.85|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4669.00||||4669.00|980.49|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|UMR [2035]|UMR OPTIONS [203501]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4669.00||||4669.00|764.7|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4669.00||||4669.00|2007.67|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|FIRST HEALTH [1375]|QUALCHOICE [137513]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4669.00||||4669.00|606.87|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|FMH BENEFIT SERVICES [1390]|FMH [139000]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4669.00||||4669.00|4669|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MULTIPLAN [1680]|IHC HS [168011]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|||4669.00||||4669.00|1400.7|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4669.00||||4669.00|855.33|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4669.00||||4669.00|868.66|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MULTIPLAN [1680]|HMA [168003]|4669.00||||4669.00|892.45|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|HEALTHNET [1495]|HEALTHNET [149500]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4669.00||||4669.00|654.47|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4669.00||||4669.00|2007.67|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4669.00||||4669.00|2339.17|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4669.00||||4669.00|1638.82|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4669.00||||4669.00|1988.99|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4669.00||||4669.00|2801.4|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4669.00||||4669.00|624.72|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4669.00||||4669.00|695.18|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4669.00||||4669.00|1431.31|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4669.00||||4669.00|594.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4669.00||||4669.00|668.84|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4669.00||||4669.00|645.97|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4669.00||||4669.00|654.47|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|TRUSTMARK [2030]|STARMARK [203000]|4669.00||||4669.00|4202.1|4669|594.97 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|AETNA [1015]|AETNA ACO WILCO [101532]|4669.00||||4669.00||| 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4669.00||||4669.00||| 36062320|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP CERV/THOR W/O IMAG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4669.00||||4669.00||| 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1785.00||||1785.00|649.64|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1785.00||||1785.00|1431.31|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1785.00||||1785.00|1071|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1785.00||||1785.00|767.55|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1785.00||||1785.00|894.29|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1785.00||||1785.00|626.54|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1785.00||||1785.00|760.41|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1785.00||||1785.00|668.84|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1785.00||||1785.00|649.64|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|TRUSTMARK [2030]|STARMARK [203000]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|HEALTHNET [1495]|HEALTHNET [149500]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1785.00||||1785.00|849.02|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MULTIPLAN [1680]|HMA [168003]|1785.00||||1785.00|885.87|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MULTIPLAN [1680]|IHC HS [168011]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1785.00||||1785.00|767.55|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1785.00||||1785.00|602.39|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1785.00||||1785.00|764.7|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|UMR [2035]|UMR OPTIONS [203501]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1785.00||||1785.00|645.97|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1785.00||||1785.00|862.25|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1785.00||||1785.00|374.85|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1785.00||||1785.00|615.21|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1785.00||||1785.00|620.11|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1785.00||||1785.00|849.02|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|CORESOURCE [1315]|CORESOURCE [131500]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|CHAMPVA [1240]|CHAMP VA [124000]|1785.00||||1785.00|1338.75|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1785.00||||1785.00|695.18|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|GEHA [1415]|GEHA [141500]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1785.00||||1785.00|668.84|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1785.00||||1785.00|590.58|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|||1785.00||||1785.00|535.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1785.00||||1785.00|855.91|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1785.00||||1785.00|1606.5|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1785.00||||1785.00|1160.25|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1785.00||||1785.00|1785|1785|374.85 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1785.00||||1785.00||| 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|AETNA [1015]|AETNA ACO WILCO [101532]|1785.00||||1785.00||| 36062321|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX OR THERA CERV/THORACIC W/IMAGE GUIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1785.00||||1785.00||| 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|GEHA [1415]|GEHA [141500]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4875.00||||4875.00|695.18|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|CORESOURCE [1315]|CORESOURCE [131500]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|CHAMPVA [1240]|CHAMP VA [124000]|4875.00||||4875.00|3656.25|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4875.00||||4875.00|615.21|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4875.00||||4875.00|668.84|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|||4875.00||||4875.00|1462.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|UMR [2035]|UMR OPTIONS [203501]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4875.00||||4875.00|4875|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4875.00||||4875.00|862.25|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4875.00||||4875.00|764.7|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4875.00||||4875.00|602.39|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4875.00||||4875.00|2096.25|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4875.00||||4875.00|1023.75|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4875.00||||4875.00|3168.75|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4875.00||||4875.00|2337.56|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MULTIPLAN [1680]|IHC HS [168011]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4875.00||||4875.00|849.02|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MULTIPLAN [1680]|HMA [168003]|4875.00||||4875.00|885.87|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|HEALTHNET [1495]|HEALTHNET [149500]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|TRUSTMARK [2030]|STARMARK [203000]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4875.00||||4875.00|668.84|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4875.00||||4875.00|2925|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4875.00||||4875.00|2076.75|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4875.00||||4875.00|1431.31|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4875.00||||4875.00|849.02|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4875.00||||4875.00|590.58|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4875.00||||4875.00|1711.13|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4875.00||||4875.00|649.64|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4875.00||||4875.00|2442.38|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4875.00||||4875.00|2096.25|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4875.00||||4875.00|620.11|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4875.00||||4875.00|649.64|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4875.00||||4875.00|645.97|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4875.00||||4875.00|4387.5|4875|590.58 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4875.00||||4875.00||| 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|AETNA [1015]|AETNA ACO WILCO [101532]|4875.00||||4875.00||| 36062322|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ DX/THRP LUM/SACRL WO IMAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4875.00||||4875.00||| 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5569.00||||5569.00|649.64|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5569.00||||5569.00|1431.31|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5569.00||||5569.00|620.11|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5569.00||||5569.00|3341.4|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5569.00||||5569.00|2790.07|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5569.00||||5569.00|1954.72|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5569.00||||5569.00|2372.39|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5569.00||||5569.00|668.84|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5569.00||||5569.00|645.97|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MULTIPLAN [1680]|IHC HS [168011]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MULTIPLAN [1680]|HMA [168003]|5569.00||||5569.00|885.87|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|FMH BENEFIT SERVICES [1390]|FMH [139000]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|FIRST HEALTH [1375]|QUALCHOICE [137513]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|HEALTHNET [1495]|HEALTHNET [149500]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5569.00||||5569.00|849.02|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5569.00||||5569.00|2394.67|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|TRUSTMARK [2030]|STARMARK [203000]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5569.00||||5569.00|602.39|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5569.00||||5569.00|764.7|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5569.00||||5569.00|649.64|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|UMR [2035]|UMR OPTIONS [203501]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5569.00||||5569.00|862.25|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5569.00||||5569.00|1169.49|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5569.00||||5569.00|3619.85|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5569.00||||5569.00|2670.34|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5569.00||||5569.00|2394.67|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|CHAMPVA [1240]|CHAMP VA [124000]|5569.00||||5569.00|4176.75|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5569.00||||5569.00|615.21|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5569.00||||5569.00|849.02|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|CORESOURCE [1315]|CORESOURCE [131500]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5569.00||||5569.00|695.18|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|GEHA [1415]|GEHA [141500]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5569.00||||5569.00|668.84|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5569.00||||5569.00|590.58|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|||5569.00||||5569.00|1670.7|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5569.00||||5569.00|5012.1|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5569.00||||5569.00|5569|5569|590.58 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5569.00||||5569.00||| 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|AETNA [1015]|AETNA ACO WILCO [101532]|5569.00||||5569.00||| 36062323|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ EPIDURAL LUMB/CAUD W/IMAGING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5569.00||||5569.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|GEHA [1415]|GEHA [141500]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|CORESOURCE [1315]|CORESOURCE [131500]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|CHAMPVA [1240]|CHAMP VA [124000]|4875.00||||4875.00|3656.25|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4875.00||||4875.00|3168.75|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4875.00||||4875.00|4875|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4875.00||||4875.00|2337.56|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4875.00||||4875.00|1023.75|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|UMR [2035]|UMR OPTIONS [203501]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4875.00||||4875.00|2096.25|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MULTIPLAN [1680]|IHC HS [168011]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|||4875.00||||4875.00|1462.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|HEALTHNET [1495]|HEALTHNET [149500]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4875.00||||4875.00|2442.38|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4875.00||||4875.00|1828.14|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4875.00||||4875.00|2925|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4875.00||||4875.00|2076.75|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4875.00||||4875.00|1711.13|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4875.00||||4875.00|2096.25|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|TRUSTMARK [2030]|STARMARK [203000]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4875.00||||4875.00|4387.5|4875|1023.75 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MULTIPLAN [1680]|HMA [168003]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|AETNA [1015]|AETNA ACO WILCO [101532]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4875.00||||4875.00||| 36062326|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC EPIDURAL INSERT-CONT W/O IMAGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4875.00||||4875.00||| 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46537.00||||46537.00|17293.84|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46537.00||||46537.00|20010.91|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46537.00||||46537.00|23315.04|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46537.00||||46537.00|19824.76|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46537.00||||46537.00|16334.49|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46537.00||||46537.00|38404.89|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46537.00||||46537.00|27922.2|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46537.00||||46537.00|17665.88|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46537.00||||46537.00|17293.84|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|TRUSTMARK [2030]|STARMARK [203000]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46537.00||||46537.00|22601.47|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MULTIPLAN [1680]|HMA [168003]|46537.00||||46537.00|23582.5|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|HEALTHNET [1495]|HEALTHNET [149500]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MULTIPLAN [1680]|IHC HS [168011]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46537.00||||46537.00|20197.62|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46537.00||||46537.00|20010.91|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46537.00||||46537.00|16036.1|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|UMR [2035]|UMR OPTIONS [203501]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46537.00||||46537.00|17061.54|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46537.00||||46537.00|22953.64|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46537.00||||46537.00|9772.77|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46537.00||||46537.00|16507.75|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46537.00||||46537.00|16249.09|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46537.00||||46537.00|22601.47|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|CORESOURCE [1315]|CORESOURCE [131500]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|CHAMPVA [1240]|CHAMP VA [124000]|46537.00||||46537.00|34902.75|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46537.00||||46537.00|18361.47|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|GEHA [1415]|GEHA [141500]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46537.00||||46537.00|41883.3|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46537.00||||46537.00|17665.88|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46537.00||||46537.00|15721.67|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|||46537.00||||46537.00|13961.1|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46537.00||||46537.00|30249.05|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46537.00||||46537.00|46537|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46537.00||||46537.00|22314.49|46537|9772.77 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46537.00||||46537.00||| 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|AETNA [1015]|AETNA ACO WILCO [101532]|46537.00||||46537.00||| 36062362|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INSERT INFUSION PUMP PORGRAMABLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46537.00||||46537.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12791.00||||12791.00|3575.42|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|GEHA [1415]|GEHA [141500]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12791.00||||12791.00|4040.12|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|CORESOURCE [1315]|CORESOURCE [131500]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|CHAMPVA [1240]|CHAMP VA [124000]|12791.00||||12791.00|9593.25|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12791.00||||12791.00|3887.07|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|||12791.00||||12791.00|3837.3|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12791.00||||12791.00|6133.28|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12791.00||||12791.00|12791|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|UMR [2035]|UMR OPTIONS [203501]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12791.00||||12791.00|5500.13|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12791.00||||12791.00|4444.14|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|FIRST HEALTH [1375]|QUALCHOICE [137513]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12791.00||||12791.00|2686.11|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|FMH BENEFIT SERVICES [1390]|FMH [139000]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MULTIPLAN [1680]|IHC HS [168011]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12791.00||||12791.00|8314.15|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|HEALTHNET [1495]|HEALTHNET [149500]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12791.00||||12791.00|3887.07|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12791.00||||12791.00|10913.98|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12791.00||||12791.00|6408.29|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12791.00||||12791.00|4489.64|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12791.00||||12791.00|5448.97|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12791.00||||12791.00|5500.13|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12791.00||||12791.00|3754.3|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12791.00||||12791.00|7674.6|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|TRUSTMARK [2030]|STARMARK [203000]|12791.00||||12791.00|11511.9|12791|2686.11 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MULTIPLAN [1680]|HMA [168003]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|AETNA [1015]|AETNA ACO WILCO [101532]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12791.00||||12791.00||| 36062365|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC REMOVE INFUSION PUMP OR RESERVOIR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12791.00||||12791.00||| 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|749.00||||749.00|322.07|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|749.00||||749.00|283.66|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|749.00||||749.00|375.25|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|749.00||||749.00|262.9|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|749.00||||749.00|319.07|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|749.00||||749.00|670.24|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|749.00||||749.00|270.76|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|749.00||||749.00|449.4|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|749.00||||749.00|225.92|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|749.00||||749.00|283.66|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|749.00||||749.00|218.2|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|TRUSTMARK [2030]|STARMARK [203000]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|HEALTHNET [1495]|HEALTHNET [149500]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MULTIPLAN [1680]|IHC HS [168011]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|749.00||||749.00|370.72|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MULTIPLAN [1680]|HMA [168003]|749.00||||749.00|386.81|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|FMH BENEFIT SERVICES [1390]|FMH [139000]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|FIRST HEALTH [1375]|QUALCHOICE [137513]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|749.00||||749.00|258.3|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|749.00||||749.00|322.07|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|749.00||||749.00|263.03|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|UMR [2035]|UMR OPTIONS [203501]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|749.00||||749.00|376.49|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|749.00||||749.00|157.29|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|749.00||||749.00|359.15|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|CHAMPVA [1240]|CHAMP VA [124000]|749.00||||749.00|561.75|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|749.00||||749.00|370.72|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|CORESOURCE [1315]|CORESOURCE [131500]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|749.00||||749.00|234.82|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|GEHA [1415]|GEHA [141500]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|749.00||||749.00|257.87|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|749.00||||749.00|225.92|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|||749.00||||749.00|224.7|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|749.00||||749.00|207.81|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|749.00||||749.00|486.85|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|749.00||||749.00|674.1|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|749.00||||749.00|749|749|157.29 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|749.00||||749.00||| 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|AETNA [1015]|AETNA ACO WILCO [101532]|749.00||||749.00||| 36062367|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC PUMP ANALYSIS W/O REPORGRAMMING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|749.00||||749.00||| 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|GEHA [1415]|GEHA [141500]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|CORESOURCE [1315]|CORESOURCE [131500]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|746.00||||746.00|370.72|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|CHAMPVA [1240]|CHAMP VA [124000]|746.00||||746.00|559.5|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|746.00||||746.00|225.92|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|746.00||||746.00|357.71|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|746.00||||746.00|484.9|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|746.00||||746.00|156.66|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|UMR [2035]|UMR OPTIONS [203501]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|746.00||||746.00|263.03|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|746.00||||746.00|320.78|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|746.00||||746.00|258.3|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|FIRST HEALTH [1375]|QUALCHOICE [137513]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|FMH BENEFIT SERVICES [1390]|FMH [139000]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|746.00||||746.00|746|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MULTIPLAN [1680]|IHC HS [168011]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|||746.00||||746.00|223.8|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|746.00||||746.00|370.72|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|746.00||||746.00|376.49|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MULTIPLAN [1680]|HMA [168003]|746.00||||746.00|386.81|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|HEALTHNET [1495]|HEALTHNET [149500]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|746.00||||746.00|283.66|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|746.00||||746.00|447.6|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|746.00||||746.00|270.76|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|746.00||||746.00|373.75|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|746.00||||746.00|207.81|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|746.00||||746.00|261.85|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|746.00||||746.00|320.78|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|746.00||||746.00|317.8|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|746.00||||746.00|234.82|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|746.00||||746.00|283.66|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|746.00||||746.00|225.92|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|746.00||||746.00|670.24|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|746.00||||746.00|218.2|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|TRUSTMARK [2030]|STARMARK [203000]|746.00||||746.00|671.4|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|746.00||||746.00|257.87|746|156.66 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|746.00||||746.00||| 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|AETNA [1015]|AETNA ACO WILCO [101532]|746.00||||746.00||| 36062368|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|746.00||||746.00||| 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC 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[203000]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18553.00||||18553.00|5845.97|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|HEALTHNET [1495]|HEALTHNET [149500]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|MULTIPLAN [1680]|HMA [168003]|18553.00||||18553.00|8768.95|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18553.00||||18553.00|8404.17|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM 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[103000]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18553.00||||18553.00|5845.97|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18553.00||||18553.00|5845.97|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|UMR [2035]|UMR OPTIONS [203501]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18553.00||||18553.00|5643.69|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18553.00||||18553.00|8535.12|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18553.00||||18553.00|16697.7|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18553.00||||18553.00|3896.13|18553|3896.13 36063650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC IMPLANT PERC ELECTRODES EPIDURAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE 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TRIGEMINAL|||924.00||||924.00|277.2|924|194.04 36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|924.00||||924.00|924|924|194.04 36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|924.00||||924.00|831.6|924|194.04 36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|924.00||||924.00|363.79|924|194.04 36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|924.00||||924.00|249.17|924|194.04 36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|924.00||||924.00|254.16|924|194.04 36064400|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE TRIGEMINAL|EMPLOYEE BENEFIT 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HEALTHCARE CHARTER [206031]|924.00||||924.00||| 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|924.00||||924.00|397.32|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|924.00||||924.00|272.07|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|924.00||||924.00|462.92|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|924.00||||924.00|324.32|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|924.00||||924.00|393.62|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|924.00||||924.00|591.53|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|924.00||||924.00|259.7|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|924.00||||924.00|554.4|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|924.00||||924.00|319.66|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|TRUSTMARK [2030]|STARMARK [203000]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|HEALTHNET [1495]|HEALTHNET [149500]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MULTIPLAN [1680]|IHC HS [168011]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|924.00||||924.00|355.57|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MULTIPLAN [1680]|HMA [168003]|924.00||||924.00|371|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|924.00||||924.00|378.42|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|924.00||||924.00|397.32|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|924.00||||924.00|252.28|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|UMR [2035]|UMR OPTIONS [203501]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|924.00||||924.00|361.11|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|924.00||||924.00|194.04|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|924.00||||924.00|443.06|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|924.00||||924.00|330.99|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|CHAMPVA [1240]|CHAMP VA [124000]|924.00||||924.00|693|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|924.00||||924.00|304.44|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|924.00||||924.00|355.57|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|CORESOURCE [1315]|CORESOURCE [131500]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|924.00||||924.00|344.02|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|GEHA [1415]|GEHA [141500]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|924.00||||924.00|330.99|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|924.00||||924.00|272.07|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|||924.00||||924.00|277.2|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|924.00||||924.00|600.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|924.00||||924.00|924|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|924.00||||924.00|247.34|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|924.00||||924.00|831.6|924|194.04 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|924.00||||924.00||| 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|AETNA [1015]|AETNA ACO WILCO [101532]|924.00||||924.00||| 36064405|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE GREATER OCCIPITAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|924.00||||924.00||| 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|GEHA [1415]|GEHA [141500]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|CORESOURCE [1315]|CORESOURCE [131500]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3821.00||||3821.00|1081.32|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|CHAMPVA [1240]|CHAMP VA [124000]|3821.00||||3821.00|2865.75|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3821.00||||3821.00|330.99|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3821.00||||3821.00|2483.65|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3821.00||||3821.00|1832.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3821.00||||3821.00|802.41|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3821.00||||3821.00|1128.54|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|UMR [2035]|UMR OPTIONS [203501]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3821.00||||3821.00|767.21|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3821.00||||3821.00|378.42|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3821.00||||3821.00|1643.03|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3821.00||||3821.00|3821|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MULTIPLAN [1680]|IHC HS [168011]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|||3821.00||||3821.00|1146.3|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3821.00||||3821.00|1081.32|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MULTIPLAN [1680]|HMA [168003]|3821.00||||3821.00|1128.25|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|HEALTHNET [1495]|HEALTHNET [149500]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3821.00||||3821.00|827.39|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3821.00||||3821.00|1914.32|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3821.00||||3821.00|1643.03|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3821.00||||3821.00|2292.6|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3821.00||||3821.00|789.78|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3821.00||||3821.00|304.44|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3821.00||||3821.00|1828.14|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3821.00||||3821.00|344.02|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3821.00||||3821.00|1627.75|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3821.00||||3821.00|827.39|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3821.00||||3821.00|752.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3821.00||||3821.00|330.99|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3821.00||||3821.00|1341.17|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3821.00||||3821.00|319.66|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3821.00||||3821.00|772.97|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|TRUSTMARK [2030]|STARMARK [203000]|3821.00||||3821.00|3438.9|3821|304.44 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3821.00||||3821.00||| 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|AETNA [1015]|AETNA ACO WILCO [101532]|3821.00||||3821.00||| 36064415|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL SINGLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3821.00||||3821.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2914.00||||2914.00|1253.02|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2914.00||||2914.00|1459.91|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2914.00||||2914.00|1241.36|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2914.00||||2914.00|1828.14|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2914.00||||2914.00|1748.4|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|TRUSTMARK [2030]|STARMARK [203000]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MULTIPLAN [1680]|IHC HS [168011]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2914.00||||2914.00|1253.02|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|UMR [2035]|UMR OPTIONS [203501]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2914.00||||2914.00|611.94|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|HEALTHNET [1495]|HEALTHNET [149500]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2914.00||||2914.00|2914|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2914.00||||2914.00|1022.81|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|CORESOURCE [1315]|CORESOURCE [131500]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|CHAMPVA [1240]|CHAMP VA [124000]|2914.00||||2914.00|2185.5|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|GEHA [1415]|GEHA [141500]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2914.00||||2914.00|2622.6|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|||2914.00||||2914.00|874.2|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2914.00||||2914.00|1397.26|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2914.00||||2914.00|1894.1|2914|611.94 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|AETNA [1015]|AETNA ACO WILCO [101532]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MULTIPLAN [1680]|HMA [168003]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2914.00||||2914.00||| 36064416|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BRACHIAL CONTINUOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2914.00||||2914.00||| 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|GEHA [1415]|GEHA [141500]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1532.00||||1532.00|344.02|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|CORESOURCE [1315]|CORESOURCE [131500]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|CHAMPVA [1240]|CHAMP VA [124000]|1532.00||||1532.00|1149|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1532.00||||1532.00|304.44|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1532.00||||1532.00|330.99|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|||1532.00||||1532.00|459.6|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1532.00||||1532.00|995.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1532.00||||1532.00|1532|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1532.00||||1532.00|1128.54|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1532.00||||1532.00|788.43|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1532.00||||1532.00|658.76|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1532.00||||1532.00|378.42|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|UMR [2035]|UMR OPTIONS [203501]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MULTIPLAN [1680]|IHC HS [168011]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1532.00||||1532.00|1111.23|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1532.00||||1532.00|321.72|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MULTIPLAN [1680]|HMA [168003]|1532.00||||1532.00|1159.46|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1532.00||||1532.00|734.59|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|HEALTHNET [1495]|HEALTHNET [149500]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1532.00||||1532.00|330.99|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1532.00||||1532.00|652.63|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1532.00||||1532.00|789.78|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1532.00||||1532.00|1111.23|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1532.00||||1532.00|537.73|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1532.00||||1532.00|1532|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1532.00||||1532.00|827.39|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1532.00||||1532.00|772.97|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1532.00||||1532.00|919.2|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1532.00||||1532.00|767.53|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1532.00||||1532.00|850.27|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1532.00||||1532.00|319.66|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1532.00||||1532.00|658.76|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|TRUSTMARK [2030]|STARMARK [203000]|1532.00||||1532.00|1378.8|1532|304.44 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1532.00||||1532.00||| 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|AETNA [1015]|AETNA ACO WILCO [101532]|1532.00||||1532.00||| 36064417|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE AXILLARY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1532.00||||1532.00||| 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2355.00||||2355.00|304.44|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|CHAMPVA [1240]|CHAMP VA [124000]|2355.00||||2355.00|1766.25|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2355.00||||2355.00|849.02|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|CORESOURCE [1315]|CORESOURCE [131500]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2355.00||||2355.00|344.02|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|GEHA [1415]|GEHA [141500]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2355.00||||2355.00|649.64|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2355.00||||2355.00|1431.31|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2355.00||||2355.00|620.11|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2355.00||||2355.00|1413|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2355.00||||2355.00|1179.86|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2355.00||||2355.00|826.61|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2355.00||||2355.00|1003.23|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2355.00||||2355.00|649.64|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2355.00||||2355.00|319.66|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|TRUSTMARK [2030]|STARMARK [203000]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|HEALTHNET [1495]|HEALTHNET [149500]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MULTIPLAN [1680]|IHC HS [168011]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2355.00||||2355.00|849.02|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MULTIPLAN [1680]|HMA [168003]|2355.00||||2355.00|885.87|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2355.00||||2355.00|330.99|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2355.00||||2355.00|378.42|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2355.00||||2355.00|1012.65|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2355.00||||2355.00|602.39|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2355.00||||2355.00|1012.65|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|UMR [2035]|UMR OPTIONS [203501]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2355.00||||2355.00|862.25|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2355.00||||2355.00|494.55|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2355.00||||2355.00|2355|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2355.00||||2355.00|2119.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2355.00||||2355.00|1530.75|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2355.00||||2355.00|1129.22|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|||2355.00||||2355.00|706.5|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2355.00||||2355.00|330.99|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2355.00||||2355.00|590.58|2355|304.44 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2355.00||||2355.00||| 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|AETNA [1015]|AETNA ACO WILCO [101532]|2355.00||||2355.00||| 36064418|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SUPRASCAPULAR SINGLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2355.00||||2355.00||| 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|GEHA [1415]|GEHA [141500]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|CORESOURCE [1315]|CORESOURCE [131500]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1604.00||||1604.00|849.02|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|CHAMPVA [1240]|CHAMP VA [124000]|1604.00||||1604.00|1203|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1604.00||||1604.00|304.44|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1604.00||||1604.00|330.99|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|||1604.00||||1604.00|481.2|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1604.00||||1604.00|769.12|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1604.00||||1604.00|1042.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1604.00||||1604.00|1604|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1604.00||||1604.00|336.84|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1604.00||||1604.00|862.25|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|UMR [2035]|UMR OPTIONS [203501]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1604.00||||1604.00|602.39|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1604.00||||1604.00|689.72|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1604.00||||1604.00|378.42|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MULTIPLAN [1680]|IHC HS [168011]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1604.00||||1604.00|849.02|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MULTIPLAN [1680]|HMA [168003]|1604.00||||1604.00|885.87|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|HEALTHNET [1495]|HEALTHNET [149500]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|TRUSTMARK [2030]|STARMARK [203000]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1604.00||||1604.00|319.66|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1604.00||||1604.00|649.64|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1604.00||||1604.00|330.99|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1604.00||||1604.00|689.72|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1604.00||||1604.00|803.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1604.00||||1604.00|344.02|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1604.00||||1604.00|563|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1604.00||||1604.00|683.3|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1604.00||||1604.00|962.4|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1604.00||||1604.00|620.11|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1604.00||||1604.00|1431.31|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1604.00||||1604.00|649.64|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1604.00||||1604.00|590.58|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1604.00||||1604.00|1443.6|1604|304.44 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1604.00||||1604.00||| 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|AETNA [1015]|AETNA ACO WILCO [101532]|1604.00||||1604.00||| 36064420|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL SINGLE LVL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1604.00||||1604.00||| 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3124.00||||3124.00|844|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3124.00||||3124.00|1828.14|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3124.00||||3124.00|1874.4|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3124.00||||3124.00|1343.32|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3124.00||||3124.00|1565.12|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3124.00||||3124.00|1096.52|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3124.00||||3124.00|1330.82|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3124.00||||3124.00|640.29|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3124.00||||3124.00|618.38|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|TRUSTMARK [2030]|STARMARK [203000]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|HEALTHNET [1495]|HEALTHNET [149500]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MULTIPLAN [1680]|IHC HS [168011]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3124.00||||3124.00|1103.03|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MULTIPLAN [1680]|HMA [168003]|3124.00||||3124.00|1150.91|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3124.00||||3124.00|732.05|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3124.00||||3124.00|1343.32|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3124.00||||3124.00|782.62|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|UMR [2035]|UMR OPTIONS [203501]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3124.00||||3124.00|1120.22|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3124.00||||3124.00|844|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3124.00||||3124.00|656.04|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3124.00||||3124.00|3124|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3124.00||||3124.00|2030.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3124.00||||3124.00|1497.96|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|||3124.00||||3124.00|937.2|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3124.00||||3124.00|805.64|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3124.00||||3124.00|640.29|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3124.00||||3124.00|588.94|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3124.00||||3124.00|767.27|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|CHAMPVA [1240]|CHAMP VA [124000]|3124.00||||3124.00|2343|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3124.00||||3124.00|1103.03|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|CORESOURCE [1315]|CORESOURCE [131500]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3124.00||||3124.00|665.5|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|GEHA [1415]|GEHA [141500]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3124.00||||3124.00|2811.6|3124|588.94 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3124.00||||3124.00||| 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|AETNA [1015]|AETNA ACO WILCO [101532]|3124.00||||3124.00||| 36064421|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE INTERCOSTAL MULTIPLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3124.00||||3124.00||| 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|GEHA [1415]|GEHA [141500]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|990.00||||990.00|344.02|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|CORESOURCE [1315]|CORESOURCE [131500]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|CHAMPVA [1240]|CHAMP VA [124000]|990.00||||990.00|742.5|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|990.00||||990.00|304.44|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|990.00||||990.00|330.99|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|||990.00||||990.00|297|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|990.00||||990.00|643.5|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|990.00||||990.00|990|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|990.00||||990.00|207.9|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|990.00||||990.00|862.25|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|UMR [2035]|UMR OPTIONS [203501]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|990.00||||990.00|602.39|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|990.00||||990.00|425.7|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|990.00||||990.00|378.42|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MULTIPLAN [1680]|IHC HS [168011]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|990.00||||990.00|849.02|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MULTIPLAN [1680]|HMA [168003]|990.00||||990.00|885.87|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|HEALTHNET [1495]|HEALTHNET [149500]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|990.00||||990.00|474.71|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|TRUSTMARK [2030]|STARMARK [203000]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|990.00||||990.00|849.02|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|990.00||||990.00|319.66|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|990.00||||990.00|649.64|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|990.00||||990.00|330.99|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|990.00||||990.00|425.7|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|990.00||||990.00|495.99|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|990.00||||990.00|347.49|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|990.00||||990.00|421.74|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|990.00||||990.00|594|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|990.00||||990.00|620.11|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|990.00||||990.00|990|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|990.00||||990.00|649.64|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|990.00||||990.00|590.58|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|990.00||||990.00|891|990|207.9 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|990.00||||990.00||| 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|AETNA [1015]|AETNA ACO WILCO [101532]|990.00||||990.00||| 36064425|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE ILIOINGUIN/ILIOHYPOGAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|990.00||||990.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3744.00||||3744.00|1828.14|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3744.00||||3744.00|2246.4|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3744.00||||3744.00|1875.74|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3744.00||||3744.00|1314.14|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3744.00||||3744.00|1594.94|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|TRUSTMARK [2030]|STARMARK [203000]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|HEALTHNET [1495]|HEALTHNET [149500]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MULTIPLAN [1680]|IHC HS [168011]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3744.00||||3744.00|1609.92|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|UMR [2035]|UMR OPTIONS [203501]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3744.00||||3744.00|786.24|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3744.00||||3744.00|3744|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3744.00||||3744.00|2433.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3744.00||||3744.00|1795.25|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3744.00||||3744.00|1609.92|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|||3744.00||||3744.00|1123.2|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|CHAMPVA [1240]|CHAMP VA [124000]|3744.00||||3744.00|2808|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|CORESOURCE [1315]|CORESOURCE [131500]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|GEHA [1415]|GEHA [141500]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3744.00||||3744.00|3369.6|3744|786.24 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|AETNA [1015]|AETNA ACO WILCO [101532]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MULTIPLAN [1680]|HMA [168003]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3744.00||||3744.00||| 36064430|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE PUDENDAL NERVE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3744.00||||3744.00||| 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|GEHA [1415]|GEHA [141500]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2409.00||||2409.00|665.5|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|CORESOURCE [1315]|CORESOURCE [131500]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2409.00||||2409.00|849.02|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|CHAMPVA [1240]|CHAMP VA [124000]|2409.00||||2409.00|1806.75|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2409.00||||2409.00|640.29|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|||2409.00||||2409.00|722.7|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2409.00||||2409.00|1155.12|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2409.00||||2409.00|1565.85|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2409.00||||2409.00|2409|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2409.00||||2409.00|505.89|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2409.00||||2409.00|862.25|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|UMR [2035]|UMR OPTIONS [203501]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2409.00||||2409.00|602.39|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2409.00||||2409.00|1035.87|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2409.00||||2409.00|732.05|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MULTIPLAN [1680]|IHC HS [168011]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2409.00||||2409.00|849.02|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MULTIPLAN [1680]|HMA [168003]|2409.00||||2409.00|885.87|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|HEALTHNET [1495]|HEALTHNET [149500]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|TRUSTMARK [2030]|STARMARK [203000]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2409.00||||2409.00|588.94|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2409.00||||2409.00|618.38|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2409.00||||2409.00|649.64|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2409.00||||2409.00|640.29|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2409.00||||2409.00|1035.87|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2409.00||||2409.00|1206.91|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2409.00||||2409.00|845.56|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2409.00||||2409.00|1026.23|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2409.00||||2409.00|1445.4|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2409.00||||2409.00|620.11|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2409.00||||2409.00|1431.31|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2409.00||||2409.00|649.64|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2409.00||||2409.00|590.58|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2409.00||||2409.00|2168.1|2409|505.89 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|AETNA [1015]|AETNA ACO WILCO [101532]|2409.00||||2409.00||| 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2409.00||||2409.00||| 36064445|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2409.00||||2409.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1933.00||||1933.00|831.19|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1933.00||||1933.00|968.43|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1933.00||||1933.00|678.48|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1933.00||||1933.00|823.46|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1933.00||||1933.00|1828.14|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1933.00||||1933.00|1159.8|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|TRUSTMARK [2030]|STARMARK [203000]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MULTIPLAN [1680]|IHC HS [168011]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|HEALTHNET [1495]|HEALTHNET [149500]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1933.00||||1933.00|831.19|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|UMR [2035]|UMR OPTIONS [203501]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1933.00||||1933.00|405.93|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1933.00||||1933.00|1933|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1933.00||||1933.00|1256.45|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1933.00||||1933.00|926.87|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|||1933.00||||1933.00|579.9|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|CHAMPVA [1240]|CHAMP VA [124000]|1933.00||||1933.00|1449.75|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|CORESOURCE [1315]|CORESOURCE [131500]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|GEHA [1415]|GEHA [141500]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1933.00||||1933.00|1739.7|1933|405.93 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|AETNA [1015]|AETNA ACO WILCO [101532]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MULTIPLAN [1680]|HMA [168003]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1933.00||||1933.00||| 36064446|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE SCIATIC CONTINUOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1933.00||||1933.00||| 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|GEHA [1415]|GEHA [141500]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1532.00||||1532.00|344.02|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|CORESOURCE [1315]|CORESOURCE [131500]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1532.00||||1532.00|855.33|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|CHAMPVA [1240]|CHAMP VA [124000]|1532.00||||1532.00|1149|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1532.00||||1532.00|304.44|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1532.00||||1532.00|330.99|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|||1532.00||||1532.00|459.6|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1532.00||||1532.00|995.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1532.00||||1532.00|1532|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1532.00||||1532.00|321.72|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1532.00||||1532.00|868.66|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|UMR [2035]|UMR OPTIONS [203501]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1532.00||||1532.00|606.87|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1532.00||||1532.00|658.76|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1532.00||||1532.00|378.42|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MULTIPLAN [1680]|IHC HS [168011]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1532.00||||1532.00|849.02|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MULTIPLAN [1680]|HMA [168003]|1532.00||||1532.00|885.87|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|HEALTHNET [1495]|HEALTHNET [149500]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1532.00||||1532.00|734.59|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|TRUSTMARK [2030]|STARMARK [203000]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1532.00||||1532.00|578.96|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1532.00||||1532.00|319.66|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1532.00||||1532.00|649.64|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1532.00||||1532.00|330.99|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1532.00||||1532.00|652.63|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1532.00||||1532.00|658.76|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1532.00||||1532.00|767.53|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1532.00||||1532.00|537.73|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1532.00||||1532.00|919.2|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1532.00||||1532.00|607.9|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1532.00||||1532.00|1431.31|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1532.00||||1532.00|649.64|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1532.00||||1532.00|590.58|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1532.00||||1532.00|1378.8|1532|304.44 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1532.00||||1532.00||| 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|AETNA [1015]|AETNA ACO WILCO [101532]|1532.00||||1532.00||| 36064447|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL SINGLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1532.00||||1532.00||| 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6042.00||||6042.00|850.27|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6042.00||||6042.00|1828.14|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6042.00||||6042.00|811.62|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6042.00||||6042.00|3625.2|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6042.00||||6042.00|3027.04|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6042.00||||6042.00|2120.74|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6042.00||||6042.00|2573.89|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6042.00||||6042.00|640.29|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6042.00||||6042.00|850.27|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6042.00||||6042.00|618.38|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|TRUSTMARK [2030]|STARMARK [203000]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|HEALTHNET [1495]|HEALTHNET [149500]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MULTIPLAN [1680]|IHC HS [168011]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6042.00||||6042.00|1111.23|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MULTIPLAN [1680]|HMA [168003]|6042.00||||6042.00|1159.46|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6042.00||||6042.00|732.05|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6042.00||||6042.00|2598.06|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6042.00||||6042.00|788.43|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|UMR [2035]|UMR OPTIONS [203501]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6042.00||||6042.00|1128.54|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6042.00||||6042.00|1268.82|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6042.00||||6042.00|6042|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6042.00||||6042.00|3927.3|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6042.00||||6042.00|2897.14|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6042.00||||6042.00|2598.06|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|||6042.00||||6042.00|1812.6|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6042.00||||6042.00|640.29|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6042.00||||6042.00|772.97|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6042.00||||6042.00|588.94|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|CHAMPVA [1240]|CHAMP VA [124000]|6042.00||||6042.00|4531.5|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6042.00||||6042.00|1111.23|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|CORESOURCE [1315]|CORESOURCE [131500]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6042.00||||6042.00|665.5|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|GEHA [1415]|GEHA [141500]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6042.00||||6042.00|5437.8|6042|588.94 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6042.00||||6042.00||| 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|AETNA [1015]|AETNA ACO WILCO [101532]|6042.00||||6042.00||| 36064448|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE FEMORAL CONTINUOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6042.00||||6042.00||| 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|GEHA [1415]|GEHA [141500]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|CORESOURCE [1315]|CORESOURCE [131500]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1073.00||||1073.00|849.02|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|CHAMPVA [1240]|CHAMP VA [124000]|1073.00||||1073.00|804.75|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1073.00||||1073.00|330.99|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|||1073.00||||1073.00|321.9|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1073.00||||1073.00|514.5|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1073.00||||1073.00|697.45|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1073.00||||1073.00|1073|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1073.00||||1073.00|225.33|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1073.00||||1073.00|862.25|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|UMR [2035]|UMR OPTIONS [203501]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1073.00||||1073.00|602.39|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1073.00||||1073.00|461.39|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1073.00||||1073.00|378.42|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MULTIPLAN [1680]|IHC HS [168011]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1073.00||||1073.00|849.02|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MULTIPLAN [1680]|HMA [168003]|1073.00||||1073.00|885.87|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|HEALTHNET [1495]|HEALTHNET [149500]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|TRUSTMARK [2030]|STARMARK [203000]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1073.00||||1073.00|304.44|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1073.00||||1073.00|319.66|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1073.00||||1073.00|649.64|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1073.00||||1073.00|344.02|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1073.00||||1073.00|330.99|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1073.00||||1073.00|643.8|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1073.00||||1073.00|620.11|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1073.00||||1073.00|461.39|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1073.00||||1073.00|537.57|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1073.00||||1073.00|376.62|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1073.00||||1073.00|457.1|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1073.00||||1073.00|1073|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1073.00||||1073.00|649.64|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1073.00||||1073.00|590.58|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1073.00||||1073.00|965.7|1073|225.33 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1073.00||||1073.00||| 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|AETNA [1015]|AETNA ACO WILCO [101532]|1073.00||||1073.00||| 36064450|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE OTHER PERIPHERAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1073.00||||1073.00||| 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1785.00||||1785.00|649.64|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1785.00||||1785.00|894.29|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1785.00||||1785.00|760.41|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1785.00||||1785.00|626.54|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1785.00||||1785.00|1071|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1785.00||||1785.00|824.6|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|TRUSTMARK [2030]|STARMARK [203000]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|HEALTHNET [1495]|HEALTHNET [149500]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MULTIPLAN [1680]|IHC HS [168011]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1785.00||||1785.00|849.02|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MULTIPLAN [1680]|HMA [168003]|1785.00||||1785.00|885.87|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|FMH BENEFIT SERVICES [1390]|FMH [139000]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|FIRST HEALTH [1375]|QUALCHOICE [137513]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1785.00||||1785.00|942.78|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1785.00||||1785.00|767.55|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1785.00||||1785.00|602.39|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|UMR [2035]|UMR OPTIONS [203501]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1785.00||||1785.00|862.25|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1785.00||||1785.00|649.64|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1785.00||||1785.00|374.85|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1785.00||||1785.00|1785|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1785.00||||1785.00|620.11|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1785.00||||1785.00|855.91|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1785.00||||1785.00|1160.25|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|||1785.00||||1785.00|535.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1785.00||||1785.00|767.55|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1785.00||||1785.00|824.6|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1785.00||||1785.00|590.58|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|CHAMPVA [1240]|CHAMP VA [124000]|1785.00||||1785.00|1338.75|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1785.00||||1785.00|849.02|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1785.00||||1785.00|857.07|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|CORESOURCE [1315]|CORESOURCE [131500]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|GEHA [1415]|GEHA [141500]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1785.00||||1785.00|1606.5|1785|374.85 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1785.00||||1785.00||| 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1785.00||||1785.00||| 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1785.00||||1785.00||| 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|AETNA [1015]|AETNA ACO WILCO [101532]|1785.00||||1785.00||| 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1785.00||||1785.00||| 36064451|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD NERVE NRVTG SI JOINT W/IMG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1785.00||||1785.00||| 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|GEHA [1415]|GEHA [141500]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|CORESOURCE [1315]|CORESOURCE [131500]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1876.00||||1876.00|857.07|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1876.00||||1876.00|849.02|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|CHAMPVA [1240]|CHAMP VA [124000]|1876.00||||1876.00|1407|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1876.00||||1876.00|824.6|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|||1876.00||||1876.00|562.8|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1876.00||||1876.00|1219.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1876.00||||1876.00|899.54|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1876.00||||1876.00|1876|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1876.00||||1876.00|393.96|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1876.00||||1876.00|862.25|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|UMR [2035]|UMR OPTIONS [203501]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1876.00||||1876.00|602.39|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1876.00||||1876.00|806.68|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1876.00||||1876.00|942.78|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|FIRST HEALTH [1375]|QUALCHOICE [137513]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|FMH BENEFIT SERVICES [1390]|FMH [139000]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MULTIPLAN [1680]|IHC HS [168011]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1876.00||||1876.00|849.02|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MULTIPLAN [1680]|HMA [168003]|1876.00||||1876.00|885.87|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|HEALTHNET [1495]|HEALTHNET [149500]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|TRUSTMARK [2030]|STARMARK [203000]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1876.00||||1876.00|649.64|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1876.00||||1876.00|824.6|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1876.00||||1876.00|1125.6|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1876.00||||1876.00|620.11|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1876.00||||1876.00|806.68|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1876.00||||1876.00|939.88|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1876.00||||1876.00|658.48|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1876.00||||1876.00|799.18|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1876.00||||1876.00|590.58|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1876.00||||1876.00|1688.4|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1876.00||||1876.00|649.64|1876|393.96 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1876.00||||1876.00||| 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1876.00||||1876.00||| 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|AETNA [1015]|AETNA ACO WILCO [101532]|1876.00||||1876.00||| 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1876.00||||1876.00||| 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1876.00||||1876.00||| 36064454|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ AA&/STRD GENICULAR NRV BRANCHES W/IMG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1876.00||||1876.00||| 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3124.00||||3124.00|844|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3124.00||||3124.00|1343.32|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3124.00||||3124.00|1565.12|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3124.00||||3124.00|1096.52|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3124.00||||3124.00|1330.82|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3124.00||||3124.00|805.64|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3124.00||||3124.00|1874.4|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3124.00||||3124.00|844|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3124.00||||3124.00|618.38|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|TRUSTMARK [2030]|STARMARK [203000]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MULTIPLAN [1680]|IHC HS [168011]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3124.00||||3124.00|1103.03|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|HEALTHNET [1495]|HEALTHNET [149500]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|FMH BENEFIT SERVICES [1390]|FMH [139000]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|FIRST HEALTH [1375]|QUALCHOICE [137513]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MULTIPLAN [1680]|HMA [168003]|3124.00||||3124.00|1150.91|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3124.00||||3124.00|732.05|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3124.00||||3124.00|1343.32|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3124.00||||3124.00|782.62|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|UMR [2035]|UMR OPTIONS [203501]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3124.00||||3124.00|1120.22|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3124.00||||3124.00|656.04|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3124.00||||3124.00|640.29|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3124.00||||3124.00|3124|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3124.00||||3124.00|2030.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3124.00||||3124.00|1497.96|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|||3124.00||||3124.00|937.2|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3124.00||||3124.00|1828.14|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3124.00||||3124.00|640.29|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3124.00||||3124.00|767.27|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3124.00||||3124.00|588.94|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|CHAMPVA [1240]|CHAMP VA [124000]|3124.00||||3124.00|2343|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3124.00||||3124.00|1103.03|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|CORESOURCE [1315]|CORESOURCE [131500]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3124.00||||3124.00|665.5|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|GEHA [1415]|GEHA [141500]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3124.00||||3124.00|2811.6|3124|588.94 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3124.00||||3124.00||| 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|AETNA [1015]|AETNA ACO WILCO [101532]|3124.00||||3124.00||| 36064479|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T SNGL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3124.00||||3124.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|GEHA [1415]|GEHA [141500]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|CORESOURCE [1315]|CORESOURCE [131500]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|CHAMPVA [1240]|CHAMP VA [124000]|3500.00||||3500.00|2625|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3500.00||||3500.00|330.99|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3500.00||||3500.00|1678.25|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3500.00||||3500.00|2275|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3500.00||||3500.00|3500|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3500.00||||3500.00|735|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|UMR [2035]|UMR OPTIONS [203501]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3500.00||||3500.00|1505|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY 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[183100]|3500.00||||3500.00|344.02|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3500.00||||3500.00|330.99|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3500.00||||3500.00|2100|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3500.00||||3500.00|1505|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3500.00||||3500.00|1753.5|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3500.00||||3500.00|1228.5|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3500.00||||3500.00|1491|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3500.00||||3500.00|1750|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3500.00||||3500.00|3150|3500|304.44 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MULTIPLAN [1680]|HMA [168003]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|AETNA [1015]|AETNA ACO WILCO [101532]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3500.00||||3500.00||| 36064480|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF C/T ADDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3500.00||||3500.00||| 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4659.00||||4659.00|4193.1|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4659.00||||4659.00|844|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4659.00||||4659.00|1828.14|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4659.00||||4659.00|767.27|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4659.00||||4659.00|2334.16|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4659.00||||4659.00|1635.31|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4659.00||||4659.00|1984.73|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4659.00||||4659.00|2795.4|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4659.00||||4659.00|640.29|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4659.00||||4659.00|4193.1|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4659.00||||4659.00|844|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4659.00||||4659.00|618.38|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|HUMANA MEDICARE REPLACEMENT 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[402000]|4659.00||||4659.00|767.27|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4659.00||||4659.00|1103.03|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|MULTIPLAN [1680]|HMA [168003]|4659.00||||4659.00|1150.91|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|HEALTHNET [1495]|HEALTHNET [149500]|4659.00||||4659.00|4193.1|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4659.00||||4659.00|767.27|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4659.00||||4659.00|4193.1|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4659.00||||4659.00|4193.1|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|FMH BENEFIT SERVICES [1390]|FMH [139000]|4659.00||||4659.00|4193.1|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|FIRST HEALTH [1375]|QUALCHOICE [137513]|4659.00||||4659.00|4193.1|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4659.00||||4659.00|767.27|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4659.00||||4659.00|732.05|4659|588.94 36064483|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR SNGL|HEALTHSCOPE BENEFITS 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[2940]|BCC BREAST CERVICAL CANCER [294000]|4659.00||||4659.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|GEHA [1415]|GEHA [141500]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3500.00||||3500.00|344.02|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|CORESOURCE [1315]|CORESOURCE [131500]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|CHAMPVA [1240]|CHAMP VA [124000]|3500.00||||3500.00|2625|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ 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36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3500.00||||3500.00|1678.25|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3500.00||||3500.00|2275|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3500.00||||3500.00|3500|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3500.00||||3500.00|735|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR 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[292000]|3500.00||||3500.00|378.42|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM 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SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3500.00||||3500.00|319.66|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3500.00||||3500.00|330.99|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR 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[228000]|3500.00||||3500.00|1750|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3500.00||||3500.00|3150|3500|304.44 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|MULTIPLAN [1680]|HMA [168003]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|AETNA [1015]|AETNA ACO WILCO [101532]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3500.00||||3500.00||| 36064484|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANES/STEROID TRNSF LUMBR ADDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3500.00||||3500.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3854.00||||3854.00|1657.22|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3854.00||||3854.00|1930.85|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3854.00||||3854.00|1352.75|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3854.00||||3854.00|1641.8|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3854.00||||3854.00|2312.4|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|TRUSTMARK [2030]|STARMARK [203000]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MULTIPLAN [1680]|IHC HS [168011]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|HEALTHNET [1495]|HEALTHNET [149500]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|FMH BENEFIT SERVICES [1390]|FMH [139000]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|FIRST HEALTH [1375]|QUALCHOICE [137513]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3854.00||||3854.00|1657.22|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|UMR [2035]|UMR OPTIONS [203501]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3854.00||||3854.00|809.34|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3854.00||||3854.00|3854|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3854.00||||3854.00|1927|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3854.00||||3854.00|2505.1|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3854.00||||3854.00|1847.99|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|||3854.00||||3854.00|1156.2|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|CHAMPVA [1240]|CHAMP VA [124000]|3854.00||||3854.00|2890.5|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|CORESOURCE [1315]|CORESOURCE [131500]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|GEHA [1415]|GEHA [141500]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3854.00||||3854.00|3468.6|3854|809.34 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|MULTIPLAN [1680]|HMA [168003]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|AETNA [1015]|AETNA ACO WILCO [101532]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3854.00||||3854.00||| 36064486|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK UNILAT INJECTION(S)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3854.00||||3854.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|GEHA [1415]|GEHA [141500]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|CORESOURCE [1315]|CORESOURCE [131500]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|CHAMPVA [1240]|CHAMP VA [124000]|7526.00||||7526.00|5644.5|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7526.00||||7526.00|3608.72|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7526.00||||7526.00|4891.9|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7526.00||||7526.00|7526|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7526.00||||7526.00|1580.46|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7526.00||||7526.00|3236.18|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|FIRST HEALTH [1375]|QUALCHOICE [137513]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|UMR [2035]|UMR OPTIONS [203501]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|FMH BENEFIT SERVICES [1390]|FMH [139000]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|HEALTHNET [1495]|HEALTHNET [149500]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MULTIPLAN [1680]|IHC HS [168011]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|||7526.00||||7526.00|2257.8|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|TRUSTMARK [2030]|STARMARK [203000]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7526.00||||7526.00|4515.6|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7526.00||||7526.00|3763|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7526.00||||7526.00|3236.18|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7526.00||||7526.00|3770.53|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7526.00||||7526.00|3206.08|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7526.00||||7526.00|2641.63|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7526.00||||7526.00|6773.4|7526|1580.46 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MULTIPLAN [1680]|HMA [168003]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|AETNA [1015]|AETNA ACO WILCO [101532]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7526.00||||7526.00||| 36064488|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC TAP BLOCK BILATERAL BY INJECTION(S)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7526.00||||7526.00||| 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3718.00||||3718.00|1828.14|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3718.00||||3718.00|1862.72|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3718.00||||3718.00|1305.02|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3718.00||||3718.00|1583.87|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3718.00||||3718.00|805.64|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3718.00||||3718.00|2230.8|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3718.00||||3718.00|640.29|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3718.00||||3718.00|618.38|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|TRUSTMARK [2030]|STARMARK [203000]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MULTIPLAN [1680]|IHC HS [168011]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3718.00||||3718.00|1103.03|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MULTIPLAN [1680]|HMA [168003]|3718.00||||3718.00|1150.91|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|HEALTHNET [1495]|HEALTHNET [149500]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|FMH BENEFIT SERVICES [1390]|FMH [139000]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|FIRST HEALTH [1375]|QUALCHOICE [137513]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3718.00||||3718.00|732.05|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3718.00||||3718.00|1598.74|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3718.00||||3718.00|782.62|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|UMR [2035]|UMR OPTIONS [203501]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3718.00||||3718.00|1120.22|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3718.00||||3718.00|844|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3718.00||||3718.00|780.78|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3718.00||||3718.00|3718|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3718.00||||3718.00|2416.7|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3718.00||||3718.00|1782.78|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|||3718.00||||3718.00|1115.4|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3718.00||||3718.00|1598.74|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3718.00||||3718.00|640.29|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3718.00||||3718.00|844|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3718.00||||3718.00|767.27|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3718.00||||3718.00|588.94|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|CHAMPVA [1240]|CHAMP VA [124000]|3718.00||||3718.00|2788.5|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3718.00||||3718.00|1103.03|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|CORESOURCE [1315]|CORESOURCE [131500]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3718.00||||3718.00|665.5|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|GEHA [1415]|GEHA [141500]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3718.00||||3718.00|3346.2|3718|588.94 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|AETNA [1015]|AETNA ACO WILCO [101532]|3718.00||||3718.00||| 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3718.00||||3718.00||| 36064490|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC SNGL LVL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3718.00||||3718.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|GEHA [1415]|GEHA [141500]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1561.00||||1561.00|236.23|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|CORESOURCE [1315]|CORESOURCE [131500]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|CHAMPVA [1240]|CHAMP VA [124000]|1561.00||||1561.00|1170.75|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1561.00||||1561.00|209.05|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1561.00||||1561.00|227.28|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|||1561.00||||1561.00|468.3|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1561.00||||1561.00|1014.65|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1561.00||||1561.00|1561|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1561.00||||1561.00|327.81|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|UMR [2035]|UMR OPTIONS [203501]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1561.00||||1561.00|671.23|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1561.00||||1561.00|259.85|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|HEALTHNET [1495]|HEALTHNET [149500]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MULTIPLAN [1680]|IHC HS [168011]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|TRUSTMARK [2030]|STARMARK [203000]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1561.00||||1561.00|748.5|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1561.00||||1561.00|219.5|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1561.00||||1561.00|227.28|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1561.00||||1561.00|936.6|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1561.00||||1561.00|671.23|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1561.00||||1561.00|782.06|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1561.00||||1561.00|547.91|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1561.00||||1561.00|664.99|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1561.00||||1561.00|780.5|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1561.00||||1561.00|1404.9|1561|209.05 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MULTIPLAN [1680]|HMA [168003]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|AETNA [1015]|AETNA ACO WILCO [101532]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1561.00||||1561.00||| 36064491|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC 2ND LVL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1561.00||||1561.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1236.00||||1236.00|531.48|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1236.00||||1236.00|619.24|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1236.00||||1236.00|526.54|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1236.00||||1236.00|741.6|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1236.00||||1236.00|219.5|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|TRUSTMARK [2030]|STARMARK [203000]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MULTIPLAN [1680]|IHC HS [168011]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|HEALTHNET [1495]|HEALTHNET [149500]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1236.00||||1236.00|259.85|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1236.00||||1236.00|531.48|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|UMR [2035]|UMR OPTIONS [203501]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1236.00||||1236.00|259.56|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1236.00||||1236.00|1236|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1236.00||||1236.00|803.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1236.00||||1236.00|592.66|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1236.00||||1236.00|227.28|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1236.00||||1236.00|433.84|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|||1236.00||||1236.00|370.8|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1236.00||||1236.00|618|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1236.00||||1236.00|227.28|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1236.00||||1236.00|209.05|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|CHAMPVA [1240]|CHAMP VA [124000]|1236.00||||1236.00|927|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|CORESOURCE [1315]|CORESOURCE [131500]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1236.00||||1236.00|236.23|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|GEHA [1415]|GEHA [141500]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1236.00||||1236.00|1112.4|1236|209.05 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|AETNA [1015]|AETNA ACO WILCO [101532]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|MULTIPLAN [1680]|HMA [168003]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1236.00||||1236.00||| 36064492|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT CERV/THORAC THRD>LVL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1236.00||||1236.00||| 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|GEHA [1415]|GEHA [141500]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4489.00||||4489.00|665.5|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|CORESOURCE [1315]|CORESOURCE [131500]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4489.00||||4489.00|1103.03|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|CHAMPVA [1240]|CHAMP VA [124000]|4489.00||||4489.00|3366.75|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4489.00||||4489.00|640.29|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4489.00||||4489.00|2152.48|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4489.00||||4489.00|2917.85|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4489.00||||4489.00|4489|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4489.00||||4489.00|942.69|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4489.00||||4489.00|1120.22|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4489.00||||4489.00|782.62|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4489.00||||4489.00|1930.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4489.00||||4489.00|732.05|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|FIRST HEALTH [1375]|QUALCHOICE [137513]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|UMR [2035]|UMR OPTIONS [203501]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|FMH BENEFIT SERVICES [1390]|FMH [139000]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|HEALTHNET [1495]|HEALTHNET [149500]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MULTIPLAN [1680]|IHC HS [168011]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4489.00||||4489.00|1103.03|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MULTIPLAN [1680]|HMA [168003]|4489.00||||4489.00|1150.91|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|||4489.00||||4489.00|1346.7|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|TRUSTMARK [2030]|STARMARK [203000]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4489.00||||4489.00|618.38|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4489.00||||4489.00|844|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4489.00||||4489.00|588.94|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4489.00||||4489.00|640.29|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4489.00||||4489.00|2693.4|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4489.00||||4489.00|805.64|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4489.00||||4489.00|1930.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4489.00||||4489.00|2248.99|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4489.00||||4489.00|1575.64|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4489.00||||4489.00|1912.31|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4489.00||||4489.00|1828.14|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4489.00||||4489.00|767.27|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4489.00||||4489.00|844|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4489.00||||4489.00|4040.1|4489|588.94 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4489.00||||4489.00||| 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|AETNA [1015]|AETNA ACO WILCO [101532]|4489.00||||4489.00||| 36064493|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL SNGL LVL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4489.00||||4489.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1561.00||||1561.00|780.5|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1561.00||||1561.00|664.99|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1561.00||||1561.00|671.23|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1561.00||||1561.00|782.06|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1561.00||||1561.00|547.91|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1561.00||||1561.00|936.6|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1561.00||||1561.00|227.28|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1561.00||||1561.00|219.5|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|TRUSTMARK [2030]|STARMARK [203000]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|HEALTHNET [1495]|HEALTHNET [149500]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MULTIPLAN [1680]|IHC HS [168011]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1561.00||||1561.00|259.85|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1561.00||||1561.00|671.23|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|UMR [2035]|UMR OPTIONS [203501]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1561.00||||1561.00|327.81|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1561.00||||1561.00|1561|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1561.00||||1561.00|1014.65|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1561.00||||1561.00|748.5|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|||1561.00||||1561.00|468.3|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1561.00||||1561.00|227.28|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1561.00||||1561.00|209.05|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|CHAMPVA [1240]|CHAMP VA [124000]|1561.00||||1561.00|1170.75|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|CORESOURCE [1315]|CORESOURCE [131500]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1561.00||||1561.00|236.23|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|GEHA [1415]|GEHA [141500]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1561.00||||1561.00|1404.9|1561|209.05 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|AETNA [1015]|AETNA ACO WILCO [101532]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MULTIPLAN [1680]|HMA [168003]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1561.00||||1561.00||| 36064494|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL 2ND LVL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|GEHA [1415]|GEHA [141500]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1561.00||||1561.00|236.23|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|CORESOURCE [1315]|CORESOURCE [131500]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|CHAMPVA [1240]|CHAMP VA [124000]|1561.00||||1561.00|1170.75|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1561.00||||1561.00|209.05|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1561.00||||1561.00|227.28|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|||1561.00||||1561.00|468.3|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1561.00||||1561.00|1014.65|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1561.00||||1561.00|1561|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1561.00||||1561.00|327.81|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|UMR [2035]|UMR OPTIONS [203501]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1561.00||||1561.00|671.23|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1561.00||||1561.00|259.85|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|HEALTHNET [1495]|HEALTHNET [149500]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MULTIPLAN [1680]|IHC HS [168011]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1561.00||||1561.00|748.5|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|TRUSTMARK [2030]|STARMARK [203000]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1561.00||||1561.00|219.5|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1561.00||||1561.00|227.28|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1561.00||||1561.00|936.6|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1561.00||||1561.00|671.23|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1561.00||||1561.00|782.06|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1561.00||||1561.00|547.91|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1561.00||||1561.00|664.99|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1561.00||||1561.00|780.5|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1561.00||||1561.00|1404.9|1561|209.05 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MULTIPLAN [1680]|HMA [168003]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|AETNA [1015]|AETNA ACO WILCO [101532]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1561.00||||1561.00||| 36064495|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ PARAVERT LUMB/SACRAL THRD>LVL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1561.00||||1561.00||| 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3500.00||||3500.00|844|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3500.00||||3500.00|1505|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3500.00||||3500.00|1753.5|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3500.00||||3500.00|1491|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3500.00||||3500.00|805.64|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3500.00||||3500.00|2100|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3500.00||||3500.00|640.29|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3500.00||||3500.00|844|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3500.00||||3500.00|618.38|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|TRUSTMARK [2030]|STARMARK [203000]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MULTIPLAN [1680]|IHC HS [168011]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3500.00||||3500.00|1103.03|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MULTIPLAN [1680]|HMA [168003]|3500.00||||3500.00|1150.91|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|HEALTHNET [1495]|HEALTHNET [149500]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|FMH BENEFIT SERVICES [1390]|FMH [139000]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|FIRST HEALTH [1375]|QUALCHOICE [137513]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3500.00||||3500.00|732.05|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3500.00||||3500.00|1505|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3500.00||||3500.00|782.62|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|UMR [2035]|UMR OPTIONS [203501]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3500.00||||3500.00|1120.22|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3500.00||||3500.00|735|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3500.00||||3500.00|3500|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3500.00||||3500.00|2275|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3500.00||||3500.00|1678.25|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3500.00||||3500.00|1228.5|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|||3500.00||||3500.00|1050|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3500.00||||3500.00|640.29|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3500.00||||3500.00|1828.14|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3500.00||||3500.00|767.27|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3500.00||||3500.00|588.94|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|CHAMPVA [1240]|CHAMP VA [124000]|3500.00||||3500.00|2625|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3500.00||||3500.00|1103.03|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|CORESOURCE [1315]|CORESOURCE [131500]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3500.00||||3500.00|665.5|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|GEHA [1415]|GEHA [141500]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3500.00||||3500.00|3150|3500|588.94 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3500.00||||3500.00||| 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|AETNA [1015]|AETNA ACO WILCO [101532]|3500.00||||3500.00||| 36064510|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE BLOCK STELLATE GANGLION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3500.00||||3500.00||| 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|GEHA [1415]|GEHA [141500]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|CORESOURCE [1315]|CORESOURCE [131500]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3307.00||||3307.00|1111.23|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|CHAMPVA [1240]|CHAMP VA [124000]|3307.00||||3307.00|2480.25|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3307.00||||3307.00|640.29|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|||3307.00||||3307.00|992.1|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3307.00||||3307.00|1585.71|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3307.00||||3307.00|2149.55|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3307.00||||3307.00|3307|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3307.00||||3307.00|694.47|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3307.00||||3307.00|1128.54|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3307.00||||3307.00|788.43|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3307.00||||3307.00|1422.01|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3307.00||||3307.00|732.05|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|UMR [2035]|UMR OPTIONS [203501]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|HEALTHNET [1495]|HEALTHNET [149500]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MULTIPLAN [1680]|IHC HS [168011]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3307.00||||3307.00|1111.23|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MULTIPLAN [1680]|HMA [168003]|3307.00||||3307.00|1159.46|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|TRUSTMARK [2030]|STARMARK [203000]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3307.00||||3307.00|588.94|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3307.00||||3307.00|618.38|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3307.00||||3307.00|850.27|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3307.00||||3307.00|665.5|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3307.00||||3307.00|640.29|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3307.00||||3307.00|1984.2|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3307.00||||3307.00|811.62|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3307.00||||3307.00|1422.01|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3307.00||||3307.00|1656.81|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3307.00||||3307.00|1160.76|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3307.00||||3307.00|1408.78|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3307.00||||3307.00|1828.14|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3307.00||||3307.00|772.97|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3307.00||||3307.00|850.27|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3307.00||||3307.00|2976.3|3307|588.94 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3307.00||||3307.00||| 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|AETNA [1015]|AETNA ACO WILCO [101532]|3307.00||||3307.00||| 36064517|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC NERVE BLOCK INJ HYPOGAS PLEXUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3307.00||||3307.00||| 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3124.00||||3124.00|850.27|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3124.00||||3124.00|1828.14|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3124.00||||3124.00|1565.12|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3124.00||||3124.00|1096.52|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3124.00||||3124.00|1330.82|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3124.00||||3124.00|1874.4|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3124.00||||3124.00|640.29|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3124.00||||3124.00|618.38|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|TRUSTMARK [2030]|STARMARK [203000]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3124.00||||3124.00|1111.23|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MULTIPLAN [1680]|HMA [168003]|3124.00||||3124.00|1159.46|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|HEALTHNET [1495]|HEALTHNET [149500]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3124.00||||3124.00|732.05|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3124.00||||3124.00|1343.32|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MULTIPLAN [1680]|IHC HS [168011]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3124.00||||3124.00|788.43|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|UMR [2035]|UMR OPTIONS [203501]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3124.00||||3124.00|1128.54|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3124.00||||3124.00|850.27|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3124.00||||3124.00|656.04|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3124.00||||3124.00|3124|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3124.00||||3124.00|811.62|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3124.00||||3124.00|2030.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3124.00||||3124.00|1497.96|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|||3124.00||||3124.00|937.2|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3124.00||||3124.00|1343.32|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3124.00||||3124.00|640.29|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3124.00||||3124.00|772.97|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3124.00||||3124.00|588.94|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|CHAMPVA [1240]|CHAMP VA [124000]|3124.00||||3124.00|2343|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3124.00||||3124.00|1111.23|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|CORESOURCE [1315]|CORESOURCE [131500]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3124.00||||3124.00|665.5|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|GEHA [1415]|GEHA [141500]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3124.00||||3124.00|2811.6|3124|588.94 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3124.00||||3124.00||| 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|AETNA [1015]|AETNA ACO WILCO [101532]|3124.00||||3124.00||| 36064520|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ NERVE LUMBAR/THORACIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3124.00||||3124.00||| 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|GEHA [1415]|GEHA [141500]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4831.00||||4831.00|665.5|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|CORESOURCE [1315]|CORESOURCE [131500]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4831.00||||4831.00|1111.23|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|CHAMPVA [1240]|CHAMP VA [124000]|4831.00||||4831.00|3623.25|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4831.00||||4831.00|588.94|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4831.00||||4831.00|640.29|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|||4831.00||||4831.00|1449.3|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4831.00||||4831.00|3140.15|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4831.00||||4831.00|4831|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4831.00||||4831.00|1014.51|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4831.00||||4831.00|1128.54|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|UMR [2035]|UMR OPTIONS [203501]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4831.00||||4831.00|788.43|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4831.00||||4831.00|2077.33|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4831.00||||4831.00|732.05|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|FIRST HEALTH [1375]|QUALCHOICE [137513]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|FMH BENEFIT SERVICES [1390]|FMH [139000]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|HEALTHNET [1495]|HEALTHNET [149500]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MULTIPLAN [1680]|IHC HS [168011]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4831.00||||4831.00|1111.23|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MULTIPLAN [1680]|HMA [168003]|4831.00||||4831.00|1159.46|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4831.00||||4831.00|2316.46|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|TRUSTMARK [2030]|STARMARK [203000]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4831.00||||4831.00|618.38|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4831.00||||4831.00|850.27|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4831.00||||4831.00|640.29|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4831.00||||4831.00|2077.33|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4831.00||||4831.00|2420.33|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4831.00||||4831.00|1695.68|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4831.00||||4831.00|2058.01|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4831.00||||4831.00|2898.6|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4831.00||||4831.00|811.62|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4831.00||||4831.00|1828.14|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4831.00||||4831.00|772.97|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4831.00||||4831.00|850.27|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4831.00||||4831.00|4347.9|4831|588.94 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4831.00||||4831.00||| 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|AETNA [1015]|AETNA ACO WILCO [101532]|4831.00||||4831.00||| 36064530|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC INJ ANESTHETIC AGENT CELIAC PLEX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4831.00||||4831.00||| 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|710.00||||710.00|272.07|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|710.00||||710.00|259.7|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|710.00||||710.00|426|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|710.00||||710.00|305.3|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|710.00||||710.00|355.71|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|710.00||||710.00|249.21|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|710.00||||710.00|302.46|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|710.00||||710.00|272.07|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|710.00||||710.00|219.92|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|TRUSTMARK [2030]|STARMARK [203000]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MULTIPLAN [1680]|IHC HS [168011]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|710.00||||710.00|355.57|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|HEALTHNET [1495]|HEALTHNET [149500]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MULTIPLAN [1680]|HMA [168003]|710.00||||710.00|371|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|710.00||||710.00|305.3|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|710.00||||710.00|260.36|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|710.00||||710.00|252.28|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|UMR [2035]|UMR OPTIONS [203501]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|710.00||||710.00|361.11|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|710.00||||710.00|149.1|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|710.00||||710.00|227.72|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|710.00||||710.00|710|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|710.00||||710.00|461.5|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|710.00||||710.00|340.45|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|||710.00||||710.00|213|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|710.00||||710.00|591.53|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|710.00||||710.00|227.72|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|710.00||||710.00|247.34|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|710.00||||710.00|209.45|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|CHAMPVA [1240]|CHAMP VA [124000]|710.00||||710.00|532.5|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|710.00||||710.00|355.57|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|CORESOURCE [1315]|CORESOURCE [131500]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|710.00||||710.00|236.69|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|GEHA [1415]|GEHA [141500]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|710.00||||710.00|639|710|149.1 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|710.00||||710.00||| 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|710.00||||710.00||| 36064615|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATE FACIAL/TRIGEM/CERV MUSC BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|710.00||||710.00||| 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|710.00||||710.00|247.44|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|710.00||||710.00|340.45|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|710.00||||710.00|461.5|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|710.00||||710.00|710|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|710.00||||710.00|149.1|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|710.00||||710.00|361.11|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|UMR [2035]|UMR OPTIONS [203501]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|710.00||||710.00|252.28|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|710.00||||710.00|305.3|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|FIRST HEALTH [1375]|QUALCHOICE [137513]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|FMH BENEFIT SERVICES [1390]|FMH [139000]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|710.00||||710.00|282.9|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|HEALTHNET [1495]|HEALTHNET [149500]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MULTIPLAN [1680]|IHC HS [168011]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|710.00||||710.00|355.57|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MULTIPLAN [1680]|HMA [168003]|710.00||||710.00|371|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|TRUSTMARK [2030]|STARMARK [203000]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|||710.00||||710.00|213|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|710.00||||710.00|238.96|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|710.00||||710.00|272.07|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|710.00||||710.00|247.44|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|710.00||||710.00|227.59|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|710.00||||710.00|305.3|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|710.00||||710.00|355.71|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|710.00||||710.00|249.21|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|710.00||||710.00|302.46|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|710.00||||710.00|426|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|710.00||||710.00|259.7|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|710.00||||710.00|591.53|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|710.00||||710.00|247.34|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|710.00||||710.00|272.07|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|GEHA [1415]|GEHA [141500]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|710.00||||710.00|355.57|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|710.00||||710.00|257.18|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|CORESOURCE [1315]|CORESOURCE [131500]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|710.00||||710.00|639|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|CHAMPVA [1240]|CHAMP VA [124000]|710.00||||710.00|532.5|710|149.1 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|710.00||||710.00||| 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|AETNA [1015]|AETNA ACO WILCO [101532]|710.00||||710.00||| 36064616|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERV MUSC NECK UNILAT FOR DYSTON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|710.00||||710.00||| 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|GEHA [1415]|GEHA [141500]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4910.00||||4910.00|1723.41|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MULTIPLAN [1680]|IHC HS [168011]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|TRUSTMARK [2030]|STARMARK [203000]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4910.00||||4910.00|1787|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4910.00||||4910.00|1031.1|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4910.00||||4910.00|2371.83|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4910.00||||4910.00|2268.28|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4910.00||||4910.00|2335.44|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4910.00||||4910.00|2354.35|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4910.00||||4910.00|2111.3|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4910.00||||4910.00|3191.5|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4910.00||||4910.00|2459.91|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4910.00||||4910.00|2268.28|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|FIRST HEALTH [1375]|QUALCHOICE [137513]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4910.00||||4910.00|2111.3|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4910.00||||4910.00|2091.66|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|UMR [2035]|UMR OPTIONS [203501]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4910.00||||4910.00|1657.03|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4910.00||||4910.00|2357.59|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4910.00||||4910.00|1787|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|FMH BENEFIT SERVICES [1390]|FMH [139000]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4910.00||||4910.00|2335.44|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4910.00||||4910.00|2593.35|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MULTIPLAN [1680]|HMA [168003]|4910.00||||4910.00|2436.81|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|||4910.00||||4910.00|1473|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4910.00||||4910.00|1705.77|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4910.00||||4910.00|4910|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|HEALTHNET [1495]|HEALTHNET [149500]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|CHAMPVA [1240]|CHAMP VA [124000]|4910.00||||4910.00|3682.5|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|CORESOURCE [1315]|CORESOURCE [131500]|4910.00||||4910.00|4419|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4910.00||||4910.00|1624.54|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4910.00||||4910.00|2946|4910|1031.1 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4910.00||||4910.00||| 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4910.00||||4910.00||| 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4910.00||||4910.00||| 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|AETNA [1015]|AETNA ACO WILCO [101532]|4910.00||||4910.00||| 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4910.00||||4910.00||| 36064624|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DSTRCTN NEUROLYTIC AGT GENICULAR NERVE W/IMG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4910.00||||4910.00||| 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|FMH BENEFIT SERVICES [1390]|FMH [139000]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4910.00||||4910.00|1787|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4910.00||||4910.00|2357.59|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4910.00||||4910.00|1657.03|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|TRUSTMARK [2030]|STARMARK [203000]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4910.00||||4910.00|2335.44|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4910.00||||4910.00|2268.28|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4910.00||||4910.00|2371.83|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|UMR [2035]|UMR OPTIONS [203501]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4910.00||||4910.00|1031.1|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|HEALTHNET [1495]|HEALTHNET [149500]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4910.00||||4910.00|3191.5|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4910.00||||4910.00|4910|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4910.00||||4910.00|2111.3|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4910.00||||4910.00|1705.77|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|||4910.00||||4910.00|1473|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4910.00||||4910.00|2946|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|CHAMPVA [1240]|CHAMP VA [124000]|4910.00||||4910.00|3682.5|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|GEHA [1415]|GEHA [141500]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|FIRST HEALTH [1375]|QUALCHOICE [137513]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4910.00||||4910.00|2111.3|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4910.00||||4910.00|2354.35|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|CORESOURCE [1315]|CORESOURCE [131500]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4910.00||||4910.00|2091.66|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4910.00||||4910.00|2593.35|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4910.00||||4910.00|2335.44|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MULTIPLAN [1680]|HMA [168003]|4910.00||||4910.00|2436.81|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4910.00||||4910.00|2459.91|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4910.00||||4910.00|1723.41|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4910.00||||4910.00|1624.54|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4910.00||||4910.00|1787|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4910.00||||4910.00|2268.28|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MULTIPLAN [1680]|IHC HS [168011]|4910.00||||4910.00|4419|4910|1031.1 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4910.00||||4910.00||| 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4910.00||||4910.00||| 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|AETNA [1015]|AETNA ACO WILCO [101532]|4910.00||||4910.00||| 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4910.00||||4910.00||| 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4910.00||||4910.00||| 36064625|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4910.00||||4910.00||| 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MULTIPLAN [1680]|IHC HS [168011]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4855.00||||4855.00|1787|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|HEALTHNET [1495]|HEALTHNET [149500]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|TRUSTMARK [2030]|STARMARK [203000]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4855.00||||4855.00|3899.62|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4855.00||||4855.00|759.25|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4855.00||||4855.00|2087.65|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4855.00||||4855.00|1657.03|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4855.00||||4855.00|2913|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4855.00||||4855.00|2432.36|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MULTIPLAN [1680]|HMA [168003]|4855.00||||4855.00|2436.81|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|FMH BENEFIT SERVICES [1390]|FMH [139000]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4855.00||||4855.00|610.82|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4855.00||||4855.00|1787|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4855.00||||4855.00|2335.44|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4855.00||||4855.00|2087.65|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4855.00||||4855.00|641.36|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4855.00||||4855.00|2068.23|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4855.00||||4855.00|664.08|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4855.00||||4855.00|1705.77|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4855.00||||4855.00|1704.11|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4855.00||||4855.00|1019.55|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4855.00||||4855.00|2335.44|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4855.00||||4855.00|3155.75|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4855.00||||4855.00|690.23|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|CORESOURCE [1315]|CORESOURCE [131500]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|GEHA [1415]|GEHA [141500]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4855.00||||4855.00|664.08|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|UMR [2035]|UMR OPTIONS [203501]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|FIRST HEALTH [1375]|QUALCHOICE [137513]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|CHAMPVA [1240]|CHAMP VA [124000]|4855.00||||4855.00|3641.25|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4855.00||||4855.00|4855|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4855.00||||4855.00|1624.54|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|||4855.00||||4855.00|1456.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4855.00||||4855.00|2371.83|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4855.00||||4855.00|4369.5|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4855.00||||4855.00|2327.97|4855|610.82 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|AETNA [1015]|AETNA ACO WILCO [101532]|4855.00||||4855.00||| 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4855.00||||4855.00||| 36064633|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE SGL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4855.00||||4855.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2136.00||||2136.00|232.09|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|HEALTHNET [1495]|HEALTHNET [149500]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2136.00||||2136.00|265.35|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|FIRST HEALTH [1375]|QUALCHOICE [137513]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|FMH BENEFIT SERVICES [1390]|FMH [139000]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2136.00||||2136.00|918.48|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2136.00||||2136.00|448.56|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2136.00||||2136.00|2136|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2136.00||||2136.00|1070.14|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2136.00||||2136.00|749.74|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2136.00||||2136.00|909.94|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2136.00||||2136.00|1281.6|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2136.00||||2136.00|918.48|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|TRUSTMARK [2030]|STARMARK [203000]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|UMR [2035]|UMR OPTIONS [203501]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2136.00||||2136.00|1068|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MULTIPLAN [1680]|IHC HS [168011]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2136.00||||2136.00|224.15|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|CORESOURCE [1315]|CORESOURCE [131500]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2136.00||||2136.00|1024.21|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2136.00||||2136.00|232.09|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|CHAMPVA [1240]|CHAMP VA [124000]|2136.00||||2136.00|1602|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2136.00||||2136.00|1388.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|||2136.00||||2136.00|640.8|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2136.00||||2136.00|241.23|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2136.00||||2136.00|213.48|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|GEHA [1415]|GEHA [141500]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2136.00||||2136.00|1922.4|2136|213.48 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MULTIPLAN [1680]|HMA [168003]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|AETNA [1015]|AETNA ACO WILCO [101532]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2136.00||||2136.00||| 36064634|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET C/T SPINE ADL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2136.00||||2136.00||| 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4863.00||||4863.00|2091.09|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4863.00||||4863.00|2436.36|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4863.00||||4863.00|1787|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4863.00||||4863.00|2917.8|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4863.00||||4863.00|2335.44|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4863.00||||4863.00|3899.62|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|TRUSTMARK [2030]|STARMARK [203000]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|CORESOURCE [1315]|CORESOURCE [131500]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MULTIPLAN [1680]|IHC HS [168011]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4863.00||||4863.00|2091.09|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4863.00||||4863.00|1021.23|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4863.00||||4863.00|1310.27|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4863.00||||4863.00|1787|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4863.00||||4863.00|2331.81|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4863.00||||4863.00|3160.95|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4863.00||||4863.00|1146.03|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|||4863.00||||4863.00|1458.9|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4863.00||||4863.00|1106.82|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|UMR [2035]|UMR OPTIONS [203501]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|CHAMPVA [1240]|CHAMP VA [124000]|4863.00||||4863.00|3647.25|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4863.00||||4863.00|2335.44|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4863.00||||4863.00|1191.15|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4863.00||||4863.00|1657.03|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|FIRST HEALTH [1375]|QUALCHOICE [137513]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|GEHA [1415]|GEHA [141500]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4863.00||||4863.00|2071.64|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4863.00||||4863.00|1054.12|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4863.00||||4863.00|4863|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4863.00||||4863.00|2371.83|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MULTIPLAN [1680]|HMA [168003]|4863.00||||4863.00|2436.81|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|HEALTHNET [1495]|HEALTHNET [149500]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|FMH BENEFIT SERVICES [1390]|FMH [139000]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4863.00||||4863.00|1705.77|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4863.00||||4863.00|1146.03|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4863.00||||4863.00|1624.54|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4863.00||||4863.00|1706.91|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4863.00||||4863.00|4376.7|4863|1021.23 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|AETNA [1015]|AETNA ACO WILCO [101532]|4863.00||||4863.00||| 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4863.00||||4863.00||| 36064635|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE SGL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4863.00||||4863.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|GEHA [1415]|GEHA [141500]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4960.00||||4960.00|3224|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|CORESOURCE [1315]|CORESOURCE [131500]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4960.00||||4960.00|1740.96|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4960.00||||4960.00|1041.6|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4960.00||||4960.00|4960|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|HEALTHNET [1495]|HEALTHNET [149500]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4960.00||||4960.00|664.08|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|||4960.00||||4960.00|1488|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4960.00||||4960.00|610.82|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4960.00||||4960.00|664.08|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4960.00||||4960.00|2378.32|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4960.00||||4960.00|690.23|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4960.00||||4960.00|2484.96|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4960.00||||4960.00|2132.8|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4960.00||||4960.00|759.25|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4960.00||||4960.00|2132.8|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|FIRST HEALTH [1375]|QUALCHOICE [137513]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|FMH BENEFIT SERVICES [1390]|FMH [139000]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|TRUSTMARK [2030]|STARMARK [203000]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MULTIPLAN [1680]|IHC HS [168011]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4960.00||||4960.00|2112.96|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4960.00||||4960.00|2480|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4960.00||||4960.00|641.36|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4960.00||||4960.00|2976|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|CHAMPVA [1240]|CHAMP VA [124000]|4960.00||||4960.00|3720|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|UMR [2035]|UMR OPTIONS [203501]|4960.00||||4960.00|4464|4960|610.82 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MULTIPLAN [1680]|HMA [168003]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|AETNA [1015]|AETNA ACO WILCO [101532]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4960.00||||4960.00||| 36064636|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PVFACET L/S SPINE ADL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4960.00||||4960.00||| 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2763.00||||2763.00|844|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2763.00||||2763.00|1384.26|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2763.00||||2763.00|844|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2763.00||||2763.00|782.62|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2763.00||||2763.00|1188.09|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2763.00||||2763.00|1657.8|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2763.00||||2763.00|580.23|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2763.00||||2763.00|1103.03|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MULTIPLAN [1680]|IHC HS [168011]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2763.00||||2763.00|640.29|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2763.00||||2763.00|732.05|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2763.00||||2763.00|1795.95|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|||2763.00||||2763.00|828.9|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2763.00||||2763.00|588.94|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2763.00||||2763.00|1177.04|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2763.00||||2763.00|1103.03|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|CHAMPVA [1240]|CHAMP VA [124000]|2763.00||||2763.00|2072.25|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|CORESOURCE [1315]|CORESOURCE [131500]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|GEHA [1415]|GEHA [141500]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2763.00||||2763.00|665.5|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2763.00||||2763.00|640.29|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2763.00||||2763.00|1828.14|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2763.00||||2763.00|1324.86|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2763.00||||2763.00|1188.09|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2763.00||||2763.00|2763|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|HEALTHNET [1495]|HEALTHNET [149500]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|TRUSTMARK [2030]|STARMARK [203000]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2763.00||||2763.00|969.81|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|UMR [2035]|UMR OPTIONS [203501]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MULTIPLAN [1680]|HMA [168003]|2763.00||||2763.00|1150.91|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2763.00||||2763.00|618.38|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2763.00||||2763.00|1120.22|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2763.00||||2763.00|805.64|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2763.00||||2763.00|767.27|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2763.00||||2763.00|2486.7|2763|580.23 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2763.00||||2763.00||| 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2763.00||||2763.00||| 36064640|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC DESTRUCT PERIPHERAL NERVE/BRANCH|AETNA [1015]|AETNA ACO WILCO [101532]|2763.00||||2763.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|FIRST HEALTH [1375]|QUALCHOICE [137513]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|FMH BENEFIT SERVICES [1390]|FMH [139000]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|HEALTHNET [1495]|HEALTHNET [149500]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|702.00||||702.00|591.53|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|702.00||||702.00|301.86|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|702.00||||702.00|246.4|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|702.00||||702.00|299.05|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|702.00||||702.00|351.7|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|702.00||||702.00|421.2|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MULTIPLAN [1680]|IHC HS [168011]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|TRUSTMARK [2030]|STARMARK [203000]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|702.00||||702.00|336.61|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|GEHA [1415]|GEHA [141500]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|UMR [2035]|UMR OPTIONS [203501]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|702.00||||702.00|147.42|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|702.00||||702.00|702|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|702.00||||702.00|456.3|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|CORESOURCE [1315]|CORESOURCE [131500]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|CHAMPVA [1240]|CHAMP VA [124000]|702.00||||702.00|526.5|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|||702.00||||702.00|210.6|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|702.00||||702.00|631.8|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|702.00||||702.00|301.86|702|147.42 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MULTIPLAN [1680]|HMA [168003]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|AETNA [1015]|AETNA ACO WILCO [101532]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|702.00||||702.00||| 36064650|EAP|0360 - OPERATING ROOM SERVICES-GENERAL|HC CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|702.00||||702.00||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.63||||11.63|5.83|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.63||||11.63|5|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.63||||11.63|4.95|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.63||||11.63|4.08|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.63||||11.63|5|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.63||||11.63|6.98|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.63||||11.63|5|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.63||||11.63|5|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.63||||11.63|2.44|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.63||||11.63|7.56|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.63||||11.63|7.56|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.63||||11.63|5.58|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|||11.63||||11.63|3.49|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|11.63||||11.63|8.72|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|11.63||||11.63|8.72|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.63||||11.63|5.58|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.63||||11.63|4.08|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.63||||11.63|6.98|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.63||||11.63|5.83|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|||11.63||||11.63|3.49|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.63||||11.63|4.95|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.63||||11.63|10.47|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.63||||11.63|2.44|10.47|2.44 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.63||||11.63||| 364|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.63||||11.63||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|||42.21||||42.21|12.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|||42.21||||42.21|12.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|||42.21||||42.21|12.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|||42.21||||42.21|12.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|8.86 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 36438|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.06||||58.06|29.09|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.06||||58.06|24.73|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|CHAMPVA [1240]|CHAMP VA [124000]|58.06||||58.06|43.55|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.06||||58.06|34.84|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|IHC HS [168011]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.06||||58.06|24.97|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|HEALTHNET [1495]|HEALTHNET [149500]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.06||||58.06|37.74|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.06||||58.06|12.19|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.06||||58.06|27.84|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|TRUSTMARK [2030]|STARMARK [203000]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|||58.06||||58.06|17.42|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|CORESOURCE [1315]|CORESOURCE [131500]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.06||||58.06|20.38|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|GEHA [1415]|GEHA [141500]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.06||||58.06|24.97|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|UMR [2035]|UMR OPTIONS [203501]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.06||||58.06|52.25|52.25|12.19 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|HMA [168003]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.06||||58.06||| 365|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMANTADINE HCL 50 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.06||||58.06||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|||39.00||||39.00|11.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|||39.00||||39.00|11.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|||39.00||||39.00|11.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|||39.00||||39.00|11.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|||39.00||||39.00|11.7|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|35.1|8.19 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 36612|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ROSUVASTATIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.39||||13.39|6.71|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.39||||13.39|5.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.39||||13.39|6.71|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.39||||13.39|4.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.39||||13.39|6.71|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.39||||13.39|4.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.39||||13.39|6.71|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.39||||13.39|4.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.39||||13.39|8.03|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.39||||13.39|8.03|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.39||||13.39|8.03|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.39||||13.39|5.76|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.39||||13.39|2.81|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.39||||13.39|2.81|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.39||||13.39|8.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.39||||13.39|6.42|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.39||||13.39|6.42|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.39||||13.39|6.42|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.39||||13.39|6.42|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.39||||13.39|8.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.39||||13.39|8.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.39||||13.39|8.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|||13.39||||13.39|4.02|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|||13.39||||13.39|4.02|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|||13.39||||13.39|4.02|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|||13.39||||13.39|4.02|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.39||||13.39|2.81|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.39||||13.39|2.81|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.39||||13.39|8.03|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.39||||13.39|5.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.39||||13.39|5.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.39||||13.39|5.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.39||||13.39|4.7|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|13.39||||13.39|10.04|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|13.39||||13.39|10.04|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|13.39||||13.39|10.04|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|13.39||||13.39|10.04|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.39||||13.39|12.05|12.05|2.81 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.39||||13.39||| 36775|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.39||||13.39||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|||10.00||||10.00|3|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|||10.00||||10.00|3|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 36962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|||10.00||||10.00|3|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|||10.00||||10.00|3|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 36976|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOL 1.4 % MUCOSAL AEROSOL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1238.47||||1238.47|431.35|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1238.47||||1238.47|431.35|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1238.47||||1238.47|431.35|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1238.47||||1238.47|431.35|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1238.47||||1238.47|928.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1238.47||||1238.47|928.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1238.47||||1238.47|928.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1238.47||||1238.47|928.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1238.47||||1238.47|928.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1238.47||||1238.47|483.31|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1238.47||||1238.47|483.31|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1238.47||||1238.47|431.35|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1238.47||||1238.47|483.31|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1238.47||||1238.47|483.31|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1238.47||||1238.47|483.31|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1238.47||||1238.47|265|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1238.47||||1238.47|265|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1238.47||||1238.47|265|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1238.47||||1238.47|620.47|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1238.47||||1238.47|527.59|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1238.47||||1238.47|620.47|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1238.47||||1238.47|527.59|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1238.47||||1238.47|620.47|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1238.47||||1238.47|434.7|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1238.47||||1238.47|527.59|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1238.47||||1238.47|620.47|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1238.47||||1238.47|434.7|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1238.47||||1238.47|527.59|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1238.47||||1238.47|620.47|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1238.47||||1238.47|527.59|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1238.47||||1238.47|743.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1238.47||||1238.47|743.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1238.47||||1238.47|743.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1238.47||||1238.47|743.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1238.47||||1238.47|452.93|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1238.47||||1238.47|452.93|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1238.47||||1238.47|452.93|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1238.47||||1238.47|452.93|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1238.47||||1238.47|452.93|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1238.47||||1238.47|532.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1238.47||||1238.47|530.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1238.47||||1238.47|530.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1238.47||||1238.47|530.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1238.47||||1238.47|530.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1238.47||||1238.47|530.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1238.47||||1238.47|260.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1238.47||||1238.47|260.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1238.47||||1238.47|260.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1238.47||||1238.47|260.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1238.47||||1238.47|260.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1238.47||||1238.47|743.08|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1238.47||||1238.47|805.01|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1238.47||||1238.47|805.01|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1238.47||||1238.47|805.01|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1238.47||||1238.47|805.01|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1238.47||||1238.47|805.01|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1238.47||||1238.47|593.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1238.47||||1238.47|434.7|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1238.47||||1238.47|593.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1238.47||||1238.47|593.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1238.47||||1238.47|593.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1238.47||||1238.47|593.85|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1238.47||||1238.47|434.7|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|||1238.47||||1238.47|371.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|||1238.47||||1238.47|371.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|||1238.47||||1238.47|371.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1238.47||||1238.47|434.7|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|||1238.47||||1238.47|371.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|||1238.47||||1238.47|371.54|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1238.47||||1238.47|265|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1238.47||||1238.47|465|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1238.47||||1238.47|265|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1238.47||||1238.47|1114.62|1114.62|260.08 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1238.47||||1238.47||| 36989|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1238.47||||1238.47||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3700|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4840.00||||4840.00|2081.2|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4840.00||||4840.00|2424.84|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4840.00||||4840.00|1698.84|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4840.00||||4840.00|2061.84|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|TRUSTMARK [2030]|STARMARK [203000]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MULTIPLAN [1680]|IHC HS [168011]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|HEALTHNET [1495]|HEALTHNET [149500]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4840.00||||4840.00|2081.2|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|UMR [2035]|UMR OPTIONS [203501]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4840.00||||4840.00|1016.4|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4840.00||||4840.00|4840|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4840.00||||4840.00|2320.78|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4840.00||||4840.00|2904|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4840.00||||4840.00|3146|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|||4840.00||||4840.00|1452|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|CHAMPVA [1240]|CHAMP VA [124000]|4840.00||||4840.00|3630|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|CORESOURCE [1315]|CORESOURCE [131500]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|GEHA [1415]|GEHA [141500]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4840.00||||4840.00|4356|4840|1016.4 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|AETNA [1015]|AETNA ACO WILCO [101532]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|MULTIPLAN [1680]|HMA [168003]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4840.00||||4840.00||| 37000002|EAP|0370 - ANESTHESIA-GENERAL|HC ANES EPIDURAL FLAT RATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4840.00||||4840.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|GEHA [1415]|GEHA [141500]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|CORESOURCE [1315]|CORESOURCE [131500]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|CHAMPVA [1240]|CHAMP VA [124000]|1089.00||||1089.00|816.75|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|||1089.00||||1089.00|326.7|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1089.00||||1089.00|707.85|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1089.00||||1089.00|522.18|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1089.00||||1089.00|228.69|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|UMR [2035]|UMR OPTIONS [203501]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1089.00||||1089.00|468.27|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MULTIPLAN [1680]|IHC HS [168011]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1089.00||||1089.00|1089|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|HEALTHNET [1495]|HEALTHNET [149500]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|TRUSTMARK [2030]|STARMARK [203000]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1089.00||||1089.00|653.4|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1089.00||||1089.00|468.27|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1089.00||||1089.00|545.59|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1089.00||||1089.00|463.91|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1089.00||||1089.00|382.24|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1089.00||||1089.00|980.1|1089|228.69 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MULTIPLAN [1680]|HMA [168003]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|AETNA [1015]|AETNA ACO WILCO [101532]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1089.00||||1089.00||| 37000008|EAP|0370 - ANESTHESIA-GENERAL|HC ANES LOCAL FLAT RATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1089.00||||1089.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2617.00||||2617.00|1125.31|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2617.00||||2617.00|1311.12|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2617.00||||2617.00|918.57|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2617.00||||2617.00|1570.2|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|HEALTHNET [1495]|HEALTHNET [149500]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MULTIPLAN [1680]|IHC HS [168011]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2617.00||||2617.00|1125.31|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|TRUSTMARK [2030]|STARMARK [203000]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|UMR [2035]|UMR OPTIONS [203501]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2617.00||||2617.00|549.57|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2617.00||||2617.00|2617|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2617.00||||2617.00|1254.85|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2617.00||||2617.00|1114.84|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2617.00||||2617.00|1701.05|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|||2617.00||||2617.00|785.1|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|CHAMPVA [1240]|CHAMP VA [124000]|2617.00||||2617.00|1962.75|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|CORESOURCE [1315]|CORESOURCE [131500]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|GEHA [1415]|GEHA [141500]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2617.00||||2617.00|2355.3|2617|549.57 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|AETNA [1015]|AETNA ACO WILCO [101532]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MULTIPLAN [1680]|HMA [168003]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2617.00||||2617.00||| 37000009|EAP|0370 - ANESTHESIA-GENERAL|HC ANES MAC FLAT RATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2617.00||||2617.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|GEHA [1415]|GEHA [141500]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|CORESOURCE [1315]|CORESOURCE [131500]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|CHAMPVA [1240]|CHAMP VA [124000]|3393.00||||3393.00|2544.75|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|||3393.00||||3393.00|1017.9|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3393.00||||3393.00|2205.45|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3393.00||||3393.00|3393|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|UMR [2035]|UMR OPTIONS [203501]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3393.00||||3393.00|1458.99|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3393.00||||3393.00|712.53|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MULTIPLAN [1680]|IHC HS [168011]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|HEALTHNET [1495]|HEALTHNET [149500]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3393.00||||3393.00|1626.94|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|TRUSTMARK [2030]|STARMARK [203000]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3393.00||||3393.00|2035.8|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3393.00||||3393.00|1458.99|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3393.00||||3393.00|1699.89|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3393.00||||3393.00|1445.42|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3393.00||||3393.00|1190.94|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3393.00||||3393.00|3053.7|3393|712.53 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MULTIPLAN [1680]|HMA [168003]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|AETNA [1015]|AETNA ACO WILCO [101532]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3393.00||||3393.00||| 37000021|EAP|0370 - ANESTHESIA-GENERAL|HC ANES REGIONAL FLAT RATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3393.00||||3393.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|||10.00||||10.00|3|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|||10.00||||10.00|3|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDRALAZINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|GEHA [1415]|GEHA [141500]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|CHAMPVA [1240]|CHAMP VA [124000]|834.00||||834.00|625.5|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|||834.00||||834.00|250.2|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|834.00||||834.00|399.9|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|834.00||||834.00|542.1|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|834.00||||834.00|834|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|834.00||||834.00|175.14|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|UMR [2035]|UMR OPTIONS [203501]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|834.00||||834.00|358.62|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|FIRST HEALTH [1375]|QUALCHOICE [137513]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|FMH BENEFIT SERVICES [1390]|FMH [139000]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|HEALTHNET [1495]|HEALTHNET [149500]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MULTIPLAN [1680]|IHC HS [168011]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|TRUSTMARK [2030]|STARMARK [203000]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|CORESOURCE [1315]|CORESOURCE [131500]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|834.00||||834.00|500.4|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|834.00||||834.00|358.62|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|834.00||||834.00|417.83|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|834.00||||834.00|292.73|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|834.00||||834.00|355.28|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|834.00||||834.00|417|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|834.00||||834.00|750.6|834|175.14 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MULTIPLAN [1680]|HMA [168003]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|AETNA [1015]|AETNA ACO WILCO [101532]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|834.00||||834.00||| 37099151|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION INTL 15 MIN <5YRS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|834.00||||834.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|762.00||||762.00|381|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|762.00||||762.00|327.66|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|762.00||||762.00|267.46|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|762.00||||762.00|324.61|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|762.00||||762.00|457.2|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|762.00||||762.00|327.66|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|UMR [2035]|UMR OPTIONS [203501]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|762.00||||762.00|160.02|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|762.00||||762.00|762|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|762.00||||762.00|495.3|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|762.00||||762.00|381.76|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|762.00||||762.00|365.38|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|||762.00||||762.00|228.6|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|762.00||||762.00|571.5|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|GEHA [1415]|GEHA [141500]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|762.00||||762.00|685.8|762|160.02 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MULTIPLAN [1680]|HMA [168003]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|762.00||||762.00||| 37099152|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION >=5YR 1ST 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|762.00||||762.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|||358.00||||358.00|107.4|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|358.00||||358.00|171.66|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|358.00||||358.00|358|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|UMR [2035]|UMR OPTIONS [203501]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|358.00||||358.00|153.94|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|358.00||||358.00|75.18|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|358.00||||358.00|232.7|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|358.00||||358.00|268.5|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|358.00||||358.00|214.8|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|GEHA [1415]|GEHA [141500]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|358.00||||358.00|153.94|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|358.00||||358.00|179.36|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|358.00||||358.00|125.66|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|358.00||||358.00|152.51|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|358.00||||358.00|179|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|358.00||||358.00|322.2|358|75.18 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MULTIPLAN [1680]|HMA [168003]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|358.00||||358.00||| 37099153|EAP|0370 - ANESTHESIA-GENERAL|HC MOD SEDATION EA ADDL 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|358.00||||358.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37170|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEMANTINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|||10.00||||10.00|3|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|||10.00||||10.00|3|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3720|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.54||||27.54|11.84|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.54||||27.54|11.73|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.54||||27.54|9.67|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.54||||27.54|11.73|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.54||||27.54|13.8|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.54||||27.54|13.8|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.54||||27.54|9.67|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.54||||27.54|16.52|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.54||||27.54|16.52|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.54||||27.54|11.84|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.54||||27.54|11.84|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.54||||27.54|5.78|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.54||||27.54|5.78|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.54||||27.54|17.9|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.54||||27.54|17.9|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.54||||27.54|13.21|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.54||||27.54|13.21|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|||27.54||||27.54|8.26|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|||27.54||||27.54|8.26|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.54||||27.54|11.84|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|27.54||||27.54|20.66|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|27.54||||27.54|20.66|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.54||||27.54|24.79|24.79|5.78 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.54||||27.54||| 3727|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 2.5 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.54||||27.54||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|||10.00||||10.00|3|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|||10.00||||10.00|3|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3733|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37343|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SACCHAROMYCES BOULARDII 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|48.65||||48.65|36.49|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|||48.65||||48.65|14.59|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.65||||48.65|23.33|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.65||||48.65|31.62|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.65||||48.65|10.22|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.65||||48.65|20.92|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.65||||48.65|29.19|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.65||||48.65|20.92|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48.65||||48.65|24.37|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.65||||48.65|17.08|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48.65||||48.65|20.72|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.65||||48.65|43.79|43.79|10.22 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.65||||48.65||| 3738|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.65||||48.65||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|||10.00||||10.00|3|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3760|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|12.69||||12.69|9.52|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|||12.69||||12.69|3.81|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.69||||12.69|6.08|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.69||||12.69|2.66|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.69||||12.69|5.46|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.69||||12.69|8.25|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.69||||12.69|7.61|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.69||||12.69|5.46|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.69||||12.69|6.36|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.69||||12.69|4.45|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.69||||12.69|5.41|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.69||||12.69|11.42|11.42|2.66 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.69||||12.69||| 37605|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAGNESIUM HYDROXIDE 200 MG-200 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.69||||12.69||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|||10.00||||10.00|3|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|||10.00||||10.00|3|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3761|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROMORPHONE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|||10.00||||10.00|3|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|||10.00||||10.00|3|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37648|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37649|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|||10.00||||10.00|3|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|||10.00||||10.00|3|9|2.1 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 37651|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|||10.00||||10.00|3|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|||10.00||||10.00|3|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3772|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|||10.00||||10.00|3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|||10.00||||10.00|3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|||10.00||||10.00|3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|||10.00||||10.00|3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3774|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE HCL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYZINE PAMOATE 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|||10.00||||10.00|3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|||10.00||||10.00|3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|||10.00||||10.00|3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|||10.00||||10.00|3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|||10.00||||10.00|3|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3783|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYOSCYAMINE SULFATE 0.125 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|24.15||||24.15|18.11|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|24.15||||24.15|18.11|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|24.15||||24.15|18.11|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|24.15||||24.15|18.11|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|24.15||||24.15|18.11|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|24.15||||24.15|18.11|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|||24.15||||24.15|7.24|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|||24.15||||24.15|7.24|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|||24.15||||24.15|7.24|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|||24.15||||24.15|7.24|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|||24.15||||24.15|7.24|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|||24.15||||24.15|7.24|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.15||||24.15|11.58|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.15||||24.15|11.58|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.15||||24.15|11.58|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.15||||24.15|11.58|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.15||||24.15|11.58|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.15||||24.15|15.7|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.15||||24.15|15.7|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.15||||24.15|15.7|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.15||||24.15|15.7|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.15||||24.15|15.7|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.15||||24.15|11.58|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.15||||24.15|5.07|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.15||||24.15|5.07|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.15||||24.15|5.07|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.15||||24.15|5.07|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.15||||24.15|5.07|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.15||||24.15|2.01|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.15||||24.15|2.01|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.15||||24.15|2.01|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.15||||24.15|2.01|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.15||||24.15|2.01|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.15||||24.15|2.01|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.15||||24.15|2.01|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|24.15||||24.15|8.45|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|24.15||||24.15|8.45|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|24.15||||24.15|8.45|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|24.15||||24.15|8.45|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|24.15||||24.15|8.45|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|24.15||||24.15|8.45|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|24.15||||24.15|8.45|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.15||||24.15|5.07|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.15||||24.15|5.07|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|||24.15||||24.15|7.24|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.15||||24.15|15.7|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.15||||24.15|11.58|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.15||||24.15|15.7|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.15||||24.15|14.49|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.15||||24.15|14.49|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.15||||24.15|14.49|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.15||||24.15|14.49|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.15||||24.15|14.49|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.15||||24.15|14.49|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.15||||24.15|12.1|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.15||||24.15|10.29|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.15||||24.15|12.1|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.15||||24.15|8.48|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.15||||24.15|10.29|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.15||||24.15|8.48|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.15||||24.15|10.29|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.15||||24.15|12.1|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.15||||24.15|8.48|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.15||||24.15|12.1|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.15||||24.15|8.48|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.15||||24.15|10.29|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.15||||24.15|10.29|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.15||||24.15|10.29|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.15||||24.15|8.48|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.15||||24.15|8.48|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.15||||24.15|12.1|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.15||||24.15|12.1|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.15||||24.15|12.1|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|24.15||||24.15|18.11|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.15||||24.15|10.29|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.15||||24.15|8.48|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.15||||24.15|10.38|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.15||||24.15|14.49|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|24.15||||24.15|21.74|21.74|2.01 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.15||||24.15||| 38062|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.15||||24.15||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86.86||||86.86|37.35|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86.86||||86.86|43.52|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86.86||||86.86|30.49|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86.86||||86.86|37.35|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86.86||||86.86|43.52|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86.86||||86.86|30.49|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86.86||||86.86|37|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86.86||||86.86|52.12|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86.86||||86.86|52.12|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.86||||86.86|37.35|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.86||||86.86|37.35|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86.86||||86.86|18.24|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86.86||||86.86|18.24|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86.86||||86.86|56.46|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86.86||||86.86|56.46|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.86||||86.86|41.65|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.86||||86.86|41.65|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|||86.86||||86.86|26.06|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|||86.86||||86.86|26.06|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86.86||||86.86|37|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|86.86||||86.86|65.15|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|86.86||||86.86|65.15|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|GEHA [1415]|GEHA [141500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|GEHA [1415]|GEHA [141500]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86.86||||86.86|78.17|78.17|18.24 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86.86||||86.86||| 38100|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CINACALCET 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86.86||||86.86||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38213|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|||10.00||||10.00|3|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38225|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|||10.00||||10.00|3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|||10.00||||10.00|3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|||10.00||||10.00|3|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|||10.00||||10.00|3|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE GEL IN A DROPPERETTE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|||10.00||||10.00|3|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3841|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|||10.00||||10.00|3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|||10.00||||10.00|3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|||10.00||||10.00|3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3843|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 400 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|||10.00||||10.00|3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|||10.00||||10.00|3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|||10.00||||10.00|3|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3844|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 600 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|||10.00||||10.00|3|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3845|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 800 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|||10.00||||10.00|3|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|||10.00||||10.00|3|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 38488|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|||10.00||||10.00|3|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3862|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IMIPRAMINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141.42||||141.42|60.81|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|141.42||||141.42|70.85|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141.42||||141.42|49.64|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141.42||||141.42|84.85|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|TRUSTMARK [2030]|STARMARK [203000]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MULTIPLAN [1680]|IHC HS [168011]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|HEALTHNET [1495]|HEALTHNET [149500]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|FMH BENEFIT SERVICES [1390]|FMH [139000]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141.42||||141.42|60.81|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|FIRST HEALTH [1375]|QUALCHOICE [137513]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|UMR [2035]|UMR OPTIONS [203501]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141.42||||141.42|29.7|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|141.42||||141.42|60.24|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141.42||||141.42|91.92|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141.42||||141.42|67.81|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|||141.42||||141.42|42.43|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|CHAMPVA [1240]|CHAMP VA [124000]|141.42||||141.42|106.07|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|CORESOURCE [1315]|CORESOURCE [131500]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|GEHA [1415]|GEHA [141500]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141.42||||141.42|127.28|127.28|29.7 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|AETNA [1015]|AETNA ACO WILCO [101532]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MULTIPLAN [1680]|HMA [168003]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141.42||||141.42||| 38701|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|141.42||||141.42||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 3898|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|INDOMETHACIN 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.00||||119.00|51.17|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.00||||119.00|59.62|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.00||||119.00|41.77|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.00||||119.00|118.07|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.00||||119.00|71.4|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.00||||119.00|61.46|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.00||||119.00|59.36|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|TRUSTMARK [2030]|STARMARK [203000]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|HEALTHNET [1495]|HEALTHNET [149500]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MULTIPLAN [1680]|IHC HS [168011]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.00||||119.00|70.27|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.00||||119.00|51.17|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|UMR [2035]|UMR OPTIONS [203501]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.00||||119.00|24.99|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.00||||119.00|119|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.00||||119.00|57.06|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.00||||119.00|50.69|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.00||||119.00|77.35|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|||119.00||||119.00|35.7|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.00||||119.00|61.46|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.00||||119.00|56.53|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|CHAMPVA [1240]|CHAMP VA [124000]|119.00||||119.00|89.25|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|CORESOURCE [1315]|CORESOURCE [131500]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.00||||119.00|63.88|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|GEHA [1415]|GEHA [141500]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.00||||119.00|107.1|119|24.99 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MULTIPLAN [1680]|HMA [168003]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.00||||119.00||| 39009012|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC CRYOPRECIPITATE 1 UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.00||||119.00||| 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|GEHA [1415]|GEHA [141500]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|435.00||||435.00|256.05|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|CORESOURCE [1315]|CORESOURCE [131500]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|435.00||||435.00|270.78|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435.00||||435.00|226.59|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|||435.00||||435.00|130.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435.00||||435.00|282.75|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435.00||||435.00|208.58|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435.00||||435.00|435|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435.00||||435.00|91.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435.00||||435.00|274.99|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|UMR [2035]|UMR OPTIONS [203501]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435.00||||435.00|192.12|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435.00||||435.00|187.05|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|435.00||||435.00|281.66|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MULTIPLAN [1680]|IHC HS [168011]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|435.00||||435.00|270.78|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MULTIPLAN [1680]|HMA [168003]|435.00||||435.00|282.53|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|HEALTHNET [1495]|HEALTHNET [149500]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435.00||||435.00|246.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|TRUSTMARK [2030]|STARMARK [203000]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435.00||||435.00|237.93|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|CHAMPVA [1240]|CHAMP VA [124000]|435.00||||435.00|326.25|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435.00||||435.00|207.19|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435.00||||435.00|246.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435.00||||435.00|197.77|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435.00||||435.00|261|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435.00||||435.00|435|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435.00||||435.00|187.05|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|435.00||||435.00|217.94|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|435.00||||435.00|185.31|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435.00||||435.00|152.69|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435.00||||435.00|188.35|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435.00||||435.00|391.5|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435.00||||435.00|207.19|435|91.35 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|435.00||||435.00||| 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|435.00||||435.00||| 39009016|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC REDCELLS LEUKO POOR 1 UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|435.00||||435.00||| 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126.00||||126.00|54.18|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|126.00||||126.00|63.13|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|126.00||||126.00|53.68|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126.00||||126.00|44.23|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.00||||126.00|75.6|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126.00||||126.00|87.94|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126.00||||126.00|92.13|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|TRUSTMARK [2030]|STARMARK [203000]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|HEALTHNET [1495]|HEALTHNET [149500]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MULTIPLAN [1680]|IHC HS [168011]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|126.00||||126.00|120.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MULTIPLAN [1680]|HMA [168003]|126.00||||126.00|125.63|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|126.00||||126.00|114.66|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126.00||||126.00|54.18|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126.00||||126.00|85.43|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|UMR [2035]|UMR OPTIONS [203501]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126.00||||126.00|122.28|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126.00||||126.00|96.86|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126.00||||126.00|26.46|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126.00||||126.00|126|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126.00||||126.00|100.29|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126.00||||126.00|126|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.00||||126.00|60.42|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126.00||||126.00|81.9|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|||126.00||||126.00|37.8|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126.00||||126.00|100.29|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126.00||||126.00|92.13|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126.00||||126.00|83.75|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126.00||||126.00|92.25|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|CHAMPVA [1240]|CHAMP VA [124000]|126.00||||126.00|94.5|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|126.00||||126.00|120.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|CORESOURCE [1315]|CORESOURCE [131500]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|126.00||||126.00|104.24|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|GEHA [1415]|GEHA [141500]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126.00||||126.00|113.4|126|26.46 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|126.00||||126.00||| 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|126.00||||126.00||| 39009017|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN PER UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|126.00||||126.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MULTIPLAN [1680]|IHC HS [168011]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|HEALTHNET [1495]|HEALTHNET [149500]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|TRUSTMARK [2030]|STARMARK [203000]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|349.00||||349.00|84.87|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|349.00||||349.00|87.87|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|349.00||||349.00|209.4|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|349.00||||349.00|258.06|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|349.00||||349.00|150.07|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|349.00||||349.00|174.85|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|349.00||||349.00|148.67|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|349.00||||349.00|122.5|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|349.00||||349.00|91.33|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|UMR [2035]|UMR OPTIONS [203501]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|349.00||||349.00|150.07|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|349.00||||349.00|167.35|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|349.00||||349.00|226.85|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|349.00||||349.00|87.87|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|CHAMPVA [1240]|CHAMP VA [124000]|349.00||||349.00|261.75|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|349.00||||349.00|80.82|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|||349.00||||349.00|104.7|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|349.00||||349.00|349|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|349.00||||349.00|100.47|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|GEHA [1415]|GEHA [141500]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|349.00||||349.00|73.29|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|CORESOURCE [1315]|CORESOURCE [131500]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|349.00||||349.00|314.1|349|73.29 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MULTIPLAN [1680]|HMA [168003]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|349.00||||349.00||| 39009019|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS 1 UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|349.00||||349.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|435.00||||435.00|186.97|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|435.00||||435.00|282.75|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|435.00||||435.00|187.05|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|435.00||||435.00|187.05|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|TRUSTMARK [2030]|STARMARK [203000]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|GEHA [1415]|GEHA [141500]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|435.00||||435.00|217.94|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|435.00||||435.00|213.77|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|HEALTHNET [1495]|HEALTHNET [149500]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|UMR [2035]|UMR OPTIONS [203501]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|CORESOURCE [1315]|CORESOURCE [131500]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MULTIPLAN [1680]|IHC HS [168011]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|435.00||||435.00|185.31|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|435.00||||435.00|180.58|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|CHAMPVA [1240]|CHAMP VA [124000]|435.00||||435.00|326.25|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|435.00||||435.00|186.97|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|435.00||||435.00|261|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|435.00||||435.00|435|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|435.00||||435.00|171.98|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|435.00||||435.00|152.69|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|435.00||||435.00|194.33|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|435.00||||435.00|208.58|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|435.00||||435.00|91.35|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|435.00||||435.00|334.91|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|435.00||||435.00|391.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|||435.00||||435.00|130.5|435|91.35 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MULTIPLAN [1680]|HMA [168003]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|435.00||||435.00||| 39009021|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS PACKD PER UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|435.00||||435.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|TRUSTMARK [2030]|STARMARK [203000]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|463.00||||463.00|199.09|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|463.00||||463.00|162.51|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|HEALTHNET [1495]|HEALTHNET [149500]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|463.00||||463.00|313.45|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|GEHA [1415]|GEHA [141500]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|463.00||||463.00|463|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|463.00||||463.00|199.09|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|UMR [2035]|UMR OPTIONS [203501]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|463.00||||463.00|231.96|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|||463.00||||463.00|138.9|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|463.00||||463.00|324.54|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|463.00||||463.00|371.05|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|CORESOURCE [1315]|CORESOURCE [131500]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|463.00||||463.00|97.23|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|463.00||||463.00|222.01|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|463.00||||463.00|300.95|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|463.00||||463.00|298.52|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|463.00||||463.00|463|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|CHAMPVA [1240]|CHAMP VA [124000]|463.00||||463.00|347.25|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|463.00||||463.00|197.24|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MULTIPLAN [1680]|IHC HS [168011]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|463.00||||463.00|277.8|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|463.00||||463.00|324.54|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|463.00||||463.00|337.32|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|463.00||||463.00|416.7|463|97.23 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MULTIPLAN [1680]|HMA [168003]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|AETNA [1015]|AETNA ACO WILCO [101532]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|463.00||||463.00||| 39009022|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC WASHED EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|463.00||||463.00||| 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|963.00||||963.00|549.57|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|963.00||||963.00|509.6|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|963.00||||963.00|202.23|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|963.00||||963.00|414.09|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|963.00||||963.00|461.76|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|963.00||||963.00|524.59|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|963.00||||963.00|577.8|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MULTIPLAN [1680]|IHC HS [168011]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|963.00||||963.00|675.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|963.00||||963.00|410.24|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|963.00||||963.00|338.01|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|963.00||||963.00|963|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|963.00||||963.00|414.09|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|963.00||||963.00|718.24|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|963.00||||963.00|963|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|963.00||||963.00|482.46|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|HEALTHNET [1495]|HEALTHNET [149500]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|963.00||||963.00|652.53|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|963.00||||963.00|729.43|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|TRUSTMARK [2030]|STARMARK [203000]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|GEHA [1415]|GEHA [141500]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|UMR [2035]|UMR OPTIONS [203501]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|963.00||||963.00|718.24|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|963.00||||963.00|702.21|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MULTIPLAN [1680]|HMA [168003]|963.00||||963.00|749.41|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|||963.00||||963.00|288.9|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|963.00||||963.00|675.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|CORESOURCE [1315]|CORESOURCE [131500]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|CHAMPVA [1240]|CHAMP VA [124000]|963.00||||963.00|722.25|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|963.00||||963.00|772.43|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|963.00||||963.00|625.95|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|963.00||||963.00|621.44|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|963.00||||963.00|499.61|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|963.00||||963.00|866.7|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|963.00||||963.00|549.57|963|202.23 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|963.00||||963.00||| 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|AETNA [1015]|AETNA ACO WILCO [101532]|963.00||||963.00||| 39009035|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELETS LEUKOPOOR PHERESIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|963.00||||963.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1039.00||||1039.00|520.54|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1039.00||||1039.00|623.4|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1039.00||||1039.00|364.69|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1039.00||||1039.00|1039|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1039.00||||1039.00|442.61|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1039.00||||1039.00|862.09|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1039.00||||1039.00|892.57|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1039.00||||1039.00|446.77|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|||1039.00||||1039.00|311.7|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1039.00||||1039.00|1020.49|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1039.00||||1039.00|927.71|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1039.00||||1039.00|1039|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1039.00||||1039.00|675.35|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|CORESOURCE [1315]|CORESOURCE [131500]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1039.00||||1039.00|218.19|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1039.00||||1039.00|498.2|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|UMR [2035]|UMR OPTIONS [203501]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1039.00||||1039.00|446.77|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|GEHA [1415]|GEHA [141500]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|FIRST HEALTH [1375]|QUALCHOICE [137513]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1039.00||||1039.00|892.57|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MULTIPLAN [1680]|IHC HS [168011]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|HEALTHNET [1495]|HEALTHNET [149500]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|TRUSTMARK [2030]|STARMARK [203000]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|CHAMPVA [1240]|CHAMP VA [124000]|1039.00||||1039.00|779.25|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|FMH BENEFIT SERVICES [1390]|FMH [139000]|1039.00||||1039.00|935.1|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1039.00||||1039.00|821.01|1039|218.19 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|AETNA [1015]|AETNA ACO WILCO [101532]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MULTIPLAN [1680]|HMA [168003]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1039.00||||1039.00||| 39009037|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLATELET PHERESIS L/R IRR EA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1039.00||||1039.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|656.00||||656.00|328.66|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|656.00||||656.00|137.76|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|656.00||||656.00|656|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|656.00||||656.00|426.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|656.00||||656.00|282.08|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|656.00||||656.00|463.69|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MULTIPLAN [1680]|IHC HS [168011]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|656.00||||656.00|498.99|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|656.00||||656.00|548.89|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|656.00||||656.00|230.26|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|||656.00||||656.00|196.8|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|656.00||||656.00|480.09|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|656.00||||656.00|441.6|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|CHAMPVA [1240]|CHAMP VA [124000]|656.00||||656.00|492|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|UMR [2035]|UMR OPTIONS [203501]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|CORESOURCE [1315]|CORESOURCE [131500]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|GEHA [1415]|GEHA [141500]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|TRUSTMARK [2030]|STARMARK [203000]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|656.00||||656.00|282.08|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|656.00||||656.00|480.09|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|656.00||||656.00|656|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|656.00||||656.00|393.6|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|656.00||||656.00|279.46|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|HEALTHNET [1495]|HEALTHNET [149500]|656.00||||656.00|590.4|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|656.00||||656.00|314.55|656|137.76 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MULTIPLAN [1680]|HMA [168003]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|656.00||||656.00||| 39009039|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RED CELLS DEGLYC 1 UNIT|AETNA [1015]|AETNA ACO WILCO [101532]|656.00||||656.00||| 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|507.00||||507.00|268.02|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|507.00||||507.00|297.33|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|507.00||||507.00|369.58|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|507.00||||507.00|507|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|CORESOURCE [1315]|CORESOURCE [131500]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|507.00||||507.00|335.98|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|CHAMPVA [1240]|CHAMP VA [124000]|507.00||||507.00|380.25|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|507.00||||507.00|243.11|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|507.00||||507.00|377.75|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|507.00||||507.00|329.55|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|507.00||||507.00|304.2|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|507.00||||507.00|312.21|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|507.00||||507.00|106.47|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|507.00||||507.00|218.01|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|507.00||||507.00|383.63|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|||507.00||||507.00|152.1|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|507.00||||507.00|507|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|507.00||||507.00|289.04|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MULTIPLAN [1680]|HMA [168003]|507.00||||507.00|394.14|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|HEALTHNET [1495]|HEALTHNET [149500]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|TRUSTMARK [2030]|STARMARK [203000]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|507.00||||507.00|377.75|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|507.00||||507.00|323.25|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|GEHA [1415]|GEHA [141500]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|507.00||||507.00|275.9|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|507.00||||507.00|177.96|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|507.00||||507.00|289.04|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|507.00||||507.00|323.25|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|507.00||||507.00|215.98|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|507.00||||507.00|262.76|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|507.00||||507.00|218.01|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|MULTIPLAN [1680]|IHC HS [168011]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|UMR [2035]|UMR OPTIONS [203501]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|507.00||||507.00|456.3|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|507.00||||507.00|254.01|507|106.47 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|507.00||||507.00||| 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|AETNA [1015]|AETNA ACO WILCO [101532]|507.00||||507.00||| 39009040|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC RBC L/R IRRADIATED EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|507.00||||507.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|131.00||||131.00|65.63|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131.00||||131.00|78.6|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131.00||||131.00|124.8|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|TRUSTMARK [2030]|STARMARK [203000]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MULTIPLAN [1680]|IHC HS [168011]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|FIRST HEALTH [1375]|QUALCHOICE [137513]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|GEHA [1415]|GEHA [141500]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131.00||||131.00|131|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|||131.00||||131.00|39.3|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|131.00||||131.00|129.71|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|UMR [2035]|UMR OPTIONS [203501]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131.00||||131.00|45.98|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|HEALTHNET [1495]|HEALTHNET [149500]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|CORESOURCE [1315]|CORESOURCE [131500]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|131.00||||131.00|55.81|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|131.00||||131.00|131|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131.00||||131.00|114.8|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131.00||||131.00|62.81|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131.00||||131.00|120.55|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131.00||||131.00|56.33|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131.00||||131.00|131|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131.00||||131.00|85.15|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131.00||||131.00|124.8|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|CHAMPVA [1240]|CHAMP VA [124000]|131.00||||131.00|98.25|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|FMH BENEFIT SERVICES [1390]|FMH [139000]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131.00||||131.00|117.9|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131.00||||131.00|56.33|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131.00||||131.00|27.51|131|27.51 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|AETNA [1015]|AETNA ACO WILCO [101532]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|MULTIPLAN [1680]|HMA [168003]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131.00||||131.00||| 39009044|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA CRYO REDUCED EACH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|131.00||||131.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|HEALTHNET [1495]|HEALTHNET [149500]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119.00||||119.00|116.84|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|||119.00||||119.00|35.7|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|CHAMPVA [1240]|CHAMP VA [124000]|119.00||||119.00|89.25|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|GEHA [1415]|GEHA [141500]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|CORESOURCE [1315]|CORESOURCE [131500]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119.00||||119.00|93.99|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119.00||||119.00|102.19|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119.00||||119.00|119|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119.00||||119.00|24.99|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MULTIPLAN [1680]|IHC HS [168011]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119.00||||119.00|51.17|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119.00||||119.00|77.35|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119.00||||119.00|102.19|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119.00||||119.00|57.06|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|TRUSTMARK [2030]|STARMARK [203000]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|UMR [2035]|UMR OPTIONS [203501]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119.00||||119.00|41.77|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119.00||||119.00|71.4|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119.00||||119.00|59.62|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119.00||||119.00|106.21|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119.00||||119.00|50.69|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119.00||||119.00|98.7|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|FIRST HEALTH [1375]|QUALCHOICE [137513]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|FMH BENEFIT SERVICES [1390]|FMH [139000]|119.00||||119.00|107.1|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119.00||||119.00|119|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119.00||||119.00|51.17|119|24.99 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MULTIPLAN [1680]|HMA [168003]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|AETNA [1015]|AETNA ACO WILCO [101532]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119.00||||119.00||| 39009059|EAP|0390 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC PLASMA FROZEN 8-24 HOURS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119.00||||119.00||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.65||||62.65|26.94|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHNET [1495]|HEALTHNET [149500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UMR [2035]|UMR OPTIONS [203501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|GEHA [1415]|GEHA [141500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.65||||62.65|31.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MULTIPLAN [1680]|IHC HS [168011]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.65||||62.65|26.94|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.65||||62.65|26.69|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.65||||62.65|21.99|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62.65||||62.65|26.94|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62.65||||62.65|31.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62.65||||62.65|21.99|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62.65||||62.65|26.69|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.65||||62.65|37.59|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|GEHA [1415]|GEHA [141500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CORESOURCE [1315]|CORESOURCE [131500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MULTIPLAN [1680]|IHC HS [168011]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62.65||||62.65|26.94|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHNET [1495]|HEALTHNET [149500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CHAMPVA [1240]|CHAMP VA [124000]|62.65||||62.65|46.99|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|||62.65||||62.65|18.79|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.65||||62.65|40.72|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.65||||62.65|30.04|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.65||||62.65|13.16|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62.65||||62.65|40.72|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62.65||||62.65|30.04|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|||62.65||||62.65|18.79|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62.65||||62.65|13.16|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UMR [2035]|UMR OPTIONS [203501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CHAMPVA [1240]|CHAMP VA [124000]|62.65||||62.65|46.99|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CORESOURCE [1315]|CORESOURCE [131500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|TRUSTMARK [2030]|STARMARK [203000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|TRUSTMARK [2030]|STARMARK [203000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62.65||||62.65|37.59|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA [1015]|AETNA ACO WILCO [101532]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA [1015]|AETNA ACO WILCO [101532]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MULTIPLAN [1680]|HMA [168003]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MULTIPLAN [1680]|HMA [168003]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62.65||||62.65|56.39|56.39|13.16 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62.65||||62.65||| 39136|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62.65||||62.65||| 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1873.00||||1873.00|300.64|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1873.00||||1873.00|539.28|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1873.00||||1873.00|276.54|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1873.00||||1873.00|531|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|CORESOURCE [1315]|CORESOURCE [131500]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|GEHA [1415]|GEHA [141500]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1873.00||||1873.00|312.48|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|CHAMPVA [1240]|CHAMP VA [124000]|1873.00||||1873.00|1404.75|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1873.00||||1873.00|393.33|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|||1873.00||||1873.00|561.9|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1873.00||||1873.00|898.1|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1873.00||||1873.00|376.76|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1873.00||||1873.00|797.9|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1873.00||||1873.00|290.38|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|TRUSTMARK [2030]|STARMARK [203000]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1873.00||||1873.00|406.3|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1873.00||||1873.00|1123.8|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1873.00||||1873.00|805.39|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1873.00||||1873.00|938.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1873.00||||1873.00|406.3|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1873.00||||1873.00|915.21|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1873.00||||1873.00|300.64|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1873.00||||1873.00|387.84|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|HEALTHNET [1495]|HEALTHNET [149500]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1873.00||||1873.00|1217.45|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MULTIPLAN [1680]|HMA [168003]|1873.00||||1873.00|554.05|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MULTIPLAN [1680]|IHC HS [168011]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1873.00||||1873.00|343.72|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1873.00||||1873.00|805.39|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1873.00||||1873.00|531|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1873.00||||1873.00|369.37|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1873.00||||1873.00|657.42|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|UMR [2035]|UMR OPTIONS [203501]|1873.00||||1873.00|1685.7|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1873.00||||1873.00|1873|1873|276.54 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|AETNA [1015]|AETNA ACO WILCO [101532]|1873.00||||1873.00||| 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1873.00||||1873.00||| 39136430|EAP|0391 - ADMINISTRATION, PROCESSING AND STORAGE FOR|HC TRANSFUSN BLD/BLD COMPONTS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1873.00||||1873.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 39275|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 20 MG CAPSULE,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 39276|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DULOXETINE 30 MG CAPSULE,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.13||||34.13|14.68|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.13||||34.13|11.98|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.13||||34.13|14.54|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.13||||34.13|17.1|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.13||||34.13|20.48|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.13||||34.13|14.68|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.13||||34.13|7.17|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.13||||34.13|22.18|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.13||||34.13|16.37|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|||34.13||||34.13|10.24|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|34.13||||34.13|25.6|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|34.13||||34.13|30.72|30.72|7.17 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.13||||34.13||| 39744|ERX|0250 - PHARMACY-GENERAL|FLUMAZENIL 0.1 MG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.13||||34.13||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|||10.00||||10.00|3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|||10.00||||10.00|3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|||10.00||||10.00|3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|||10.00||||10.00|3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.96||||13.96|6.99|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.96||||13.96|4.9|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.96||||13.96|5.95|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.96||||13.96|6|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.96||||13.96|6.99|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.96||||13.96|4.9|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.96||||13.96|5.95|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.96||||13.96|8.38|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.96||||13.96|6|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.96||||13.96|6|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.96||||13.96|2.93|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.96||||13.96|2.93|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.96||||13.96|9.07|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.96||||13.96|9.07|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.96||||13.96|6.69|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.96||||13.96|6.69|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|||13.96||||13.96|4.19|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|||13.96||||13.96|4.19|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.96||||13.96|8.38|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.96||||13.96|6|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.96||||13.96|10.47|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|GEHA [1415]|GEHA [141500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|GEHA [1415]|GEHA [141500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.96||||13.96|10.47|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.96||||13.96||| 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.96||||13.96|12.56|12.56|2.93 40010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.96||||13.96||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|||90.00||||90.00|27|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400291|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.69|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|||90.00||||90.00|27|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.69 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 400292|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % IV BOLUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|||29.00||||29.00|8.7|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|4.11|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|4.11 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 40133639|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFAZOLIN 2 GRAM/20 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|829.00||||829.00|117.36|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|829.00||||829.00|356.47|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|829.00||||829.00|415.33|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|829.00||||829.00|290.98|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|829.00||||829.00|268.93|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|829.00||||829.00|497.4|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|829.00||||829.00|112.03|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|829.00||||829.00|128.35|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|829.00||||829.00|117.36|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|TRUSTMARK [2030]|STARMARK [203000]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|AETNA [1015]|AETNA ACO WILCO [101532]|829.00||||829.00|149.97|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MULTIPLAN [1680]|IHC HS [168011]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|829.00||||829.00|153.38|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MULTIPLAN [1680]|HMA [168003]|829.00||||829.00|160.04|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|HEALTHNET [1495]|HEALTHNET [149500]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|FMH BENEFIT SERVICES [1390]|FMH [139000]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|FIRST HEALTH [1375]|QUALCHOICE [137513]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|829.00||||829.00|146.75|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|829.00||||829.00|356.47|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|829.00||||829.00|108.82|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|UMR [2035]|UMR OPTIONS [203501]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|829.00||||829.00|155.77|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|829.00||||829.00|174.09|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|829.00||||829.00|123.97|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|829.00||||829.00|829|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|829.00||||829.00|538.85|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|829.00||||829.00|353.15|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|829.00||||829.00|397.51|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|||829.00||||829.00|248.7|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|829.00||||829.00|128.35|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|829.00||||829.00|106.69|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|829.00||||829.00|118.07|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|CHAMPVA [1240]|CHAMP VA [124000]|829.00||||829.00|621.75|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|829.00||||829.00|153.38|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|CORESOURCE [1315]|CORESOURCE [131500]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|829.00||||829.00|133.4|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|GEHA [1415]|GEHA [141500]|829.00||||829.00|746.1|829|106.69 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|829.00||||829.00||| 40276536|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SOFT TISSUE HEAD/NECK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|829.00||||829.00||| 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|GEHA [1415]|GEHA [141500]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|682.00||||682.00|85.65|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|CORESOURCE [1315]|CORESOURCE [131500]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|682.00||||682.00|153.38|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|682.00||||682.00|75.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|682.00||||682.00|82.41|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|||682.00||||682.00|204.6|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|682.00||||682.00|86.25|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|682.00||||682.00|327.02|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|682.00||||682.00|682|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|682.00||||682.00|155.77|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|UMR [2035]|UMR OPTIONS [203501]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|682.00||||682.00|108.82|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|682.00||||682.00|293.26|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|682.00||||682.00|94.22|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|FIRST HEALTH [1375]|QUALCHOICE [137513]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|FMH BENEFIT SERVICES [1390]|FMH [139000]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|HEALTHNET [1495]|HEALTHNET [149500]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MULTIPLAN [1680]|IHC HS [168011]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|682.00||||682.00|153.38|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|682.00||||682.00|143.22|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|682.00||||682.00|443.3|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MULTIPLAN [1680]|HMA [168003]|682.00||||682.00|160.04|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|AETNA [1015]|AETNA ACO WILCO [101532]|682.00||||682.00|106.58|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|TRUSTMARK [2030]|STARMARK [203000]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|682.00||||682.00|79.6|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|CHAMPVA [1240]|CHAMP VA [124000]|682.00||||682.00|511.5|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|682.00||||682.00|117.36|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|682.00||||682.00|82.41|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|682.00||||682.00|112.03|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|682.00||||682.00|409.2|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|682.00||||682.00|268.93|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|682.00||||682.00|293.26|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|682.00||||682.00|341.68|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|682.00||||682.00|290.53|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|682.00||||682.00|239.38|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|682.00||||682.00|106.69|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|682.00||||682.00|117.36|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|682.00||||682.00|613.8|682|75.8 40276604|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC US CHEST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|682.00||||682.00||| 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1213.00||||1213.00|117.36|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1213.00||||1213.00|106.69|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1213.00||||1213.00|521.59|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1213.00||||1213.00|425.76|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1213.00||||1213.00|516.74|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1213.00||||1213.00|268.93|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1213.00||||1213.00|727.8|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1213.00||||1213.00|112.03|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1213.00||||1213.00|114.2|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1213.00||||1213.00|123.97|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1213.00||||1213.00|106.69|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1213.00||||1213.00|103.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|1213.00||||1213.00|139.58|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1213.00||||1213.00|149.25|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MULTIPLAN [1680]|HMA [168003]|1213.00||||1213.00|160.04|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1213.00||||1213.00|103.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1213.00||||1213.00|103.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1213.00||||1213.00|146.75|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1213.00||||1213.00|103.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1213.00||||1213.00|521.59|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1213.00||||1213.00|108.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1213.00||||1213.00|106.69|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|UMR [2035]|UMR OPTIONS [203501]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1213.00||||1213.00|155.77|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1213.00||||1213.00|254.73|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1213.00||||1213.00|1213|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1213.00||||1213.00|103.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1213.00||||1213.00|788.45|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1213.00||||1213.00|581.63|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1213.00||||1213.00|128.35|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1213.00||||1213.00|103.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1213.00||||1213.00|607.71|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|||1213.00||||1213.00|363.9|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1213.00||||1213.00|128.35|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1213.00||||1213.00|106.69|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1213.00||||1213.00|103.82|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1213.00||||1213.00|118.07|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|1213.00||||1213.00|909.75|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1213.00||||1213.00|153.38|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1213.00||||1213.00|133.4|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|GEHA [1415]|GEHA [141500]|1213.00||||1213.00|1091.7|1213|103.82 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1213.00||||1213.00||| 40276700|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1213.00||||1213.00||| 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|GEHA [1415]|GEHA [141500]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1004.00||||1004.00|133.4|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1004.00||||1004.00|153.38|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|1004.00||||1004.00|753|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1004.00||||1004.00|118.07|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1004.00||||1004.00|128.35|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|||1004.00||||1004.00|301.2|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1004.00||||1004.00|481.42|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1004.00||||1004.00|652.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1004.00||||1004.00|1004|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1004.00||||1004.00|210.84|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|UMR [2035]|UMR OPTIONS [203501]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1004.00||||1004.00|108.82|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1004.00||||1004.00|431.72|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1004.00||||1004.00|146.75|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1004.00||||1004.00|155.77|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MULTIPLAN [1680]|IHC HS [168011]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1004.00||||1004.00|153.38|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MULTIPLAN [1680]|HMA [168003]|1004.00||||1004.00|160.04|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|1004.00||||1004.00|105.97|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|TRUSTMARK [2030]|STARMARK [203000]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1004.00||||1004.00|123.97|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1004.00||||1004.00|117.36|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1004.00||||1004.00|128.35|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1004.00||||1004.00|112.03|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1004.00||||1004.00|602.4|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1004.00||||1004.00|268.93|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1004.00||||1004.00|431.72|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1004.00||||1004.00|503|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1004.00||||1004.00|352.4|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1004.00||||1004.00|427.7|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1004.00||||1004.00|106.69|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1004.00||||1004.00|114.2|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1004.00||||1004.00|903.6|1004|105.97 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1004.00||||1004.00||| 40276705|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ABDOMEN LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1004.00||||1004.00||| 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1069.00||||1069.00|117.36|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1069.00||||1069.00|459.67|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1069.00||||1069.00|535.57|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1069.00||||1069.00|375.22|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1069.00||||1069.00|455.39|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1069.00||||1069.00|268.93|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1069.00||||1069.00|641.4|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1069.00||||1069.00|128.35|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1069.00||||1069.00|117.36|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|1069.00||||1069.00|130.41|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MULTIPLAN [1680]|HMA [168003]|1069.00||||1069.00|160.04|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1069.00||||1069.00|153.38|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1069.00||||1069.00|146.75|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1069.00||||1069.00|459.67|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1069.00||||1069.00|108.82|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|UMR [2035]|UMR OPTIONS [203501]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1069.00||||1069.00|155.77|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1069.00||||1069.00|123.97|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1069.00||||1069.00|224.49|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1069.00||||1069.00|112.03|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1069.00||||1069.00|1069|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1069.00||||1069.00|694.85|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1069.00||||1069.00|512.59|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|||1069.00||||1069.00|320.7|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1069.00||||1069.00|128.35|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1069.00||||1069.00|106.69|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1069.00||||1069.00|118.07|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|1069.00||||1069.00|801.75|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1069.00||||1069.00|153.38|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1069.00||||1069.00|133.4|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|GEHA [1415]|GEHA [141500]|1069.00||||1069.00|962.1|1069|106.69 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1069.00||||1069.00||| 40276770|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1069.00||||1069.00||| 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|GEHA [1415]|GEHA [141500]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|815.00||||815.00|133.4|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|815.00||||815.00|153.38|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|815.00||||815.00|118.07|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|||815.00||||815.00|244.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|815.00||||815.00|390.79|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|815.00||||815.00|815|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|815.00||||815.00|155.77|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|UMR [2035]|UMR OPTIONS [203501]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|815.00||||815.00|350.45|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|815.00||||815.00|146.75|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|815.00||||815.00|108.82|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|815.00||||815.00|171.15|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MULTIPLAN [1680]|IHC HS [168011]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|815.00||||815.00|153.38|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MULTIPLAN [1680]|HMA [168003]|815.00||||815.00|160.04|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|815.00||||815.00|529.75|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|815.00||||815.00|128.35|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|815.00||||815.00|50.95|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|TRUSTMARK [2030]|STARMARK [203000]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|815.00||||815.00|123.97|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|815.00||||815.00|611.25|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|815.00||||815.00|117.36|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|815.00||||815.00|128.35|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|815.00||||815.00|112.03|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|815.00||||815.00|489|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|815.00||||815.00|268.93|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|815.00||||815.00|350.45|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|815.00||||815.00|408.32|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|815.00||||815.00|347.19|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|815.00||||815.00|286.07|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|815.00||||815.00|106.69|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|815.00||||815.00|117.36|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|815.00||||815.00|733.5|815|50.95 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|815.00||||815.00||| 40276775|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC RETROPERITIONEAL LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|815.00||||815.00||| 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|730.00||||730.00|117.36|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|730.00||||730.00|313.9|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|730.00||||730.00|256.23|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|730.00||||730.00|310.98|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|730.00||||730.00|268.93|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|730.00||||730.00|438|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|730.00||||730.00|112.03|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|730.00||||730.00|128.35|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|730.00||||730.00|117.36|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|730.00||||730.00|123.97|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|AETNA [1015]|COVENTRY HEALTHCARE [101502]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|AETNA [1015]|AETNA ACO WILCO [101532]|730.00||||730.00|201.93|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MULTIPLAN [1680]|IHC HS [168011]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|730.00||||730.00|153.38|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MULTIPLAN [1680]|HMA [168003]|730.00||||730.00|160.04|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|HEALTHNET [1495]|HEALTHNET [149500]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|FMH BENEFIT SERVICES [1390]|FMH [139000]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|FIRST HEALTH [1375]|QUALCHOICE [137513]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|730.00||||730.00|146.75|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|730.00||||730.00|313.9|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|730.00||||730.00|108.82|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|TRUSTMARK [2030]|STARMARK [203000]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|UMR [2035]|UMR OPTIONS [203501]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|730.00||||730.00|155.77|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|730.00||||730.00|153.3|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|730.00||||730.00|730|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|730.00||||730.00|474.5|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|730.00||||730.00|350.04|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|730.00||||730.00|365.73|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|||730.00||||730.00|219|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|730.00||||730.00|128.35|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|730.00||||730.00|106.69|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|730.00||||730.00|118.07|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|CHAMPVA [1240]|CHAMP VA [124000]|730.00||||730.00|547.5|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|730.00||||730.00|153.38|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|CORESOURCE [1315]|CORESOURCE [131500]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|730.00||||730.00|133.4|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|GEHA [1415]|GEHA [141500]|730.00||||730.00|657|730|106.69 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|730.00||||730.00||| 40276776|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC KIDNEY TRANSPLANT US|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|730.00||||730.00||| 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|GEHA [1415]|GEHA [141500]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|968.00||||968.00|133.4|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|968.00||||968.00|153.38|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|CHAMPVA [1240]|CHAMP VA [124000]|968.00||||968.00|726|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|968.00||||968.00|118.07|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|968.00||||968.00|128.35|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|||968.00||||968.00|290.4|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|968.00||||968.00|464.16|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|968.00||||968.00|629.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|968.00||||968.00|968|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|968.00||||968.00|203.28|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|UMR [2035]|UMR OPTIONS [203501]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|968.00||||968.00|105.9|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|968.00||||968.00|416.24|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|968.00||||968.00|146.75|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|968.00||||968.00|155.77|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|HEALTHNET [1495]|HEALTHNET [149500]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MULTIPLAN [1680]|IHC HS [168011]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|968.00||||968.00|149.25|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MULTIPLAN [1680]|HMA [168003]|968.00||||968.00|155.73|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|AETNA [1015]|AETNA ACO WILCO [101532]|968.00||||968.00|124.9|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|TRUSTMARK [2030]|STARMARK [203000]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|968.00||||968.00|123.97|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|CORESOURCE [1315]|CORESOURCE [131500]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|968.00||||968.00|114.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|968.00||||968.00|128.35|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|968.00||||968.00|109.01|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|968.00||||968.00|580.8|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|968.00||||968.00|106.69|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|968.00||||968.00|268.93|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|968.00||||968.00|416.24|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|968.00||||968.00|484.97|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|968.00||||968.00|339.77|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|968.00||||968.00|412.37|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|968.00||||968.00|103.82|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|968.00||||968.00|114.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|968.00||||968.00|871.2|968|103.82 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|968.00||||968.00||| 40276801|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY <14WKS TRANSABDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|968.00||||968.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|556.00||||556.00|239.08|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|556.00||||556.00|278.56|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|556.00||||556.00|195.16|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|556.00||||556.00|278|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|556.00||||556.00|333.6|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|556.00||||556.00|82.41|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|TRUSTMARK [2030]|STARMARK [203000]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|AETNA [1015]|AETNA ACO WILCO [101532]|556.00||||556.00|37.28|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MULTIPLAN [1680]|IHC HS [168011]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|HEALTHNET [1495]|HEALTHNET [149500]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|FMH BENEFIT SERVICES [1390]|FMH [139000]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|FIRST HEALTH [1375]|QUALCHOICE [137513]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|556.00||||556.00|94.22|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|556.00||||556.00|239.08|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|UMR [2035]|UMR OPTIONS [203501]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|556.00||||556.00|116.76|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|556.00||||556.00|79.6|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|556.00||||556.00|556|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|556.00||||556.00|361.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|556.00||||556.00|236.86|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|556.00||||556.00|266.6|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|||556.00||||556.00|166.8|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|556.00||||556.00|82.41|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|556.00||||556.00|75.8|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|CHAMPVA [1240]|CHAMP VA [124000]|556.00||||556.00|417|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|CORESOURCE [1315]|CORESOURCE [131500]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|556.00||||556.00|85.65|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|GEHA [1415]|GEHA [141500]|556.00||||556.00|500.4|556|37.28 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MULTIPLAN [1680]|HMA [168003]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|556.00||||556.00||| 40276802|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY ADDTL GEST <14 WKS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|556.00||||556.00||| 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|GEHA [1415]|GEHA [141500]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|930.00||||930.00|133.4|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|CORESOURCE [1315]|CORESOURCE [131500]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|930.00||||930.00|153.38|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|CHAMPVA [1240]|CHAMP VA [124000]|930.00||||930.00|697.5|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|930.00||||930.00|118.07|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|||930.00||||930.00|279|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|930.00||||930.00|445.94|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|930.00||||930.00|930|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|930.00||||930.00|195.3|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|930.00||||930.00|155.77|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|UMR [2035]|UMR OPTIONS [203501]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|930.00||||930.00|399.9|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|930.00||||930.00|146.75|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|FIRST HEALTH [1375]|QUALCHOICE [137513]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|930.00||||930.00|108.82|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|FMH BENEFIT SERVICES [1390]|FMH [139000]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|HEALTHNET [1495]|HEALTHNET [149500]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MULTIPLAN [1680]|IHC HS [168011]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|930.00||||930.00|153.38|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|930.00||||930.00|604.5|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MULTIPLAN [1680]|HMA [168003]|930.00||||930.00|160.04|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|930.00||||930.00|128.35|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|AETNA [1015]|AETNA ACO WILCO [101532]|930.00||||930.00|155.47|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|TRUSTMARK [2030]|STARMARK [203000]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|930.00||||930.00|123.97|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|930.00||||930.00|117.36|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|930.00||||930.00|128.35|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|930.00||||930.00|112.03|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|930.00||||930.00|558|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|930.00||||930.00|268.93|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|930.00||||930.00|326.43|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|930.00||||930.00|399.9|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|930.00||||930.00|465.93|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|930.00||||930.00|396.18|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|930.00||||930.00|106.69|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|930.00||||930.00|117.36|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|930.00||||930.00|837|930|106.69 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|930.00||||930.00||| 40276805|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY >=14WKS TRANSABDL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|930.00||||930.00||| 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|790.00||||790.00|117.36|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|790.00||||790.00|339.7|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|790.00||||790.00|277.29|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|790.00||||790.00|336.54|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|790.00||||790.00|268.93|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|790.00||||790.00|474|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|790.00||||790.00|112.03|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|790.00||||790.00|117.36|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|790.00||||790.00|79.6|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|790.00||||790.00|88.84|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MULTIPLAN [1680]|IHC HS [168011]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|790.00||||790.00|153.38|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MULTIPLAN [1680]|HMA [168003]|790.00||||790.00|160.04|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|790.00||||790.00|94.22|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|790.00||||790.00|339.7|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|790.00||||790.00|108.82|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|UMR [2035]|UMR OPTIONS [203501]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|790.00||||790.00|155.77|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|TRUSTMARK [2030]|STARMARK [203000]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|790.00||||790.00|165.9|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|790.00||||790.00|82.41|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|790.00||||790.00|790|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|790.00||||790.00|513.5|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|790.00||||790.00|378.81|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|790.00||||790.00|395.79|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|||790.00||||790.00|237|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|790.00||||790.00|82.41|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|790.00||||790.00|106.69|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|790.00||||790.00|75.8|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|790.00||||790.00|592.5|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|790.00||||790.00|153.38|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|790.00||||790.00|85.65|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|GEHA [1415]|GEHA [141500]|790.00||||790.00|711|790|75.8 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|790.00||||790.00||| 40276815|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|790.00||||790.00||| 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|GEHA [1415]|GEHA [141500]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|600.00||||600.00|85.65|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|600.00||||600.00|153.38|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|CHAMPVA [1240]|CHAMP VA [124000]|600.00||||600.00|450|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|600.00||||600.00|75.8|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|600.00||||600.00|82.41|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|||600.00||||600.00|180|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|600.00||||600.00|287.7|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|600.00||||600.00|390|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|600.00||||600.00|600|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|600.00||||600.00|126|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|UMR [2035]|UMR OPTIONS [203501]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|600.00||||600.00|108.82|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|600.00||||600.00|258|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|600.00||||600.00|94.22|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|600.00||||600.00|155.77|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|HEALTHNET [1495]|HEALTHNET [149500]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MULTIPLAN [1680]|IHC HS [168011]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|600.00||||600.00|153.38|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MULTIPLAN [1680]|HMA [168003]|600.00||||600.00|160.04|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|AETNA [1015]|AETNA ACO WILCO [101532]|600.00||||600.00|101.07|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|TRUSTMARK [2030]|STARMARK [203000]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|600.00||||600.00|79.6|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|600.00||||600.00|117.36|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|600.00||||600.00|82.41|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|CORESOURCE [1315]|CORESOURCE [131500]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|600.00||||600.00|112.03|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|600.00||||600.00|360|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|600.00||||600.00|268.93|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|600.00||||600.00|258|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|600.00||||600.00|300.6|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|600.00||||600.00|210.6|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|600.00||||600.00|255.6|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|600.00||||600.00|106.69|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|600.00||||600.00|117.36|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|600.00||||600.00|540|600|75.8 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|600.00||||600.00||| 40276817|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PREGNANCY TRANSVAGINAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|600.00||||600.00||| 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|869.00||||869.00|117.36|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|869.00||||869.00|373.67|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|869.00||||869.00|435.37|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|869.00||||869.00|305.02|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|869.00||||869.00|268.93|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|869.00||||869.00|521.4|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|869.00||||869.00|128.35|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|869.00||||869.00|117.36|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|869.00||||869.00|123.97|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|TRUSTMARK [2030]|STARMARK [203000]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|AETNA [1015]|AETNA ACO WILCO [101532]|869.00||||869.00|149.97|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MULTIPLAN [1680]|IHC HS [168011]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MULTIPLAN [1680]|HMA [168003]|869.00||||869.00|160.04|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|HEALTHNET [1495]|HEALTHNET [149500]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|FMH BENEFIT SERVICES [1390]|FMH [139000]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|869.00||||869.00|153.38|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|FIRST HEALTH [1375]|QUALCHOICE [137513]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|869.00||||869.00|146.75|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|869.00||||869.00|373.67|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|869.00||||869.00|108.82|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|UMR [2035]|UMR OPTIONS [203501]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|869.00||||869.00|155.77|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|869.00||||869.00|182.49|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|869.00||||869.00|869|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|869.00||||869.00|564.85|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|869.00||||869.00|112.03|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|869.00||||869.00|370.19|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|869.00||||869.00|416.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|||869.00||||869.00|260.7|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|869.00||||869.00|128.35|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|869.00||||869.00|106.69|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|869.00||||869.00|118.07|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|CHAMPVA [1240]|CHAMP VA [124000]|869.00||||869.00|651.75|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|869.00||||869.00|153.38|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|CORESOURCE [1315]|CORESOURCE [131500]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|869.00||||869.00|133.4|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|GEHA [1415]|GEHA [141500]|869.00||||869.00|782.1|869|106.69 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|869.00||||869.00||| 40276830|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSVAGINAL SONO NON OB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|869.00||||869.00||| 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|GEHA [1415]|GEHA [141500]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|983.00||||983.00|133.4|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|983.00||||983.00|153.38|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|983.00||||983.00|118.07|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|||983.00||||983.00|294.9|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|983.00||||983.00|471.35|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|983.00||||983.00|638.95|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|983.00||||983.00|983|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|983.00||||983.00|155.77|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|UMR [2035]|UMR OPTIONS [203501]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|983.00||||983.00|422.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|983.00||||983.00|146.75|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|983.00||||983.00|108.82|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|983.00||||983.00|206.43|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|983.00||||983.00|153.38|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MULTIPLAN [1680]|HMA [168003]|983.00||||983.00|160.04|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|983.00||||983.00|128.35|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|983.00||||983.00|129.18|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|983.00||||983.00|123.97|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|983.00||||983.00|737.25|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|983.00||||983.00|117.36|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|983.00||||983.00|128.35|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|983.00||||983.00|109.01|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|983.00||||983.00|589.8|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|983.00||||983.00|268.93|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|983.00||||983.00|345.03|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|983.00||||983.00|422.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|983.00||||983.00|492.48|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|983.00||||983.00|418.76|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|983.00||||983.00|106.69|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|983.00||||983.00|117.36|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|983.00||||983.00|884.7|983|106.69 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|983.00||||983.00||| 40276856|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|983.00||||983.00||| 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|TRUSTMARK [2030]|STARMARK [203000]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|AETNA [1015]|AETNA ACO WILCO [101532]|726.00||||726.00|41.17|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MULTIPLAN [1680]|IHC HS [168011]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|726.00||||726.00|149.25|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MULTIPLAN [1680]|HMA [168003]|726.00||||726.00|155.73|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|FMH BENEFIT SERVICES [1390]|FMH [139000]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|FIRST HEALTH [1375]|QUALCHOICE [137513]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|726.00||||726.00|94.22|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|726.00||||726.00|312.18|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|726.00||||726.00|105.9|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|UMR [2035]|UMR OPTIONS [203501]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|726.00||||726.00|155.77|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|726.00||||726.00|152.46|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|726.00||||726.00|726|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|HEALTHNET [1495]|HEALTHNET [149500]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|726.00||||726.00|471.9|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|726.00||||726.00|348.12|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|||726.00||||726.00|217.8|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|726.00||||726.00|82.41|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|726.00||||726.00|75.8|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|CHAMPVA [1240]|CHAMP VA [124000]|726.00||||726.00|544.5|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|726.00||||726.00|153.38|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|CORESOURCE [1315]|CORESOURCE [131500]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|726.00||||726.00|85.65|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|GEHA [1415]|GEHA [141500]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|726.00||||726.00|82.41|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|726.00||||726.00|435.6|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|726.00||||726.00|312.18|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|726.00||||726.00|109.01|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|726.00||||726.00|79.6|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|726.00||||726.00|114.2|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|726.00||||726.00|363.73|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|726.00||||726.00|309.28|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|726.00||||726.00|653.4|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|726.00||||726.00|268.93|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|726.00||||726.00|114.2|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|726.00||||726.00|106.69|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|726.00||||726.00|254.83|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|726.00||||726.00|103.82|726|41.17 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|726.00||||726.00||| 40276857|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC PELVIS NON OB LIMITED/FOLLOW-UP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|726.00||||726.00||| 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|933.00||||933.00|933|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|933.00||||933.00|559.8|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|933.00||||933.00|467.43|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|933.00||||933.00|155.77|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|933.00||||933.00|149.25|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|933.00||||933.00|114.2|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|FIRST HEALTH [1375]|QUALCHOICE [137513]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|933.00||||933.00|105.9|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|933.00||||933.00|327.48|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|HEALTHNET [1495]|HEALTHNET [149500]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|933.00||||933.00|397.46|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MULTIPLAN [1680]|IHC HS [168011]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|933.00||||933.00|153.38|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|933.00||||933.00|401.19|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|CORESOURCE [1315]|CORESOURCE [131500]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|933.00||||933.00|109.01|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|CHAMPVA [1240]|CHAMP VA [124000]|933.00||||933.00|699.75|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|933.00||||933.00|146.75|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|TRUSTMARK [2030]|STARMARK [203000]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|UMR [2035]|UMR OPTIONS [203501]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|933.00||||933.00|114.2|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|933.00||||933.00|128.35|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|GEHA [1415]|GEHA [141500]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|933.00||||933.00|128.35|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|933.00||||933.00|123.97|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|933.00||||933.00|106.69|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|AETNA [1015]|AETNA ACO WILCO [101532]|933.00||||933.00|126.14|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|FMH BENEFIT SERVICES [1390]|FMH [139000]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|||933.00||||933.00|279.9|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|933.00||||933.00|195.93|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|933.00||||933.00|106.69|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|933.00||||933.00|447.37|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|933.00||||933.00|401.19|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|933.00||||933.00|606.45|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MULTIPLAN [1680]|HMA [168003]|933.00||||933.00|155.73|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|933.00||||933.00|103.82|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|933.00||||933.00|118.07|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|933.00||||933.00|268.93|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|933.00||||933.00|133.4|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|933.00||||933.00|839.7|933|103.82 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|933.00||||933.00||| 40276870|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC SCROTUM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|933.00||||933.00||| 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|817.00||||817.00|146.75|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|817.00||||817.00|155.77|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|817.00||||817.00|171.57|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|817.00||||817.00|153.38|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|AETNA [1015]|AETNA ACO WILCO [101532]|817.00||||817.00|163.42|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MULTIPLAN [1680]|IHC HS [168011]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|817.00||||817.00|531.05|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|817.00||||817.00|153.38|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|CORESOURCE [1315]|CORESOURCE [131500]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|817.00||||817.00|351.31|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|817.00||||817.00|490.2|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|817.00||||817.00|133.4|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|817.00||||817.00|123.97|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|817.00||||817.00|391.75|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|817.00||||817.00|409.32|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|817.00||||817.00|108.82|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|817.00||||817.00|286.77|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|817.00||||817.00|268.93|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|||817.00||||817.00|245.1|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|817.00||||817.00|117.36|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|817.00||||817.00|112.03|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|817.00||||817.00|128.35|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|GEHA [1415]|GEHA [141500]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MULTIPLAN [1680]|HMA [168003]|817.00||||817.00|160.04|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|817.00||||817.00|117.36|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|817.00||||817.00|128.35|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|817.00||||817.00|106.69|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|817.00||||817.00|817|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|817.00||||817.00|351.31|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|TRUSTMARK [2030]|STARMARK [203000]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|HEALTHNET [1495]|HEALTHNET [149500]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|CHAMPVA [1240]|CHAMP VA [124000]|817.00||||817.00|612.75|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|UMR [2035]|UMR OPTIONS [203501]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|817.00||||817.00|735.3|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|817.00||||817.00|118.07|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|817.00||||817.00|348.04|817|106.69 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|817.00||||817.00||| 40276872|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|817.00||||817.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|GEHA [1415]|GEHA [141500]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6323.00||||6323.00|3031.88|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6323.00||||6323.00|146.75|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6323.00||||6323.00|2718.89|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6323.00||||6323.00|268.93|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|FMH BENEFIT SERVICES [1390]|FMH [139000]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6323.00||||6323.00|128.35|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6323.00||||6323.00|133.4|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|||6323.00||||6323.00|1896.9|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6323.00||||6323.00|6323|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6323.00||||6323.00|118.07|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|HEALTHNET [1495]|HEALTHNET [149500]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|AETNA [1015]|AETNA ACO WILCO [101532]|6323.00||||6323.00|164.63|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MULTIPLAN [1680]|IHC HS [168011]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|TRUSTMARK [2030]|STARMARK [203000]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|CHAMPVA [1240]|CHAMP VA [124000]|6323.00||||6323.00|4742.25|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|CORESOURCE [1315]|CORESOURCE [131500]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6323.00||||6323.00|1327.83|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6323.00||||6323.00|2219.37|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6323.00||||6323.00|4109.95|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|FIRST HEALTH [1375]|QUALCHOICE [137513]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6323.00||||6323.00|123.97|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6323.00||||6323.00|2693.6|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6323.00||||6323.00|128.35|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6323.00||||6323.00|2718.89|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6323.00||||6323.00|3167.82|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|UMR [2035]|UMR OPTIONS [203501]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6323.00||||6323.00|3793.8|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6323.00||||6323.00|5690.7|6323|118.07 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MULTIPLAN [1680]|HMA [168003]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6323.00||||6323.00||| 40276873|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC TRANSRECTAL PROSTATE VOL STUDY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6323.00||||6323.00||| 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|541.00||||541.00|232.63|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|541.00||||541.00|108.82|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|541.00||||541.00|138.25|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|541.00||||541.00|405.75|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|UMR [2035]|UMR OPTIONS [203501]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|541.00||||541.00|111.23|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|541.00||||541.00|120.92|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|541.00||||541.00|155.77|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|541.00||||541.00|351.65|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|541.00||||541.00|153.38|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|GEHA [1415]|GEHA [141500]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|541.00||||541.00|125.68|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|541.00||||541.00|113.61|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|541.00||||541.00|541|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|541.00||||541.00|259.41|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|||541.00||||541.00|162.3|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|541.00||||541.00|232.63|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|541.00||||541.00|117.36|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|541.00||||541.00|153.38|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|541.00||||541.00|324.6|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|541.00||||541.00|120.92|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|541.00||||541.00|189.89|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|541.00||||541.00|109.01|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|541.00||||541.00|268.93|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|541.00||||541.00|230.47|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|541.00||||541.00|116.79|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|TRUSTMARK [2030]|STARMARK [203000]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|541.00||||541.00|271.04|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|541.00||||541.00|106.69|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MULTIPLAN [1680]|HMA [168003]|541.00||||541.00|160.04|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MULTIPLAN [1680]|IHC HS [168011]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|541.00||||541.00|486.9|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|541.00||||541.00|117.36|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|541.00||||541.00|56.45|541|56.45 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|541.00||||541.00||| 40276882|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC EXTREMITY NONVASC LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|541.00||||541.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|TRUSTMARK [2030]|STARMARK [203000]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|884.00||||884.00|423.88|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|GEHA [1415]|GEHA [141500]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|CHAMPVA [1240]|CHAMP VA [124000]|884.00||||884.00|663|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|CORESOURCE [1315]|CORESOURCE [131500]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|UMR [2035]|UMR OPTIONS [203501]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|884.00||||884.00|574.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|884.00||||884.00|380.12|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|884.00||||884.00|884|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|AETNA [1015]|AETNA ACO WILCO [101532]|884.00||||884.00|33.61|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|FIRST HEALTH [1375]|QUALCHOICE [137513]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|HEALTHNET [1495]|HEALTHNET [149500]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|FMH BENEFIT SERVICES [1390]|FMH [139000]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MULTIPLAN [1680]|IHC HS [168011]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|884.00||||884.00|442.88|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|884.00||||884.00|310.28|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|884.00||||884.00|442|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|884.00||||884.00|530.4|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|884.00||||884.00|185.64|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|884.00||||884.00|380.12|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|884.00||||884.00|376.58|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|||884.00||||884.00|265.2|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|884.00||||884.00|795.6|884|33.61 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|884.00||||884.00||| 40276937|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC ULTRASOUND GUIDNC VASCLR ACCSS|MULTIPLAN [1680]|HMA [168003]|884.00||||884.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|952.00||||952.00|952|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|HEALTHNET [1495]|HEALTHNET [149500]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|AETNA [1015]|AETNA ACO WILCO [101532]|952.00||||952.00|43.01|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|952.00||||952.00|476.95|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|952.00||||952.00|409.36|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MULTIPLAN [1680]|IHC HS [168011]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|952.00||||952.00|476|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|952.00||||952.00|334.15|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|952.00||||952.00|405.55|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|TRUSTMARK [2030]|STARMARK [203000]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|FMH BENEFIT SERVICES [1390]|FMH [139000]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|952.00||||952.00|199.92|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|952.00||||952.00|409.36|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|FIRST HEALTH [1375]|QUALCHOICE [137513]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|952.00||||952.00|456.48|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|CHAMPVA [1240]|CHAMP VA [124000]|952.00||||952.00|714|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|GEHA [1415]|GEHA [141500]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|952.00||||952.00|58.74|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|952.00||||952.00|618.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|UMR [2035]|UMR OPTIONS [203501]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|CORESOURCE [1315]|CORESOURCE [131500]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|||952.00||||952.00|285.6|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|952.00||||952.00|571.2|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|952.00||||952.00|856.8|952|43.01 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MULTIPLAN [1680]|HMA [168003]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|952.00||||952.00||| 40276942|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDANCE NEEDLE PLCMT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|952.00||||952.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|CHAMPVA [1240]|CHAMP VA [124000]|1679.00||||1679.00|1259.25|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MULTIPLAN [1680]|IHC HS [168011]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1679.00||||1679.00|1091.35|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|CORESOURCE [1315]|CORESOURCE [131500]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|||1679.00||||1679.00|503.7|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|UMR [2035]|UMR OPTIONS [203501]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1679.00||||1679.00|805.08|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1679.00||||1679.00|721.97|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|AETNA [1015]|AETNA ACO WILCO [101532]|1679.00||||1679.00|43.01|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1679.00||||1679.00|589.33|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1679.00||||1679.00|715.25|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|TRUSTMARK [2030]|STARMARK [203000]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1679.00||||1679.00|839.5|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1679.00||||1679.00|721.97|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1679.00||||1679.00|841.18|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|HEALTHNET [1495]|HEALTHNET [149500]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1679.00||||1679.00|1679|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1679.00||||1679.00|352.59|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1679.00||||1679.00|1007.4|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|GEHA [1415]|GEHA [141500]|1679.00||||1679.00|1511.1|1679|43.01 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MULTIPLAN [1680]|HMA [168003]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1679.00||||1679.00||| 40276965|EAP|0402 - OTHER IMAGING SERVICES-ULTRASOUND|HC GUIDED INTERSTITIAL THERAPY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1679.00||||1679.00||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|||0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401001|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVICORE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|||0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401002|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDCURRENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|||0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401003|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM MEDICALIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|||0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401004|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NDSC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|||0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401005|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM NIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|||0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401006|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM TEST APPROP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|||0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401007|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AIM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|||0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401008|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CRANBERRY PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|||0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401009|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SAGE HEALTH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|||0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401010|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM STANSON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|||0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401011|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM QUALIFIED NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|||0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401012|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM AGILEMD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|||0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401013|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EVIDENCECARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|||0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401014|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INVENIQA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|||0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401015|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM RELIANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|||0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401016|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|||0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401017|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM HEALTHHELP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|||0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401018|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INFINX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|||0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401019|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM LOGICNETS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|||0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401020|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM CURBSIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|||0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401021|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM EHEALTHLINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|||0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401022|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM INTERMOUNTAIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|||0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 40401023|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5500.00||||5500.00|1321.78|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5500.00||||5500.00|1511.02|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5500.00||||5500.00|1368.53|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5500.00||||5500.00|2365|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5500.00||||5500.00|2755.5|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|TRUSTMARK [2030]|STARMARK [203000]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5500.00||||5500.00|1930.5|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5500.00||||5500.00|2343|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5500.00||||5500.00|1442.33|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5500.00||||5500.00|3300|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5500.00||||5500.00|3287.87|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5500.00||||5500.00|1511.02|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5500.00||||5500.00|1422.42|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|GEHA [1415]|GEHA [141500]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|CORESOURCE [1315]|CORESOURCE [131500]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5500.00||||5500.00|1974.76|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|CHAMPVA [1240]|CHAMP VA [124000]|5500.00||||5500.00|4125|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5500.00||||5500.00|1368.53|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5500.00||||5500.00|2637.25|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5500.00||||5500.00|3575|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5500.00||||5500.00|5500|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5500.00||||5500.00|1155|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|||5500.00||||5500.00|1650|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5500.00||||5500.00|2005.53|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|UMR [2035]|UMR OPTIONS [203501]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5500.00||||5500.00|1401.12|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5500.00||||5500.00|1258.81|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5500.00||||5500.00|2365|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5500.00||||5500.00|1564.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|FIRST HEALTH [1375]|QUALCHOICE [137513]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|FMH BENEFIT SERVICES [1390]|FMH [139000]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|HEALTHNET [1495]|HEALTHNET [149500]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MULTIPLAN [1680]|IHC HS [168011]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5500.00||||5500.00|1974.76|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|MULTIPLAN [1680]|HMA [168003]|5500.00||||5500.00|2060.48|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5500.00||||5500.00|4950|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5500.00||||5500.00|1373.65|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|AETNA [1015]|AETNA ACO WILCO [101532]|5500.00||||5500.00|2498.64|5500|1155 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5500.00||||5500.00||| 40478815|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC CT FUSN IMAGE SKUL TO THGH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5500.00||||5500.00||| 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5885.00||||5885.00|1511.02|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5885.00||||5885.00|2530.55|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5885.00||||5885.00|2948.39|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5885.00||||5885.00|2507.01|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5885.00||||5885.00|3287.87|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5885.00||||5885.00|1442.33|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5885.00||||5885.00|1368.53|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5885.00||||5885.00|1511.02|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5885.00||||5885.00|1321.78|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|TRUSTMARK [2030]|STARMARK [203000]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|AETNA [1015]|AETNA ACO WILCO [101532]|5885.00||||5885.00|2498.64|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5885.00||||5885.00|1974.76|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MULTIPLAN [1680]|HMA [168003]|5885.00||||5885.00|2060.48|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|HEALTHNET [1495]|HEALTHNET [149500]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|FMH BENEFIT SERVICES [1390]|FMH [139000]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|FIRST HEALTH [1375]|QUALCHOICE [137513]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5885.00||||5885.00|1564.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5885.00||||5885.00|2530.55|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MULTIPLAN [1680]|IHC HS [168011]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5885.00||||5885.00|1401.12|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|UMR [2035]|UMR OPTIONS [203501]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5885.00||||5885.00|2005.53|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5885.00||||5885.00|1235.85|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5885.00||||5885.00|5885|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5885.00||||5885.00|3531|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5885.00||||5885.00|3825.25|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5885.00||||5885.00|2821.86|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|||5885.00||||5885.00|1765.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5885.00||||5885.00|2065.64|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5885.00||||5885.00|1368.53|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5885.00||||5885.00|1373.65|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5885.00||||5885.00|1258.81|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|CHAMPVA [1240]|CHAMP VA [124000]|5885.00||||5885.00|4413.75|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5885.00||||5885.00|1974.76|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|CORESOURCE [1315]|CORESOURCE [131500]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|GEHA [1415]|GEHA [141500]|5885.00||||5885.00|5296.5|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5885.00||||5885.00|1422.42|5885|1235.85 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5885.00||||5885.00||| 40478816|EAP|0404 - OTHER IMAGING SERVICES-POSITRON EMISSION TO|HC PET/CT IMAGING WHOLE BODY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5885.00||||5885.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|||10.00||||10.00|3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|||10.00||||10.00|3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|||10.00||||10.00|3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|||10.00||||10.00|3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4065|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|||10.00||||10.00|3|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4068|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ISOSORBIDE DINITRATE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|GEHA [1415]|GEHA [141500]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|CORESOURCE [1315]|CORESOURCE [131500]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|||578.17||||578.17|173.45|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|578.17||||578.17|277.23|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|578.17||||578.17|375.81|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|578.17||||578.17|121.42|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|UMR [2035]|UMR OPTIONS [203501]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|FIRST HEALTH [1375]|QUALCHOICE [137513]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|578.17||||578.17|248.61|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|FMH BENEFIT SERVICES [1390]|FMH [139000]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHNET [1495]|HEALTHNET [149500]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MULTIPLAN [1680]|IHC HS [168011]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|TRUSTMARK [2030]|STARMARK [203000]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|CHAMPVA [1240]|CHAMP VA [124000]|578.17||||578.17|433.63|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|578.17||||578.17|248.61|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|578.17||||578.17|289.66|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|578.17||||578.17|202.94|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|578.17||||578.17|246.3|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|578.17||||578.17|346.9|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|578.17||||578.17|520.35|520.35|121.42 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MULTIPLAN [1680]|HMA [168003]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|AETNA [1015]|AETNA ACO WILCO [101532]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|578.17||||578.17||| 40698|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|578.17||||578.17||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|898.04||||898.04|386.16|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|898.04||||898.04|449.92|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|898.04||||898.04|315.21|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|TRUSTMARK [2030]|STARMARK [203000]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHNET [1495]|HEALTHNET [149500]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|FMH BENEFIT SERVICES [1390]|FMH [139000]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|898.04||||898.04|386.16|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|FIRST HEALTH [1375]|QUALCHOICE [137513]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MULTIPLAN [1680]|IHC HS [168011]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|UMR [2035]|UMR OPTIONS [203501]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|898.04||||898.04|188.59|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|898.04||||898.04|382.57|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|898.04||||898.04|538.82|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|898.04||||898.04|583.73|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|898.04||||898.04|430.61|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|||898.04||||898.04|269.41|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|CHAMPVA [1240]|CHAMP VA [124000]|898.04||||898.04|673.53|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|CORESOURCE [1315]|CORESOURCE [131500]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|GEHA [1415]|GEHA [141500]|898.04||||898.04|808.24|808.24|188.59 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|AETNA [1015]|AETNA ACO WILCO [101532]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MULTIPLAN [1680]|HMA [168003]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|898.04||||898.04||| 40699|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|898.04||||898.04||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|||10.00||||10.00|3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|||10.00||||10.00|3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|||10.00||||10.00|3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|||10.00||||10.00|3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|||10.00||||10.00|3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40807877|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|THIAMINE (VITAMIN B1) 100 MG TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|||29.00||||29.00|8.7|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 408104207|ERX|0250 - PHARMACY-GENERAL|LIDOCAINE (PF) 10 MG/ML (1%) INJECTION SOLUTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|GEHA [1415]|GEHA [141500]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|CORESOURCE [1315]|CORESOURCE [131500]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|||192.97||||192.97|57.89|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.97||||192.97|92.53|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192.97||||192.97|40.52|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192.97||||192.97|8.08|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|UMR [2035]|UMR OPTIONS [203501]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|FIRST HEALTH [1375]|QUALCHOICE [137513]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192.97||||192.97|82.98|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|FMH BENEFIT SERVICES [1390]|FMH [139000]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|HEALTHNET [1495]|HEALTHNET [149500]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MULTIPLAN [1680]|IHC HS [168011]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MULTIPLAN [1680]|HMA [168003]|192.97||||192.97|67.54|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192.97||||192.97|125.43|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|TRUSTMARK [2030]|STARMARK [203000]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|CHAMPVA [1240]|CHAMP VA [124000]|192.97||||192.97|144.73|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192.97||||192.97|82.98|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192.97||||192.97|96.68|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192.97||||192.97|67.73|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192.97||||192.97|82.21|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.97||||192.97|115.78|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192.97||||192.97|173.67|173.67|8.08 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|AETNA [1015]|AETNA ACO WILCO [101532]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.97||||192.97||| 40811023|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PHYTONADIONE (VITAMIN K1) 10 MG/ML INJECTION SOLUTION *MIXTURE COMPONENT*|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192.97||||192.97||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.29||||17.29|7.43|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.29||||17.29|3.63|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.29||||17.29|11.24|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.29||||17.29|8.29|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|||17.29||||17.29|5.19|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.29||||17.29|8.66|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.29||||17.29|6.07|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.29||||17.29|7.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.29||||17.29|10.37|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.29||||17.29|12.97|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|17.29||||17.29|15.56|15.56|3.63 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 40811371|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.29||||17.29||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|CORESOURCE [1315]|CORESOURCE [131500]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|CHAMPVA [1240]|CHAMP VA [124000]|79.60||||79.60|59.7|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|||79.60||||79.60|23.88|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79.60||||79.60|38.17|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79.60||||79.60|51.74|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79.60||||79.60|16.72|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79.60||||79.60|34.23|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|UMR [2035]|UMR OPTIONS [203501]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|HEALTHNET [1495]|HEALTHNET [149500]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MULTIPLAN [1680]|IHC HS [168011]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|TRUSTMARK [2030]|STARMARK [203000]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79.60||||79.60|34.23|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|GEHA [1415]|GEHA [141500]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79.60||||79.60|39.88|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79.60||||79.60|27.94|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79.60||||79.60|33.91|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79.60||||79.60|47.76|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79.60||||79.60|71.64|71.64|16.72 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MULTIPLAN [1680]|HMA [168003]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79.60||||79.60||| 408121844|ERX|0250 - PHARMACY-GENERAL|SODIUM BICARBONATE 1 MEQ/ML (8.4%) IV WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79.60||||79.60||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|||10.00||||10.00|3|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|||10.00||||10.00|3|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 408123707|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL PACKET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.11|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.11|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|0.11|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|||29.00||||29.00|8.7|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|||29.00||||29.00|8.7|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|||29.00||||29.00|8.7|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|0.11 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 408125938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN, PORCINE (PF) 100 UNIT/ML IV WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.94||||34.94|16.75|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.94||||34.94|22.71|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.94||||34.94|15.02|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.94||||34.94|7.34|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.94||||34.94|16.75|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|||34.94||||34.94|10.48|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.94||||34.94|12.26|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|34.94||||34.94|26.21|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.94||||34.94|15.02|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.94||||34.94|15.02|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.94||||34.94|12.26|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.94||||34.94|14.88|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|GEHA [1415]|GEHA [141500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.94||||34.94|20.96|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.94||||34.94|7.34|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.94||||34.94|15.02|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|GEHA [1415]|GEHA [141500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.94||||34.94|20.96|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.94||||34.94|12.26|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.94||||34.94|15.02|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.94||||34.94|15.02|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.94||||34.94|17.5|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.94||||34.94|14.88|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.94||||34.94|16.75|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|34.94||||34.94|26.21|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|GEHA [1415]|GEHA [141500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.94||||34.94|17.5|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.94||||34.94|14.88|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.94||||34.94|22.71|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|||34.94||||34.94|10.48|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.94||||34.94|22.71|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|||34.94||||34.94|10.48|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.94||||34.94|31.45|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.94||||34.94|17.5|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.94||||34.94|20.96|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|34.94||||34.94|26.21|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.94||||34.94|7.34|31.45|7.34 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.94||||34.94||| 408128130|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM-MINERAL OIL EYE OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.94||||34.94||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|||10.00||||10.00|3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|||10.00||||10.00|3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|||10.00||||10.00|3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 408131110|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACTULOSE 10 GRAM/15 ML ORAL SOLUTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|||11.17||||11.17|3.35|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.17||||11.17|5.36|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.17||||11.17|5.36|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|11.17||||11.17|8.38|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|11.17||||11.17|8.38|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|11.17||||11.17|8.38|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|GEHA [1415]|GEHA [141500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|GEHA [1415]|GEHA [141500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|GEHA [1415]|GEHA [141500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|||11.17||||11.17|3.35|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.17||||11.17|5.36|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|||11.17||||11.17|3.35|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.17||||11.17|6.7|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.17||||11.17|6.7|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.17||||11.17|4.76|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.17||||11.17|4.8|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.17||||11.17|3.92|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.17||||11.17|4.8|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.17||||11.17|5.6|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.17||||11.17|3.92|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.17||||11.17|4.8|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.17||||11.17|5.6|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.17||||11.17|3.92|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.17||||11.17|6.7|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.17||||11.17|4.8|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.17||||11.17|4.8|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.17||||11.17|4.8|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.17||||11.17|4.76|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.17||||11.17|2.35|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.17||||11.17|5.6|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.17||||11.17|4.76|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.17||||11.17|2.35|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.17||||11.17|2.35|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.17||||11.17|7.26|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.17||||11.17|7.26|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|11.17||||11.17|10.05|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.17||||11.17|7.26|10.05|2.35 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.17||||11.17||| 40813818|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM TOPICAL OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.17||||11.17||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CORESOURCE [1315]|CORESOURCE [131500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CHAMPVA [1240]|CHAMP VA [124000]|38.07||||38.07|28.55|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CHAMPVA [1240]|CHAMP VA [124000]|38.07||||38.07|28.55|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.07||||38.07|24.75|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.07||||38.07|18.25|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|||38.07||||38.07|11.42|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|||38.07||||38.07|11.42|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|GEHA [1415]|GEHA [141500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|GEHA [1415]|GEHA [141500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.07||||38.07|18.25|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.07||||38.07|24.75|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.07||||38.07|7.99|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UMR [2035]|UMR OPTIONS [203501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UMR [2035]|UMR OPTIONS [203501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.07||||38.07|16.37|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.07||||38.07|16.37|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MULTIPLAN [1680]|IHC HS [168011]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.07||||38.07|16.37|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.07||||38.07|19.07|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.07||||38.07|13.36|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.07||||38.07|16.22|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.07||||38.07|16.37|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.07||||38.07|22.84|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.07||||38.07|22.84|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.07||||38.07|19.07|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.07||||38.07|16.22|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.07||||38.07|13.36|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.07||||38.07|7.99|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|TRUSTMARK [2030]|STARMARK [203000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CORESOURCE [1315]|CORESOURCE [131500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHNET [1495]|HEALTHNET [149500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HEALTHNET [1495]|HEALTHNET [149500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MULTIPLAN [1680]|HMA [168003]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MULTIPLAN [1680]|HMA [168003]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|MULTIPLAN [1680]|IHC HS [168011]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|TRUSTMARK [2030]|STARMARK [203000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.07||||38.07|34.26|34.26|7.99 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.07||||38.07||| 408165389|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION WRAP REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.07||||38.07||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|GEHA [1415]|GEHA [141500]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|UMR [2035]|UMR OPTIONS [203501]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|147.74||||147.74|63.53|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|||147.74||||147.74|44.32|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|TRUSTMARK [2030]|STARMARK [203000]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|147.74||||147.74|62.94|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|147.74||||147.74|31.03|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|147.74||||147.74|63.53|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|147.74||||147.74|74.02|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|147.74||||147.74|88.64|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MULTIPLAN [1680]|IHC HS [168011]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|HEALTHNET [1495]|HEALTHNET [149500]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|147.74||||147.74|70.84|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|CORESOURCE [1315]|CORESOURCE [131500]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|147.74||||147.74|96.03|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|147.74||||147.74|132.97|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|CHAMPVA [1240]|CHAMP VA [124000]|147.74||||147.74|110.81|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|147.74||||147.74|51.86|132.97|31.03 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MULTIPLAN [1680]|HMA [168003]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|147.74||||147.74||| 4082365|ERX|0250 - PHARMACY-GENERAL|DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|147.74||||147.74||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CORESOURCE [1315]|CORESOURCE [131500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CHAMPVA [1240]|CHAMP VA [124000]|13.33||||13.33|10|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.33||||13.33|6.39|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|||13.33||||13.33|4|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|||13.33||||13.33|4|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.33||||13.33|8.66|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.33||||13.33|5.73|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|GEHA [1415]|GEHA [141500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.33||||13.33|2.8|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UMR [2035]|UMR OPTIONS [203501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UMR [2035]|UMR OPTIONS [203501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CHAMPVA [1240]|CHAMP VA [124000]|13.33||||13.33|10|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.33||||13.33|5.73|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MULTIPLAN [1680]|IHC HS [168011]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|TRUSTMARK [2030]|STARMARK [203000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|GEHA [1415]|GEHA [141500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CORESOURCE [1315]|CORESOURCE [131500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.33||||13.33|8.66|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.33||||13.33|6.68|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.33||||13.33|5.68|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.33||||13.33|5.73|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.33||||13.33|8|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.33||||13.33|6.39|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.33||||13.33|8|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.33||||13.33|4.68|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.33||||13.33|2.8|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.33||||13.33|4.68|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.33||||13.33|5.73|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.33||||13.33|6.68|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.33||||13.33|5.68|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MULTIPLAN [1680]|IHC HS [168011]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MULTIPLAN [1680]|HMA [168003]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA [1015]|AETNA ACO WILCO [101532]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHNET [1495]|HEALTHNET [149500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|TRUSTMARK [2030]|STARMARK [203000]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHNET [1495]|HEALTHNET [149500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.33||||13.33|12|12|2.8 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|AETNA [1015]|AETNA ACO WILCO [101532]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.33||||13.33||| 40827466|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROSE 40 % ORAL GEL (NEO/PED)|MULTIPLAN [1680]|HMA [168003]|13.33||||13.33||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|||10.00||||10.00|3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|||10.00||||10.00|3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|||10.00||||10.00|3|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40829270|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 120 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|||10.00||||10.00|3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|||10.00||||10.00|3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|||10.00||||10.00|3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|||10.00||||10.00|3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40829272|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DILTIAZEM 180 MG CAPSULE,EXTENDED RELEASE 24 HR WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|||10.00||||10.00|3|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4083077|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FERROUS SULFATE 325 MG (65 MG IRON) TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|||10.00||||10.00|3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|||10.00||||10.00|3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|||10.00||||10.00|3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|||10.00||||10.00|3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|||10.00||||10.00|3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40835942|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|||10.00||||10.00|3|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|||10.00||||10.00|3|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4083726|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROCORTISONE 1 % TOPICAL CREAM WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|HEALTHNET [1495]|HEALTHNET [149500]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MULTIPLAN [1680]|IHC HS [168011]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|TRUSTMARK [2030]|STARMARK [203000]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|736.00||||736.00|368.74|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|736.00||||736.00|258.34|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|736.00||||736.00|316.48|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|736.00||||736.00|368|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|736.00||||736.00|313.54|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|736.00||||736.00|316.48|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|736.00||||736.00|441.6|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|GEHA [1415]|GEHA [141500]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|CORESOURCE [1315]|CORESOURCE [131500]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|||736.00||||736.00|220.8|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|CHAMPVA [1240]|CHAMP VA [124000]|736.00||||736.00|552|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|736.00||||736.00|352.91|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|736.00||||736.00|478.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|736.00||||736.00|154.56|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|UMR [2035]|UMR OPTIONS [203501]|736.00||||736.00|662.4|662.4|154.56 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MULTIPLAN [1680]|HMA [168003]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|AETNA [1015]|AETNA ACO WILCO [101532]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|736.00||||736.00||| 40840060|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO GA67 GALLIUM CITRATE PER MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|736.00||||736.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|550.00||||550.00|275|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|550.00||||550.00|236.5|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|550.00||||550.00|275.55|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|550.00||||550.00|193.05|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|550.00||||550.00|234.3|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|TRUSTMARK [2030]|STARMARK [203000]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MULTIPLAN [1680]|IHC HS [168011]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MULTIPLAN [1680]|HMA [168003]|550.00||||550.00|192.5|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|HEALTHNET [1495]|HEALTHNET [149500]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|550.00||||550.00|236.5|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|UMR [2035]|UMR OPTIONS [203501]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|550.00||||550.00|115.5|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|550.00||||550.00|330|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|550.00||||550.00|357.5|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|550.00||||550.00|263.73|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|||550.00||||550.00|165|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|CHAMPVA [1240]|CHAMP VA [124000]|550.00||||550.00|412.5|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|CORESOURCE [1315]|CORESOURCE [131500]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|GEHA [1415]|GEHA [141500]|550.00||||550.00|495|495|115.5 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|AETNA [1015]|AETNA ACO WILCO [101532]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|550.00||||550.00||| 40840062|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M RBC PER DOSE UP TO 30MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|550.00||||550.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|CORESOURCE [1315]|CORESOURCE [131500]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|CHAMPVA [1240]|CHAMP VA [124000]|590.00||||590.00|442.5|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|||590.00||||590.00|177|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|590.00||||590.00|282.91|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|590.00||||590.00|383.5|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|590.00||||590.00|253.7|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|UMR [2035]|UMR OPTIONS [203501]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|HEALTHNET [1495]|HEALTHNET [149500]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MULTIPLAN [1680]|IHC HS [168011]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MULTIPLAN [1680]|HMA [168003]|590.00||||590.00|206.5|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|590.00||||590.00|123.9|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|TRUSTMARK [2030]|STARMARK [203000]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|590.00||||590.00|253.7|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|GEHA [1415]|GEHA [141500]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|590.00||||590.00|295.59|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|590.00||||590.00|207.09|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|590.00||||590.00|251.34|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|590.00||||590.00|354|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|590.00||||590.00|295|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|590.00||||590.00|531|531|123.9 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|AETNA [1015]|AETNA ACO WILCO [101532]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|590.00||||590.00||| 40840068|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M MERTIATIDE (MAG3) PER DOSE UP TO 15MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|590.00||||590.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|513.00||||513.00|307.8|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|513.00||||513.00|220.59|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|513.00||||513.00|180.06|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|513.00||||513.00|218.54|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|TRUSTMARK [2030]|STARMARK [203000]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MULTIPLAN [1680]|IHC HS [168011]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|HEALTHNET [1495]|HEALTHNET [149500]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|FMH BENEFIT SERVICES [1390]|FMH [139000]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|513.00||||513.00|220.59|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MULTIPLAN [1680]|HMA [168003]|513.00||||513.00|179.55|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|FIRST HEALTH [1375]|QUALCHOICE [137513]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|UMR [2035]|UMR OPTIONS [203501]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|513.00||||513.00|107.73|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|513.00||||513.00|333.45|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|513.00||||513.00|257.01|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|513.00||||513.00|256.5|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|513.00||||513.00|245.98|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|||513.00||||513.00|153.9|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|CHAMPVA [1240]|CHAMP VA [124000]|513.00||||513.00|384.75|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|CORESOURCE [1315]|CORESOURCE [131500]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|GEHA [1415]|GEHA [141500]|513.00||||513.00|461.7|461.7|107.73 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|AETNA [1015]|AETNA ACO WILCO [101532]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|513.00||||513.00||| 40840076|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SESTAMIBI (MIBI) PER DOSE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|513.00||||513.00||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|GEHA [1415]|GEHA [141500]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|CORESOURCE [1315]|CORESOURCE [131500]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|CHAMPVA [1240]|CHAMP VA [124000]|19.23||||19.23|14.42|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|||19.23||||19.23|5.77|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.23||||19.23|9.22|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.23||||19.23|4.04|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|UMR [2035]|UMR OPTIONS [203501]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.23||||19.23|8.27|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|HEALTHNET [1495]|HEALTHNET [149500]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MULTIPLAN [1680]|IHC HS [168011]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MULTIPLAN [1680]|HMA [168003]|19.23||||19.23|6.73|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.23||||19.23|12.5|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|TRUSTMARK [2030]|STARMARK [203000]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.23||||19.23|8.27|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.23||||19.23|9.63|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.23||||19.23|6.75|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.23||||19.23|8.19|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.23||||19.23|11.54|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.23||||19.23|9.62|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.23||||19.23|17.31|17.31|4.04 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|AETNA [1015]|AETNA ACO WILCO [101532]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.23||||19.23||| 40840078|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M PERTECHNETATE PER MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.23||||19.23||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|358.00||||358.00|179|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|358.00||||358.00|214.8|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|358.00||||358.00|153.94|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|358.00||||358.00|179.36|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|358.00||||358.00|125.66|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|TRUSTMARK [2030]|STARMARK [203000]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|HEALTHNET [1495]|HEALTHNET [149500]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MULTIPLAN [1680]|IHC HS [168011]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|358.00||||358.00|153.94|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|UMR [2035]|UMR OPTIONS [203501]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|358.00||||358.00|75.18|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|358.00||||358.00|152.51|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|358.00||||358.00|232.7|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|358.00||||358.00|171.66|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|||358.00||||358.00|107.4|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|CHAMPVA [1240]|CHAMP VA [124000]|358.00||||358.00|268.5|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|CORESOURCE [1315]|CORESOURCE [131500]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|GEHA [1415]|GEHA [141500]|358.00||||358.00|322.2|322.2|75.18 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|AETNA [1015]|AETNA ACO WILCO [101532]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MULTIPLAN [1680]|HMA [168003]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|358.00||||358.00||| 40840081|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M GLUCOHEPTONATE PER DOSE UP TO 25 MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|358.00||||358.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|CORESOURCE [1315]|CORESOURCE [131500]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|CHAMPVA [1240]|CHAMP VA [124000]|2163.00||||2163.00|1622.25|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|||2163.00||||2163.00|648.9|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2163.00||||2163.00|1037.16|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2163.00||||2163.00|1405.95|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|UMR [2035]|UMR OPTIONS [203501]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2163.00||||2163.00|930.09|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|HEALTHNET [1495]|HEALTHNET [149500]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MULTIPLAN [1680]|IHC HS [168011]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2163.00||||2163.00|454.23|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|TRUSTMARK [2030]|STARMARK [203000]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|GEHA [1415]|GEHA [141500]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2163.00||||2163.00|930.09|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2163.00||||2163.00|1083.66|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2163.00||||2163.00|759.21|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2163.00||||2163.00|921.44|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2163.00||||2163.00|1297.8|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2163.00||||2163.00|1081.5|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2163.00||||2163.00|1946.7|1946.7|454.23 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MULTIPLAN [1680]|HMA [168003]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|AETNA [1015]|AETNA ACO WILCO [101532]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2163.00||||2163.00||| 40840085|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M BICISATE PER DOSE UP TO 25MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2163.00||||2163.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1351.00||||1351.00|810.6|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1351.00||||1351.00|580.93|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1351.00||||1351.00|474.2|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1351.00||||1351.00|575.53|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|TRUSTMARK [2030]|STARMARK [203000]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MULTIPLAN [1680]|IHC HS [168011]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MULTIPLAN [1680]|HMA [168003]|1351.00||||1351.00|472.85|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|HEALTHNET [1495]|HEALTHNET [149500]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1351.00||||1351.00|580.93|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|UMR [2035]|UMR OPTIONS [203501]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1351.00||||1351.00|283.71|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1351.00||||1351.00|676.85|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1351.00||||1351.00|878.15|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1351.00||||1351.00|675.5|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1351.00||||1351.00|647.8|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|||1351.00||||1351.00|405.3|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|CHAMPVA [1240]|CHAMP VA [124000]|1351.00||||1351.00|1013.25|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|CORESOURCE [1315]|CORESOURCE [131500]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|GEHA [1415]|GEHA [141500]|1351.00||||1351.00|1215.9|1215.9|283.71 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|AETNA [1015]|AETNA ACO WILCO [101532]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1351.00||||1351.00||| 40840089|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM PET ISO NAF18 (SODIUM FLUORIDE) PER DOSE UP TO 30 MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1351.00||||1351.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|GEHA [1415]|GEHA [141500]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|CORESOURCE [1315]|CORESOURCE [131500]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|||448.00||||448.00|134.4|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|448.00||||448.00|214.82|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|448.00||||448.00|291.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|448.00||||448.00|94.08|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|UMR [2035]|UMR OPTIONS [203501]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|448.00||||448.00|192.64|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|HEALTHNET [1495]|HEALTHNET [149500]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MULTIPLAN [1680]|IHC HS [168011]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MULTIPLAN [1680]|HMA [168003]|448.00||||448.00|156.8|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|TRUSTMARK [2030]|STARMARK [203000]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|CHAMPVA [1240]|CHAMP VA [124000]|448.00||||448.00|336|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|448.00||||448.00|192.64|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|448.00||||448.00|224.45|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|448.00||||448.00|157.25|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|448.00||||448.00|190.85|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|448.00||||448.00|268.8|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|448.00||||448.00|224|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|448.00||||448.00|403.2|403.2|94.08 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|AETNA [1015]|AETNA ACO WILCO [101532]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|448.00||||448.00||| 40840090|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 SODIUM IODIDE DX (CAPSULE) PER 100UCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|448.00||||448.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4426.00||||4426.00|2213|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4426.00||||4426.00|1903.18|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4426.00||||4426.00|2217.43|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4426.00||||4426.00|1553.53|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4426.00||||4426.00|1271.72|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4426.00||||4426.00|1228.28|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|TRUSTMARK [2030]|STARMARK [203000]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|HEALTHNET [1495]|HEALTHNET [149500]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MULTIPLAN [1680]|IHC HS [168011]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4426.00||||4426.00|1903.18|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4426.00||||4426.00|1453.97|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|UMR [2035]|UMR OPTIONS [203501]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4426.00||||4426.00|929.46|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4426.00||||4426.00|1885.48|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4426.00||||4426.00|2876.9|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4426.00||||4426.00|2122.27|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4426.00||||4426.00|2655.6|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|||4426.00||||4426.00|1327.8|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4426.00||||4426.00|1271.72|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4426.00||||4426.00|1169.76|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|CHAMPVA [1240]|CHAMP VA [124000]|4426.00||||4426.00|3319.5|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|CORESOURCE [1315]|CORESOURCE [131500]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|GEHA [1415]|GEHA [141500]|4426.00||||4426.00|3983.4|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4426.00||||4426.00|1321.79|3983.4|929.46 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|AETNA [1015]|AETNA ACO WILCO [101532]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MULTIPLAN [1680]|HMA [168003]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4426.00||||4426.00||| 40840125|ERX|0344 - NUCLEAR MEDICINE-THERAPEUTIC RADIOPHARMACEU|NM ISO SR-89 STRONTIUM CHLORIDE PER MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4426.00||||4426.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|CORESOURCE [1315]|CORESOURCE [131500]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|CHAMPVA [1240]|CHAMP VA [124000]|6371.00||||6371.00|4778.25|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|||6371.00||||6371.00|1911.3|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6371.00||||6371.00|3054.89|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6371.00||||6371.00|4141.15|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6371.00||||6371.00|1337.91|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6371.00||||6371.00|2739.53|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|UMR [2035]|UMR OPTIONS [203501]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|HEALTHNET [1495]|HEALTHNET [149500]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MULTIPLAN [1680]|IHC HS [168011]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|TRUSTMARK [2030]|STARMARK [203000]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6371.00||||6371.00|2739.53|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|GEHA [1415]|GEHA [141500]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6371.00||||6371.00|3191.87|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6371.00||||6371.00|2236.22|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6371.00||||6371.00|2714.05|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6371.00||||6371.00|3822.6|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6371.00||||6371.00|3185.5|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6371.00||||6371.00|5733.9|5733.9|1337.91 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MULTIPLAN [1680]|HMA [168003]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|AETNA [1015]|AETNA ACO WILCO [101532]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6371.00||||6371.00||| 40840129|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 ZEVALIN PER DOSE UP TO 5 MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6371.00||||6371.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.97||||17.97|10.78|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.01||||16.01|9.61|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.97||||17.97|7.73|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.97||||17.97|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.97||||17.97|6.31|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.01||||16.01|6.88|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.01||||16.01|8.02|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.01||||16.01|6.82|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.01||||16.01|6.88|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.01||||16.01|8.02|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.01||||16.01|6.82|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUSTMARK [2030]|STARMARK [203000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUSTMARK [2030]|STARMARK [203000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|IHC HS [168011]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|IHC HS [168011]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHNET [1495]|HEALTHNET [149500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHNET [1495]|HEALTHNET [149500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|HMA [168003]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|HMA [168003]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|HMA [168003]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.97||||17.97|7.73|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.01||||16.01|6.88|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.01||||16.01|6.88|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR [2035]|UMR OPTIONS [203501]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR [2035]|UMR OPTIONS [203501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR [2035]|UMR OPTIONS [203501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.97||||17.97|3.77|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.01||||16.01|3.36|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.01||||16.01|3.36|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.97||||17.97|11.68|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.01||||16.01|10.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.01||||16.01|10.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.97||||17.97|8.62|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.01||||16.01|7.68|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.01||||16.01|7.68|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|||10.00||||10.00|3|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|||17.97||||17.97|5.39|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|||16.01||||16.01|4.8|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|||16.01||||16.01|4.8|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|||10.00||||10.00|3|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.01||||16.01|5.62|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.01||||16.01|5.62|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.97||||17.97|7.66|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.01||||16.01|9.61|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.97||||17.97|13.48|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHAMPVA [1240]|CHAMP VA [124000]|16.01||||16.01|12.01|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHAMPVA [1240]|CHAMP VA [124000]|16.01||||16.01|12.01|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CORESOURCE [1315]|CORESOURCE [131500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CORESOURCE [1315]|CORESOURCE [131500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|GEHA [1415]|GEHA [141500]|17.97||||17.97|16.17|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|GEHA [1415]|GEHA [141500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|GEHA [1415]|GEHA [141500]|16.01||||16.01|14.41|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|16.17|2.1 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.97||||17.97||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.01||||16.01||| 40840262|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DEXTROMETHORPHAN-GUAIFENESIN 10-100/5ML LIQUID/SYRUP WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.01||||16.01||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|||10.00||||10.00|3|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|||10.00||||10.00|3|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840265|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|||10.00||||10.00|3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840266|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MULTIVITAMIN WITH MINERALS TABLET WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.1 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 40840277|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HYDROMORPHONE 2 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|477.05||||477.05|232.97|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|477.05||||477.05|286.23|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|477.05||||477.05|205.13|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|477.05||||477.05|167.44|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|477.05||||477.05|203.22|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|477.05||||477.05|259.32|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|477.05||||477.05|222.38|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|477.05||||477.05|232.97|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|477.05||||477.05|250.47|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|477.05||||477.05|304.47|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|477.05||||477.05|166.97|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|477.05||||477.05|205.13|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|477.05||||477.05|216.02|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|477.05||||477.05|296.48|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|477.05||||477.05|224.5|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|477.05||||477.05|100.18|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|477.05||||477.05|239|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|477.05||||477.05|310.08|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|477.05||||477.05|300.33|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|477.05||||477.05|228.75|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|||477.05||||477.05|143.11|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|477.05||||477.05|259.32|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|477.05||||477.05|211.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|477.05||||477.05|304.47|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|477.05||||477.05|238.53|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|477.05||||477.05|357.79|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|477.05||||477.05|429.35|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|477.05||||477.05|269.53|429.35|100.18 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|477.05||||477.05||| 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|477.05||||477.05||| 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|477.05||||477.05||| 40840286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GLUCAGON 1 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|477.05||||477.05||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|||229.89||||229.89|68.97|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|229.89||||229.89|110.23|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|229.89||||229.89|149.43|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|229.89||||229.89|48.28|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|UMR [2035]|UMR OPTIONS [203501]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|229.89||||229.89|98.85|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|HEALTHNET [1495]|HEALTHNET [149500]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MULTIPLAN [1680]|IHC HS [168011]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|TRUSTMARK [2030]|STARMARK [203000]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|229.89||||229.89|98.85|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|229.89||||229.89|115.17|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|229.89||||229.89|80.69|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|229.89||||229.89|97.93|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|229.89||||229.89|137.93|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|CHAMPVA [1240]|CHAMP VA [124000]|229.89||||229.89|172.42|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|GEHA [1415]|GEHA [141500]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|CORESOURCE [1315]|CORESOURCE [131500]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|229.89||||229.89|206.9|206.9|48.28 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MULTIPLAN [1680]|HMA [168003]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|229.89||||229.89||| 40840292|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEO-POLY-HC OTIC DROPS WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|229.89||||229.89||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.38||||60.38|28.95|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60.38||||60.38|36.23|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60.38||||60.38|30.25|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.38||||60.38|25.96|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|60.38||||60.38|45.29|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MULTIPLAN [1680]|IHC HS [168011]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|||60.38||||60.38|18.11|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|TRUSTMARK [2030]|STARMARK [203000]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60.38||||60.38|25.72|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60.38||||60.38|39.25|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|GEHA [1415]|GEHA [141500]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60.38||||60.38|12.68|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|UMR [2035]|UMR OPTIONS [203501]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60.38||||60.38|25.96|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60.38||||60.38|54.34|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60.38||||60.38|21.19|54.34|12.68 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MULTIPLAN [1680]|HMA [168003]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60.38||||60.38||| 40840398|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 10% INTRATHECAL INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.38||||60.38||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|||90.00||||90.00|27|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|||90.00||||90.00|27|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|||90.00||||90.00|27|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|||90.00||||90.00|27|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|||90.00||||90.00|27|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|0.67|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|||90.00||||90.00|27|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|0.67 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 40840473|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION 250 ML ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|14.00||||14.00|14|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|14.00||||14.00|12.14|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|CHAMPVA [1240]|CHAMP VA [124000]|14.00||||14.00|10.5|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|14.00||||14.00|9.1|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|GEHA [1415]|GEHA [141500]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|CORESOURCE [1315]|CORESOURCE [131500]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.00||||14.00|6.71|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|14.00||||14.00|13.2|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|14.00||||14.00|2.94|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|UMR [2035]|UMR OPTIONS [203501]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|FIRST HEALTH [1375]|QUALCHOICE [137513]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|14.00||||14.00|13.72|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|||14.00||||14.00|4.2|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|TRUSTMARK [2030]|STARMARK [203000]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|14.00||||14.00|12.75|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14.00||||14.00|8.4|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|14.00||||14.00|7|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|14.00||||14.00|4.91|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|14.00||||14.00|5.96|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|14.00||||14.00|13.2|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|14.00||||14.00|6.02|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MULTIPLAN [1680]|IHC HS [168011]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|HEALTHNET [1495]|HEALTHNET [149500]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|14.00||||14.00|7.01|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|FMH BENEFIT SERVICES [1390]|FMH [139000]|14.00||||14.00|12.6|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.00||||14.00|6.02|14|2.94 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|AETNA [1015]|AETNA ACO WILCO [101532]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MULTIPLAN [1680]|HMA [168003]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|14.00||||14.00||| 40840556|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M NON-HEU ADD-ON FOR STUDY DOSE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.00||||14.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|||29.00||||29.00|8.7|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.67|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.67 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 40840803|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM IN 10 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|5.34|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|||29.00||||29.00|8.7|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|5.34 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 40840804|ERX|0250 - PHARMACY-GENERAL|CEFTRIAXONE 2 GRAMS IN 20 ML 0.9% SODIUM CHLORIDE INTRAVENOUS SYRINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|||10.00||||10.00|3|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|||10.00||||10.00|3|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRENATAL VITAMIN WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|||10.00||||10.00|3|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|||10.00||||10.00|3|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 40840962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID (RENAL VITAMIN WRAP)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|HEALTHNET [1495]|HEALTHNET [149500]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.21||||11.21|5.38|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.21||||11.21|2.35|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.21||||11.21|4.78|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.21||||11.21|3.93|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.21||||11.21|5.62|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.21||||11.21|6.73|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.21||||11.21|4.82|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|TRUSTMARK [2030]|STARMARK [203000]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MULTIPLAN [1680]|IHC HS [168011]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|UMR [2035]|UMR OPTIONS [203501]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.21||||11.21|7.29|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.21||||11.21|4.82|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|||11.21||||11.21|3.36|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|CORESOURCE [1315]|CORESOURCE [131500]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|GEHA [1415]|GEHA [141500]|11.21||||11.21|10.09|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|CHAMPVA [1240]|CHAMP VA [124000]|11.21||||11.21|8.41|10.09|2.35 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MULTIPLAN [1680]|HMA [168003]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|AETNA [1015]|AETNA ACO WILCO [101532]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.21||||11.21||| 40842017|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VANCOMYCIN 25 MG/ML ORAL SOLUTION SIMPLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.21||||11.21||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.1 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 4085002|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METOCLOPRAMIDE 5 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.98|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.98 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 4085170|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 2 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.98|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.98|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.98|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|1.98|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|||29.00||||29.00|8.7|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|1.98 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 4085172|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MORPHINE 4 MG/ML INJECTION WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|||10.00||||10.00|3|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4085536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN ER 250 MG CAPSULE/TABLET,EXTENDED RELEASE WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156.14||||156.14|67.14|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|156.14||||156.14|66.52|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156.14||||156.14|54.81|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156.14||||156.14|67.14|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156.14||||156.14|54.81|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|156.14||||156.14|66.52|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|TRUSTMARK [2030]|STARMARK [203000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MULTIPLAN [1680]|IHC HS [168011]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|156.14||||156.14|78.23|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHNET [1495]|HEALTHNET [149500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|FMH BENEFIT SERVICES [1390]|FMH [139000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156.14||||156.14|93.68|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156.14||||156.14|67.14|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|FMH BENEFIT SERVICES [1390]|FMH [139000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156.14||||156.14|67.14|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|FIRST HEALTH [1375]|QUALCHOICE [137513]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156.14||||156.14|93.68|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|156.14||||156.14|78.23|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHNET [1495]|HEALTHNET [149500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UMR [2035]|UMR OPTIONS [203501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MULTIPLAN [1680]|IHC HS [168011]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|TRUSTMARK [2030]|STARMARK [203000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156.14||||156.14|32.79|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156.14||||156.14|32.79|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UMR [2035]|UMR OPTIONS [203501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156.14||||156.14|101.49|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156.14||||156.14|101.49|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156.14||||156.14|74.87|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156.14||||156.14|74.87|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CHAMPVA [1240]|CHAMP VA [124000]|156.14||||156.14|117.11|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CHAMPVA [1240]|CHAMP VA [124000]|156.14||||156.14|117.11|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CORESOURCE [1315]|CORESOURCE [131500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CORESOURCE [1315]|CORESOURCE [131500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|GEHA [1415]|GEHA [141500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA [1015]|AETNA ACO WILCO [101532]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MULTIPLAN [1680]|HMA [168003]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MULTIPLAN [1680]|HMA [168003]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|AETNA [1015]|AETNA ACO WILCO [101532]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|GEHA [1415]|GEHA [141500]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|FIRST HEALTH [1375]|QUALCHOICE [137513]|156.14||||156.14|140.53|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|||156.14||||156.14|46.84|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|||156.14||||156.14|46.84|140.53|32.79 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|156.14||||156.14||| 408736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1% DROPS (FOR SUBLINGUAL USE)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|156.14||||156.14||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|GEHA [1415]|GEHA [141500]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|||12.31||||12.31|3.69|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|||10.00||||10.00|3|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.31||||12.31|8|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.31||||12.31|2.59|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UMR [2035]|UMR OPTIONS [203501]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MULTIPLAN [1680]|IHC HS [168011]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.31||||12.31|5.29|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|TRUSTMARK [2030]|STARMARK [203000]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.31||||12.31|5.9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.31||||12.31|5.29|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.31||||12.31|6.17|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.31||||12.31|4.32|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.31||||12.31|5.24|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.31||||12.31|7.39|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MULTIPLAN [1680]|HMA [168003]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.31||||12.31||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.31||||12.31|11.08|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|12.31||||12.31|9.23|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|11.08|2.1 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 408854|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN-BACITRACN ZN-POLYMYXN 3.5 MG-400 UNIT-5,000 UNIT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.31||||12.31||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26.99||||26.99|9.47|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26.99||||26.99|11.5|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FMH BENEFIT SERVICES [1390]|FMH [139000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.99||||17.99|7.74|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17.99||||17.99|3.78|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.15||||96.15|20.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR [2035]|UMR OPTIONS [203501]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26.99||||26.99|5.67|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26.99||||26.99|5.67|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TRUSTMARK [2030]|STARMARK [203000]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|FIRST HEALTH [1375]|QUALCHOICE [137513]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHNET [1495]|HEALTHNET [149500]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|IHC HS [168011]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.15||||96.15|41.34|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17.99||||17.99|11.69|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.15||||96.15|62.5|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26.99||||26.99|17.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26.99||||26.99|11.61|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.99||||17.99|8.63|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.15||||96.15|46.1|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|||17.99||||17.99|5.4|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|||26.99||||26.99|8.1|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|||26.99||||26.99|8.1|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|||96.15||||96.15|28.84|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26.99||||26.99|11.61|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26.99||||26.99|12.94|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26.99||||26.99|17.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26.99||||26.99|12.94|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|17.99||||17.99|13.49|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|26.99||||26.99|20.24|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|26.99||||26.99|20.24|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CORESOURCE [1315]|CORESOURCE [131500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHAMPVA [1240]|CHAMP VA [124000]|96.15||||96.15|72.11|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|GEHA [1415]|GEHA [141500]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|GEHA [1415]|GEHA [141500]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|GEHA [1415]|GEHA [141500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|GEHA [1415]|GEHA [141500]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26.99||||26.99|13.52|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17.99||||17.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.15||||96.15|86.54|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26.99||||26.99|24.29|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17.99||||17.99|10.79|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.15||||96.15|57.69|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|HMA [168003]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA [1015]|AETNA ACO WILCO [101532]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.99||||17.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26.99||||26.99||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.15||||96.15||| 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26.99||||26.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26.99||||26.99|16.19|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17.99||||17.99|7.74|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17.99||||17.99|9.01|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17.99||||17.99|6.31|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17.99||||17.99|7.66|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.15||||96.15|41.34|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.15||||96.15|48.17|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.15||||96.15|33.75|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.15||||96.15|40.96|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26.99||||26.99|11.61|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26.99||||26.99|13.52|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26.99||||26.99|9.47|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26.99||||26.99|11.5|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26.99||||26.99|11.61|86.54|3.78 4089922|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WHITE PETROLATUM TOPICAL OINTMENT WRAP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.15||||96.15||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|||10.00||||10.00|3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|||10.00||||10.00|3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|||10.00||||10.00|3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|||10.00||||10.00|3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41003|ERX|0250 - PHARMACY-GENERAL|GLYCERIN (ADULT) RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1263.00||||1263.00|265.01|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1263.00||||1263.00|603.08|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1263.00||||1263.00|757.8|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1263.00||||1263.00|252.97|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1263.00||||1263.00|543.09|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1263.00||||1263.00|443.31|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1263.00||||1263.00|538.04|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1263.00||||1263.00|265.01|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1263.00||||1263.00|210.88|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|TRUSTMARK [2030]|STARMARK [203000]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MULTIPLAN [1680]|IHC HS [168011]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1263.00||||1263.00|346.35|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MULTIPLAN [1680]|HMA [168003]|1263.00||||1263.00|361.38|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|FMH BENEFIT SERVICES [1390]|FMH [139000]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|HEALTHNET [1495]|HEALTHNET [149500]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|FIRST HEALTH [1375]|QUALCHOICE [137513]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1263.00||||1263.00|249.63|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1263.00||||1263.00|543.09|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1263.00||||1263.00|245.74|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|UMR [2035]|UMR OPTIONS [203501]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1263.00||||1263.00|351.74|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1263.00||||1263.00|265.23|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1263.00||||1263.00|1263|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1263.00||||1263.00|218.34|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1263.00||||1263.00|632.76|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1263.00||||1263.00|820.95|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1263.00||||1263.00|605.61|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|||1263.00||||1263.00|378.9|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1263.00||||1263.00|218.34|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1263.00||||1263.00|240.92|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1263.00||||1263.00|200.83|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|CHAMPVA [1240]|CHAMP VA [124000]|1263.00||||1263.00|947.25|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1263.00||||1263.00|346.35|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|CORESOURCE [1315]|CORESOURCE [131500]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|GEHA [1415]|GEHA [141500]|1263.00||||1263.00|1136.7|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1263.00||||1263.00|226.94|1263|200.83 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1263.00||||1263.00||| 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|AETNA [1015]|AETNA ACO WILCO [101532]|1263.00||||1263.00||| 41092950|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1263.00||||1263.00||| 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5875.00||||5875.00|268.48|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|GEHA [1415]|GEHA [141500]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5875.00||||5875.00|635.67|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|CHAMPVA [1240]|CHAMP VA [124000]|5875.00||||5875.00|4406.25|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5875.00||||5875.00|237.6|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5875.00||||5875.00|258.31|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|||5875.00||||5875.00|1762.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5875.00||||5875.00|2817.06|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5875.00||||5875.00|3818.75|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5875.00||||5875.00|5875|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5875.00||||5875.00|1233.75|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5875.00||||5875.00|645.57|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|UMR [2035]|UMR OPTIONS [203501]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5875.00||||5875.00|451.02|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5875.00||||5875.00|2526.25|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5875.00||||5875.00|295.33|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|HEALTHNET [1495]|HEALTHNET [149500]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MULTIPLAN [1680]|IHC HS [168011]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5875.00||||5875.00|635.67|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MULTIPLAN [1680]|HMA [168003]|5875.00||||5875.00|663.26|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|TRUSTMARK [2030]|STARMARK [203000]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5875.00||||5875.00|249.48|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5875.00||||5875.00|486.39|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5875.00||||5875.00|258.31|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5875.00||||5875.00|464.28|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5875.00||||5875.00|3525|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5875.00||||5875.00|2526.25|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|CORESOURCE [1315]|CORESOURCE [131500]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5875.00||||5875.00|2943.38|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5875.00||||5875.00|2062.13|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5875.00||||5875.00|2502.75|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5875.00||||5875.00|1218.95|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5875.00||||5875.00|486.39|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5875.00||||5875.00|442.17|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5875.00||||5875.00|5287.5|5875|237.6 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5875.00||||5875.00||| 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|AETNA [1015]|AETNA ACO WILCO [101532]|5875.00||||5875.00||| 41094002|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR FIRST DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5875.00||||5875.00||| 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5528.00||||5528.00|1218.95|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5528.00||||5528.00|2377.04|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5528.00||||5528.00|1940.33|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5528.00||||5528.00|2354.93|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5528.00||||5528.00|3316.8|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5528.00||||5528.00|464.28|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5528.00||||5528.00|258.31|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5528.00||||5528.00|486.39|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|TRUSTMARK [2030]|STARMARK [203000]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MULTIPLAN [1680]|IHC HS [168011]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5528.00||||5528.00|635.67|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MULTIPLAN [1680]|HMA [168003]|5528.00||||5528.00|663.26|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|HEALTHNET [1495]|HEALTHNET [149500]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5528.00||||5528.00|295.33|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5528.00||||5528.00|2377.04|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5528.00||||5528.00|451.02|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|UMR [2035]|UMR OPTIONS [203501]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5528.00||||5528.00|645.57|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5528.00||||5528.00|1160.88|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5528.00||||5528.00|249.48|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5528.00||||5528.00|5528|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5528.00||||5528.00|3593.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5528.00||||5528.00|2769.53|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5528.00||||5528.00|2650.68|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|||5528.00||||5528.00|1658.4|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5528.00||||5528.00|258.31|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5528.00||||5528.00|486.39|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5528.00||||5528.00|442.17|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5528.00||||5528.00|237.6|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|CHAMPVA [1240]|CHAMP VA [124000]|5528.00||||5528.00|4146|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5528.00||||5528.00|635.67|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|CORESOURCE [1315]|CORESOURCE [131500]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|GEHA [1415]|GEHA [141500]|5528.00||||5528.00|4975.2|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5528.00||||5528.00|268.48|5528|237.6 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5528.00||||5528.00||| 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|AETNA [1015]|AETNA ACO WILCO [101532]|5528.00||||5528.00||| 41094003|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC VENTILATOR SUBSEQUENT DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5528.00||||5528.00||| 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|283.00||||283.00|225.65|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|CORESOURCE [1315]|CORESOURCE [131500]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|283.00||||283.00|251.73|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|283.00||||283.00|199.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|283.00||||283.00|217.1|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|||283.00||||283.00|84.9|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|283.00||||283.00|135.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|283.00||||283.00|283|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|283.00||||283.00|255.65|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|UMR [2035]|UMR OPTIONS [203501]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|283.00||||283.00|178.61|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|283.00||||283.00|121.69|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|283.00||||283.00|248.21|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|FIRST HEALTH [1375]|QUALCHOICE [137513]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|FMH BENEFIT SERVICES [1390]|FMH [139000]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|HEALTHNET [1495]|HEALTHNET [149500]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MULTIPLAN [1680]|IHC HS [168011]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|283.00||||283.00|251.73|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|283.00||||283.00|59.43|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|283.00||||283.00|183.95|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MULTIPLAN [1680]|HMA [168003]|283.00||||283.00|262.66|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|AETNA [1015]|COVENTRY HEALTHCARE [101502]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|TRUSTMARK [2030]|STARMARK [203000]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|283.00||||283.00|209.69|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|CHAMPVA [1240]|CHAMP VA [124000]|283.00||||283.00|212.25|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|283.00||||283.00|192.62|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|283.00||||283.00|217.1|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|283.00||||283.00|121.69|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|GEHA [1415]|GEHA [141500]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|283.00||||283.00|141.78|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|283.00||||283.00|99.33|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|283.00||||283.00|120.56|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|283.00||||283.00|178.91|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|283.00||||283.00|169.8|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|283.00||||283.00|283|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|283.00||||283.00|187.43|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|283.00||||283.00|175.11|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|283.00||||283.00|254.7|283|59.43 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|283.00||||283.00||| 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|AETNA [1015]|AETNA ACO WILCO [101532]|283.00||||283.00||| 41094640|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|283.00||||283.00||| 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|371.00||||371.00|114.16|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|371.00||||371.00|159.53|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|371.00||||371.00|130.22|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|371.00||||371.00|158.05|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|371.00||||371.00|254.52|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|371.00||||371.00|222.6|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|371.00||||371.00|108.97|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|371.00||||371.00|114.16|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|371.00||||371.00|167.79|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MULTIPLAN [1680]|IHC HS [168011]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|371.00||||371.00|149.2|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MULTIPLAN [1680]|HMA [168003]|371.00||||371.00|155.68|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|FMH BENEFIT SERVICES [1390]|FMH [139000]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|FIRST HEALTH [1375]|QUALCHOICE [137513]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|371.00||||371.00|198.62|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|HEALTHNET [1495]|HEALTHNET [149500]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|371.00||||371.00|159.53|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|371.00||||371.00|105.86|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|TRUSTMARK [2030]|STARMARK [203000]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|UMR [2035]|UMR OPTIONS [203501]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|371.00||||371.00|151.52|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|371.00||||371.00|77.91|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|371.00||||371.00|173.73|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|371.00||||371.00|371|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|371.00||||371.00|241.15|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|371.00||||371.00|177.89|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|371.00||||371.00|185.87|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|||371.00||||371.00|111.3|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|371.00||||371.00|173.73|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|371.00||||371.00|103.78|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|371.00||||371.00|159.8|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|CHAMPVA [1240]|CHAMP VA [124000]|371.00||||371.00|278.25|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|371.00||||371.00|149.2|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|CORESOURCE [1315]|CORESOURCE [131500]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|GEHA [1415]|GEHA [141500]|371.00||||371.00|333.9|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|371.00||||371.00|180.57|371|77.91 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|371.00||||371.00||| 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|AETNA [1015]|AETNA ACO WILCO [101532]|371.00||||371.00||| 41094644|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEBULIZER ADULT/PED 1ST HOUR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|371.00||||371.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|237.00||||237.00|61.85|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|GEHA [1415]|GEHA [141500]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|CORESOURCE [1315]|CORESOURCE [131500]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|CHAMPVA [1240]|CHAMP VA [124000]|237.00||||237.00|177.75|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237.00||||237.00|54.73|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237.00||||237.00|59.51|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|||237.00||||237.00|71.1|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237.00||||237.00|113.64|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237.00||||237.00|154.05|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237.00||||237.00|237|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237.00||||237.00|49.77|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|UMR [2035]|UMR OPTIONS [203501]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237.00||||237.00|101.91|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|237.00||||237.00|68.04|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|FIRST HEALTH [1375]|QUALCHOICE [137513]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|FMH BENEFIT SERVICES [1390]|FMH [139000]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|HEALTHNET [1495]|HEALTHNET [149500]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MULTIPLAN [1680]|IHC HS [168011]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|TRUSTMARK [2030]|STARMARK [203000]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237.00||||237.00|57.47|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237.00||||237.00|59.51|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237.00||||237.00|142.2|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237.00||||237.00|118.5|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237.00||||237.00|101.91|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|237.00||||237.00|118.74|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237.00||||237.00|83.19|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|237.00||||237.00|100.96|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237.00||||237.00|213.3|237|49.77 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MULTIPLAN [1680]|HMA [168003]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|AETNA [1015]|AETNA ACO WILCO [101532]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237.00||||237.00||| 41094645|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CONTINUOUS NEB SUBSQ HOUR ADULT/PED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237.00||||237.00||| 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|736.00||||736.00|192.62|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|736.00||||736.00|316.48|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|736.00||||736.00|368.74|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|736.00||||736.00|258.34|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|736.00||||736.00|313.54|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|736.00||||736.00|457.98|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|736.00||||736.00|441.6|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|736.00||||736.00|127.33|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|736.00||||736.00|192.62|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|TRUSTMARK [2030]|STARMARK [203000]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MULTIPLAN [1680]|IHC HS [168011]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MULTIPLAN [1680]|HMA [168003]|736.00||||736.00|262.66|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|HEALTHNET [1495]|HEALTHNET [149500]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|736.00||||736.00|251.73|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|736.00||||736.00|145.57|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|736.00||||736.00|316.48|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|736.00||||736.00|178.61|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|UMR [2035]|UMR OPTIONS [203501]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|736.00||||736.00|122.98|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|736.00||||736.00|255.65|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|736.00||||736.00|154.56|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|736.00||||736.00|178.91|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|736.00||||736.00|736|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|736.00||||736.00|478.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|736.00||||736.00|352.91|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|||736.00||||736.00|220.8|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|736.00||||736.00|127.33|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|736.00||||736.00|175.11|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|736.00||||736.00|117.12|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|CHAMPVA [1240]|CHAMP VA [124000]|736.00||||736.00|552|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|736.00||||736.00|251.73|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|CORESOURCE [1315]|CORESOURCE [131500]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|GEHA [1415]|GEHA [141500]|736.00||||736.00|662.4|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|736.00||||736.00|132.34|736|117.12 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|736.00||||736.00||| 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|AETNA [1015]|AETNA ACO WILCO [101532]|736.00||||736.00||| 41094660|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CPAP PER DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|736.00||||736.00||| 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|319.00||||319.00|225.65|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|CORESOURCE [1315]|CORESOURCE [131500]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|319.00||||319.00|251.73|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|319.00||||319.00|199.7|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|||319.00||||319.00|95.7|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|319.00||||319.00|152.96|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|319.00||||319.00|319|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|319.00||||319.00|255.65|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|UMR [2035]|UMR OPTIONS [203501]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|319.00||||319.00|137.17|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|319.00||||319.00|248.21|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|319.00||||319.00|178.61|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|HEALTHNET [1495]|HEALTHNET [149500]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|319.00||||319.00|66.99|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MULTIPLAN [1680]|IHC HS [168011]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|319.00||||319.00|251.73|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MULTIPLAN [1680]|HMA [168003]|319.00||||319.00|262.66|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|319.00||||319.00|207.35|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|319.00||||319.00|217.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|TRUSTMARK [2030]|STARMARK [203000]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|319.00||||319.00|209.69|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|CHAMPVA [1240]|CHAMP VA [124000]|319.00||||319.00|239.25|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|319.00||||319.00|192.62|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|319.00||||319.00|217.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|GEHA [1415]|GEHA [141500]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|319.00||||319.00|183.86|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|319.00||||319.00|191.4|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|319.00||||319.00|319|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|319.00||||319.00|137.17|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|319.00||||319.00|159.82|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|319.00||||319.00|111.97|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|319.00||||319.00|135.89|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|319.00||||319.00|192.62|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|319.00||||319.00|175.11|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|319.00||||319.00|287.1|319|66.99 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|319.00||||319.00||| 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|AETNA [1015]|AETNA ACO WILCO [101532]|319.00||||319.00||| 41094664|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC AEROSOL/NEBULIZER/INHALER/IPPB DEMO OR EVAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|319.00||||319.00||| 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166.00||||166.00|114.16|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166.00||||166.00|71.38|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166.00||||166.00|58.27|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|166.00||||166.00|70.72|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166.00||||166.00|166|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166.00||||166.00|99.6|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166.00||||166.00|108.97|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166.00||||166.00|217.1|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166.00||||166.00|114.16|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166.00||||166.00|166|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MULTIPLAN [1680]|IHC HS [168011]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|166.00||||166.00|149.2|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MULTIPLAN [1680]|HMA [168003]|166.00||||166.00|155.68|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|HEALTHNET [1495]|HEALTHNET [149500]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|166.00||||166.00|166|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166.00||||166.00|71.38|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166.00||||166.00|105.86|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|TRUSTMARK [2030]|STARMARK [203000]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|UMR [2035]|UMR OPTIONS [203501]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166.00||||166.00|151.52|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166.00||||166.00|34.86|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166.00||||166.00|166|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166.00||||166.00|107.9|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166.00||||166.00|79.6|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|166.00||||166.00|83.17|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|||166.00||||166.00|49.8|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166.00||||166.00|217.1|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166.00||||166.00|103.78|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166.00||||166.00|166|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|CHAMPVA [1240]|CHAMP VA [124000]|166.00||||166.00|124.5|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|166.00||||166.00|149.2|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|CORESOURCE [1315]|CORESOURCE [131500]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|GEHA [1415]|GEHA [141500]|166.00||||166.00|149.4|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|166.00||||166.00|225.65|225.65|34.86 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|166.00||||166.00||| 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|AETNA [1015]|AETNA ACO WILCO [101532]|166.00||||166.00||| 41094667|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY DEMO/EVAL INITIAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|166.00||||166.00||| 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|114.00||||114.00|71.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|GEHA [1415]|GEHA [141500]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|114.00||||114.00|114|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|CHAMPVA [1240]|CHAMP VA [124000]|114.00||||114.00|85.5|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114.00||||114.00|63.53|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114.00||||114.00|69.06|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|||114.00||||114.00|34.2|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114.00||||114.00|54.66|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114.00||||114.00|74.1|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114.00||||114.00|114|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114.00||||114.00|23.94|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|UMR [2035]|UMR OPTIONS [203501]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114.00||||114.00|105.86|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114.00||||114.00|49.02|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|114.00||||114.00|78.96|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114.00||||114.00|114|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|HEALTHNET [1495]|HEALTHNET [149500]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MULTIPLAN [1680]|IHC HS [168011]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|114.00||||114.00|114|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MULTIPLAN [1680]|HMA [168003]|114.00||||114.00|155.68|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|TRUSTMARK [2030]|STARMARK [203000]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114.00||||114.00|66.71|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|CORESOURCE [1315]|CORESOURCE [131500]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114.00||||114.00|114.16|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114.00||||114.00|69.06|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114.00||||114.00|108.97|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114.00||||114.00|68.4|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114.00||||114.00|114|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114.00||||114.00|49.02|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|114.00||||114.00|57.11|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114.00||||114.00|40.01|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|114.00||||114.00|48.56|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114.00||||114.00|114.16|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114.00||||114.00|103.78|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114.00||||114.00|102.6|155.68|23.94 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|114.00||||114.00||| 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|AETNA [1015]|AETNA ACO WILCO [101532]|114.00||||114.00||| 41094668|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC CHEST PHYSIOTHERAPY SUBSEQUENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|114.00||||114.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|98.00||||98.00|42.14|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|98.00||||98.00|49.1|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|98.00||||98.00|34.4|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|98.00||||98.00|49|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|98.00||||98.00|58.8|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|TRUSTMARK [2030]|STARMARK [203000]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MULTIPLAN [1680]|IHC HS [168011]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|HEALTHNET [1495]|HEALTHNET [149500]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|98.00||||98.00|42.14|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|UMR [2035]|UMR OPTIONS [203501]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|98.00||||98.00|20.58|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|98.00||||98.00|98|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|98.00||||98.00|63.7|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|98.00||||98.00|46.99|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|||98.00||||98.00|29.4|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|98.00||||98.00|41.75|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|CHAMPVA [1240]|CHAMP VA [124000]|98.00||||98.00|73.5|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|CORESOURCE [1315]|CORESOURCE [131500]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|GEHA [1415]|GEHA [141500]|98.00||||98.00|88.2|98|20.58 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MULTIPLAN [1680]|HMA [168003]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|98.00||||98.00||| 41098960|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC SELF-MGNMT EDUC & TRAIN 1 PT 30 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|98.00||||98.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|GEHA [1415]|GEHA [141500]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.00||||39.00|28.98|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|CORESOURCE [1315]|CORESOURCE [131500]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|CHAMPVA [1240]|CHAMP VA [124000]|39.00||||39.00|29.25|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.00||||39.00|25.64|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|||39.00||||39.00|11.7|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.00||||39.00|25.35|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.00||||39.00|18.7|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.00||||39.00|39|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.00||||39.00|8.19|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|UMR [2035]|UMR OPTIONS [203501]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.00||||39.00|16.77|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.00||||39.00|31.88|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MULTIPLAN [1680]|IHC HS [168011]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|HEALTHNET [1495]|HEALTHNET [149500]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.00||||39.00|27.88|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|TRUSTMARK [2030]|STARMARK [203000]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.00||||39.00|26.92|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.00||||39.00|27.88|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.00||||39.00|23.4|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.00||||39.00|39|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.00||||39.00|16.77|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.00||||39.00|19.54|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.00||||39.00|16.61|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.00||||39.00|13.69|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.00||||39.00|35.1|39|8.19 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MULTIPLAN [1680]|HMA [168003]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.00||||39.00||| 41099406|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING 3-10 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.00||||39.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43.00||||43.00|21.54|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43.00||||43.00|18.32|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43.00||||43.00|15.09|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43.00||||43.00|43|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43.00||||43.00|25.8|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|HEALTHNET [1495]|HEALTHNET [149500]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MULTIPLAN [1680]|IHC HS [168011]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43.00||||43.00|31.88|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43.00||||43.00|18.49|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|UMR [2035]|UMR OPTIONS [203501]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|TRUSTMARK [2030]|STARMARK [203000]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43.00||||43.00|26.92|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43.00||||43.00|9.03|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43.00||||43.00|27.88|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43.00||||43.00|43|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43.00||||43.00|20.62|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43.00||||43.00|27.95|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43.00||||43.00|18.49|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|||43.00||||43.00|12.9|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43.00||||43.00|27.88|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43.00||||43.00|25.64|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|CHAMPVA [1240]|CHAMP VA [124000]|43.00||||43.00|32.25|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|CORESOURCE [1315]|CORESOURCE [131500]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43.00||||43.00|28.98|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|GEHA [1415]|GEHA [141500]|43.00||||43.00|38.7|43|9.03 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|MULTIPLAN [1680]|HMA [168003]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43.00||||43.00||| 41099407|EAP|0410 - RESPIRATORY SERVICES-GENERAL|HC BEHAV CHNG SMOKING > 10 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43.00||||43.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41125|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CYCLOSPORINE MODIFIED 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232.64||||232.64|116.32|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|288.53||||288.53|144.27|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118.58||||118.58|59.29|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232.64||||232.64|139.58|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|288.53||||288.53|173.12|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|356.29||||356.29|213.77|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118.58||||118.58|71.15|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232.64||||232.64|100.04|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|232.64||||232.64|116.55|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|232.64||||232.64|99.1|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|288.53||||288.53|124.07|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|288.53||||288.53|144.55|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|288.53||||288.53|122.91|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|356.29||||356.29|153.2|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|356.29||||356.29|178.5|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|356.29||||356.29|125.06|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|356.29||||356.29|151.78|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118.58||||118.58|50.99|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118.58||||118.58|59.41|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118.58||||118.58|41.62|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118.58||||118.58|50.52|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232.64||||232.64|100.04|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|288.53||||288.53|124.07|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|356.29||||356.29|153.2|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118.58||||118.58|50.99|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118.58||||118.58|9.59|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232.64||||232.64|19.19|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|288.53||||288.53|28.78|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|356.29||||356.29|38.37|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232.64||||232.64|48.85|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|288.53||||288.53|60.59|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|356.29||||356.29|74.82|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118.58||||118.58|24.9|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232.64||||232.64|151.22|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|288.53||||288.53|187.54|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|356.29||||356.29|231.59|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118.58||||118.58|77.08|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232.64||||232.64|111.55|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|288.53||||288.53|138.35|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|356.29||||356.29|170.84|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118.58||||118.58|56.86|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|||356.29||||356.29|106.89|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|||118.58||||118.58|35.57|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|||232.64||||232.64|69.79|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|||288.53||||288.53|86.56|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|288.53||||288.53|101.27|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232.64||||232.64|81.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|356.29||||356.29|178.15|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|232.64||||232.64|174.48|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|288.53||||288.53|216.4|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118.58||||118.58||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|356.29||||356.29|267.22|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|118.58||||118.58|88.94|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|232.64||||232.64|209.38|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|288.53||||288.53|259.68|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|118.58||||118.58|106.72|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|356.29||||356.29|320.66|320.66|9.59 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|232.64||||232.64||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|288.53||||288.53||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|356.29||||356.29||| 41137|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118.58||||118.58||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|316.97||||316.97|74.32|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|316.97||||316.97|237.73|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|316.97||||316.97|65.48|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|316.97||||316.97|71.5|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|||316.97||||316.97|95.09|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|316.97||||316.97|151.99|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|316.97||||316.97|206.03|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|316.97||||316.97|62.54|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|316.97||||316.97|81.59|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|316.97||||316.97|136.3|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|316.97||||316.97|110.94|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|316.97||||316.97|66.56|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|316.97||||316.97|68.76|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|316.97||||316.97|71.5|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|316.97||||316.97|136.3|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|316.97||||316.97|158.8|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|316.97||||316.97|111.26|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|316.97||||316.97|135.03|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|316.97||||316.97|190.18|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|316.97||||316.97|285.27|285.27|62.54 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|316.97||||316.97||| 41144|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 50 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|316.97||||316.97||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.47||||52.47|31.48|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.47||||52.47|22.56|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.47||||52.47|18.42|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.47||||52.47|22.35|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|TRUSTMARK [2030]|STARMARK [203000]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|HEALTHNET [1495]|HEALTHNET [149500]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|IHC HS [168011]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.47||||52.47|22.56|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|UMR [2035]|UMR OPTIONS [203501]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.47||||52.47|11.02|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.47||||52.47|34.11|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.47||||52.47|26.29|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.47||||52.47|25.16|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|||52.47||||52.47|15.74|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|CHAMPVA [1240]|CHAMP VA [124000]|52.47||||52.47|39.35|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|CORESOURCE [1315]|CORESOURCE [131500]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|GEHA [1415]|GEHA [141500]|52.47||||52.47|47.22|47.22|11.02 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|HMA [168003]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|AETNA [1015]|AETNA ACO WILCO [101532]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.47||||52.47||| 41382|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FENTANYL 12 MCG/HR TRANSDERMAL PATCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.47||||52.47||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|||29.00||||29.00|8.7|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|||29.00||||29.00|8.7|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 41463|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % (PF) INJECTION SOLUTION *VIAL* REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.90||||128.90|27.07|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.90||||128.90|27.07|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.90||||128.90|27.07|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.90||||128.90|83.79|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.90||||128.90|83.79|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.90||||128.90|83.79|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128.90||||128.90|83.79|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.90||||128.90|61.81|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.90||||128.90|61.81|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.90||||128.90|61.81|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128.90||||128.90|61.81|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|||128.90||||128.90|38.67|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|||128.90||||128.90|38.67|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128.90||||128.90|27.07|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|||128.90||||128.90|38.67|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|||128.90||||128.90|38.67|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|128.90||||128.90|96.68|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|128.90||||128.90|96.68|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|128.90||||128.90|96.68|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|128.90||||128.90|96.68|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.90||||128.90|64.58|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.90||||128.90|54.91|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.90||||128.90|77.34|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.90||||128.90|54.91|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.90||||128.90|64.58|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.90||||128.90|77.34|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.90||||128.90|77.34|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128.90||||128.90|77.34|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.90||||128.90|45.24|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.90||||128.90|45.24|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128.90||||128.90|55.43|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.90||||128.90|64.58|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.90||||128.90|45.24|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128.90||||128.90|45.24|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.90||||128.90|54.91|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128.90||||128.90|54.91|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128.90||||128.90|64.58|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|128.90||||128.90|116.01|116.01|27.07 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128.90||||128.90||| 41831|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LIDOCAINE 5 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128.90||||128.90||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|||10.00||||10.00|3|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|||10.00||||10.00|3|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 41832|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILDENAFIL (PULMONARY HYPERTENSION) 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|220.00||||220.00|19.39|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|FIRST HEALTH [1375]|QUALCHOICE [137513]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|220.00||||220.00|132|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|220.00||||220.00|14.84|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|220.00||||220.00|110|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|220.00||||220.00|93.72|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|220.00||||220.00|14.84|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|220.00||||220.00|94.6|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|220.00||||220.00|20.91|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|220.00||||220.00|14.16|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHNET [1495]|HEALTHNET [149500]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|TRUSTMARK [2030]|STARMARK [203000]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA [1015]|COVENTRY HEALTHCARE [101502]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|220.00||||220.00|156|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|220.00||||220.00|110.22|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|220.00||||220.00|57.2|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|220.00||||220.00|19.39|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|220.00||||220.00|94.6|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MULTIPLAN [1680]|IHC HS [168011]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|220.00||||220.00|13.76|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|220.00||||220.00|21.65|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|220.00||||220.00|19.7|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|220.00||||220.00|77.22|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|220.00||||220.00|105.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|220.00||||220.00|220|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|220.00||||220.00|21.65|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UMR [2035]|UMR OPTIONS [203501]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|220.00||||220.00|46.2|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|220.00||||220.00|143|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|220.00||||220.00|24.76|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|220.00||||220.00|13.49|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|FMH BENEFIT SERVICES [1390]|FMH [139000]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|||220.00||||220.00|66|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CORESOURCE [1315]|CORESOURCE [131500]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|220.00||||220.00|22.5|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|220.00||||220.00|19.91|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CHAMPVA [1240]|CHAMP VA [124000]|220.00||||220.00|165|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|GEHA [1415]|GEHA [141500]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|220.00||||220.00|198|220|13.49 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA [1015]|AETNA ACO WILCO [101532]|220.00||||220.00||| 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|220.00||||220.00||| 42000283|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MULTIPLAN [1680]|HMA [168003]|220.00||||220.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|FMH BENEFIT SERVICES [1390]|FMH [139000]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|664.00||||664.00|398.4|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|664.00||||664.00|431.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|CHAMPVA [1240]|CHAMP VA [124000]|664.00||||664.00|498|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|GEHA [1415]|GEHA [141500]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|CORESOURCE [1315]|CORESOURCE [131500]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|664.00||||664.00|208.59|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|HEALTHNET [1495]|HEALTHNET [149500]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|664.00||||664.00|139.44|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|664.00||||664.00|191.86|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MULTIPLAN [1680]|IHC HS [168011]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|UMR [2035]|UMR OPTIONS [203501]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|FIRST HEALTH [1375]|QUALCHOICE [137513]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|664.00||||664.00|238.48|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|TRUSTMARK [2030]|STARMARK [203000]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|664.00||||664.00|156|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|664.00||||664.00|282.86|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|664.00||||664.00|664|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|664.00||||664.00|318.39|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|664.00||||664.00|201.46|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|664.00||||664.00|216.8|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|664.00||||664.00|208.59|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|664.00||||664.00|332.66|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|||664.00||||664.00|199.2|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|664.00||||664.00|285.52|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|664.00||||664.00|233.06|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|664.00||||664.00|285.52|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|664.00||||664.00|563.08|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|664.00||||664.00|597.6|664|139.44 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MULTIPLAN [1680]|HMA [168003]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|AETNA [1015]|AETNA ACO WILCO [101532]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|664.00||||664.00||| 42029445|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC APPL CAST LEG RIGID TOTAL CONT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|664.00||||664.00||| 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135.00||||135.00|81|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135.00||||135.00|58.05|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135.00||||135.00|62.3|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|FMH BENEFIT SERVICES [1390]|FMH [139000]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135.00||||135.00|47.39|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135.00||||135.00|47.06|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHNET [1495]|HEALTHNET [149500]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135.00||||135.00|28.35|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MULTIPLAN [1680]|HMA [168003]|135.00||||135.00|67.23|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|TRUSTMARK [2030]|STARMARK [203000]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MULTIPLAN [1680]|IHC HS [168011]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135.00||||135.00|57.51|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135.00||||135.00|88.98|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135.00||||135.00|58.05|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135.00||||135.00|49.3|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135.00||||135.00|45.72|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135.00||||135.00|92.13|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135.00||||135.00|62.75|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135.00||||135.00|92.13|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|FIRST HEALTH [1375]|QUALCHOICE [137513]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135.00||||135.00|64.73|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135.00||||135.00|135|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135.00||||135.00|49.3|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135.00||||135.00|67.64|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|||135.00||||135.00|40.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CHAMPVA [1240]|CHAMP VA [124000]|135.00||||135.00|101.25|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135.00||||135.00|62.3|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135.00||||135.00|135|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135.00||||135.00|87.75|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135.00||||135.00|44.82|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135.00||||135.00|95.76|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|GEHA [1415]|GEHA [141500]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135.00||||135.00|105.33|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CORESOURCE [1315]|CORESOURCE [131500]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UMR [2035]|UMR OPTIONS [203501]|135.00||||135.00|121.5|135|28.35 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135.00||||135.00||| 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135.00||||135.00||| 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135.00||||135.00||| 42090912|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA [1015]|AETNA ACO WILCO [101532]|135.00||||135.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.00||||75.00|75|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.00||||75.00|35.96|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.00||||75.00|43.37|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.00||||75.00|36.65|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.00||||75.00|75|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UMR [2035]|UMR OPTIONS [203501]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MULTIPLAN [1680]|IHC HS [168011]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.00||||75.00|45|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.00||||75.00|37.94|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|TRUSTMARK [2030]|STARMARK [203000]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.00||||75.00|32.25|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHNET [1495]|HEALTHNET [149500]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.00||||75.00|15.75|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.00||||75.00|31.95|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.00||||75.00|26.33|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.00||||75.00|37.58|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.00||||75.00|32.25|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CORESOURCE [1315]|CORESOURCE [131500]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|GEHA [1415]|GEHA [141500]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CHAMPVA [1240]|CHAMP VA [124000]|75.00||||75.00|56.25|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.00||||75.00|67.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|||75.00||||75.00|22.5|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.00||||75.00|48.75|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.00||||75.00|39.43|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.00||||75.00|37.94|75|15.75 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MULTIPLAN [1680]|HMA [168003]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA [1015]|AETNA ACO WILCO [101532]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.00||||75.00||| 42090913|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.00||||75.00||| 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201.00||||201.00|120.6|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201.00||||201.00|70.55|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201.00||||201.00|86.43|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201.00||||201.00|42.26|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201.00||||201.00|100.5|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201.00||||201.00|125.24|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|201.00||||201.00|156|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201.00||||201.00|40.34|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MULTIPLAN [1680]|IHC HS [168011]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201.00||||201.00|120.96|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MULTIPLAN [1680]|HMA [168003]|201.00||||201.00|57.63|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|UMR [2035]|UMR OPTIONS [203501]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|201.00||||201.00|143.18|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201.00||||201.00|39.19|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|HEALTHNET [1495]|HEALTHNET [149500]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|||201.00||||201.00|60.3|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201.00||||201.00|53.79|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|201.00||||201.00|53.4|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|201.00||||201.00|85.63|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201.00||||201.00|201|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|201.00||||201.00|100.7|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|TRUSTMARK [2030]|STARMARK [203000]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201.00||||201.00|130.65|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201.00||||201.00|96.38|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201.00||||201.00|42.26|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201.00||||201.00|125.24|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201.00||||201.00|86.43|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201.00||||201.00|42.21|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201.00||||201.00|115.2|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|CHAMPVA [1240]|CHAMP VA [124000]|201.00||||201.00|150.75|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|201.00||||201.00|130.17|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|CORESOURCE [1315]|CORESOURCE [131500]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201.00||||201.00|38.42|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|GEHA [1415]|GEHA [141500]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|201.00||||201.00|180.9|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|201.00||||201.00|53.4|201|38.42 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|AETNA [1015]|AETNA ACO WILCO [101532]|201.00||||201.00||| 42095992|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC CANALITH REPOSITIONING PER DAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|201.00||||201.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|83.00||||83.00|23.01|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|CORESOURCE [1315]|CORESOURCE [131500]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83.00||||83.00|20.36|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83.00||||83.00|22.14|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83.00||||83.00|53.95|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83.00||||83.00|21.58|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83.00||||83.00|83|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|||83.00||||83.00|24.9|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83.00||||83.00|17.43|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|CHAMPVA [1240]|CHAMP VA [124000]|83.00||||83.00|62.25|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|UMR [2035]|UMR OPTIONS [203501]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MULTIPLAN [1680]|IHC HS [168011]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|83.00||||83.00|25.31|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHNET [1495]|HEALTHNET [149500]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|GEHA [1415]|GEHA [141500]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83.00||||83.00|51.54|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83.00||||83.00|21.38|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|TRUSTMARK [2030]|STARMARK [203000]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|83.00||||83.00|41.58|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|83.00||||83.00|83|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83.00||||83.00|21.58|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83.00||||83.00|22.14|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83.00||||83.00|39.8|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|83.00||||83.00|51.46|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83.00||||83.00|35.69|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83.00||||83.00|29.13|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|83.00||||83.00|35.36|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|83.00||||83.00|51.46|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.00||||83.00|35.69|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83.00||||83.00|41.5|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83.00||||83.00|74.7|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83.00||||83.00|49.8|83|17.43 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MULTIPLAN [1680]|HMA [168003]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA [1015]|AETNA ACO WILCO [101532]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83.00||||83.00||| 42097010|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC HOT/COLD PACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.00||||83.00||| 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|154.00||||154.00|19.05|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|154.00||||154.00|21.61|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|TRUSTMARK [2030]|STARMARK [203000]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|154.00||||154.00|18.4|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|154.00||||154.00|15.78|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|154.00||||154.00|65.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|154.00||||154.00|54.05|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|154.00||||154.00|92.4|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|154.00||||154.00|16.53|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|154.00||||154.00|77|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|154.00||||154.00|16.53|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|154.00||||154.00|154|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|154.00||||154.00|77.15|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|154.00||||154.00|66.22|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MULTIPLAN [1680]|IHC HS [168011]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MULTIPLAN [1680]|HMA [168003]|154.00||||154.00|22.55|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|HEALTHNET [1495]|HEALTHNET [149500]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|154.00||||154.00|21.79|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|154.00||||154.00|15.33|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|154.00||||154.00|100.1|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|154.00||||154.00|154|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|154.00||||154.00|21.94|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|154.00||||154.00|19.05|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|||154.00||||154.00|46.2|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|154.00||||154.00|73.84|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|154.00||||154.00|66.22|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|154.00||||154.00|32.34|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|154.00||||154.00|17.52|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|UMR [2035]|UMR OPTIONS [203501]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|CHAMPVA [1240]|CHAMP VA [124000]|154.00||||154.00|115.5|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|154.00||||154.00|21.61|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|154.00||||154.00|15.03|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|CORESOURCE [1315]|CORESOURCE [131500]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|GEHA [1415]|GEHA [141500]|154.00||||154.00|138.6|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|154.00||||154.00|19.8|154|15.03 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|AETNA [1015]|AETNA ACO WILCO [101532]|154.00||||154.00||| 42097012|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT TRACTION MECHANICAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|154.00||||154.00||| 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|CORESOURCE [1315]|CORESOURCE [131500]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118.00||||118.00|9.17|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|||118.00||||118.00|35.4|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118.00||||118.00|6|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118.00||||118.00|56.58|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118.00||||118.00|8.58|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MULTIPLAN [1680]|HMA [168003]|118.00||||118.00|8.82|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118.00||||118.00|50.74|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118.00||||118.00|8.34|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|UMR [2035]|UMR OPTIONS [203501]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|GEHA [1415]|GEHA [141500]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118.00||||118.00|8.02|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118.00||||118.00|118|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118.00||||118.00|24.78|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118.00||||118.00|76.7|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118.00||||118.00|118|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118.00||||118.00|7.38|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118.00||||118.00|6.47|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118.00||||118.00|8.02|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118.00||||118.00|50.74|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118.00||||118.00|41.42|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118.00||||118.00|6.17|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118.00||||118.00|70.8|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118.00||||118.00|6.47|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118.00||||118.00|59.12|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118.00||||118.00|8.45|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHNET [1495]|HEALTHNET [149500]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|CHAMPVA [1240]|CHAMP VA [124000]|118.00||||118.00|88.5|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118.00||||118.00|5.88|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118.00||||118.00|7.75|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MULTIPLAN [1680]|IHC HS [168011]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118.00||||118.00|8.45|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118.00||||118.00|50.27|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118.00||||118.00|59|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|TRUSTMARK [2030]|STARMARK [203000]|118.00||||118.00|106.2|118|5.88 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118.00||||118.00||| 42097018|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA [1015]|AETNA ACO WILCO [101532]|118.00||||118.00||| 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133.00||||133.00|46.68|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133.00||||133.00|57.19|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133.00||||133.00|15.44|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133.00||||133.00|79.8|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133.00||||133.00|16.17|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|133.00||||133.00|56.66|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133.00||||133.00|16.17|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133.00||||133.00|20.41|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133.00||||133.00|19.71|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|133.00||||133.00|21.13|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133.00||||133.00|20.41|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133.00||||133.00|63.77|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MULTIPLAN [1680]|IHC HS [168011]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133.00||||133.00|133|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MULTIPLAN [1680]|HMA [168003]|133.00||||133.00|22.05|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHNET [1495]|HEALTHNET [149500]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|FMH BENEFIT SERVICES [1390]|FMH [139000]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|FIRST HEALTH [1375]|QUALCHOICE [137513]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|133.00||||133.00|23.33|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|||133.00||||133.00|39.9|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|TRUSTMARK [2030]|STARMARK [203000]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133.00||||133.00|27.93|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|133.00||||133.00|133|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133.00||||133.00|86.45|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133.00||||133.00|57.19|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133.00||||133.00|66.5|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133.00||||133.00|14.99|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|133.00||||133.00|66.63|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UMR [2035]|UMR OPTIONS [203501]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133.00||||133.00|21.46|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133.00||||133.00|18.77|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CHAMPVA [1240]|CHAMP VA [124000]|133.00||||133.00|99.75|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133.00||||133.00|14.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|133.00||||133.00|21.21|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|GEHA [1415]|GEHA [141500]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CORESOURCE [1315]|CORESOURCE [131500]|133.00||||133.00|119.7|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|133.00||||133.00|21.13|133|14.7 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA [1015]|AETNA ACO WILCO [101532]|133.00||||133.00||| 42097032|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|133.00||||133.00||| 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|424.00||||424.00|23.81|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|424.00||||424.00|26.91|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|GEHA [1415]|GEHA [141500]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|424.00||||424.00|25.89|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|424.00||||424.00|275.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|424.00||||424.00|89.04|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|||424.00||||424.00|127.2|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|424.00||||424.00|424|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|424.00||||424.00|29.2|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UMR [2035]|UMR OPTIONS [203501]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|424.00||||424.00|22.34|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|424.00||||424.00|254.4|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|424.00||||424.00|20.72|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|424.00||||424.00|318|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|424.00||||424.00|29.65|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|424.00||||424.00|25|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|424.00||||424.00|22.34|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|424.00||||424.00|203.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|424.00||||424.00|25.89|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|424.00||||424.00|148.82|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|424.00||||424.00|180.62|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MULTIPLAN [1680]|HMA [168003]|424.00||||424.00|30.47|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|424.00||||424.00|212|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|424.00||||424.00|21.33|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|424.00||||424.00|156|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|424.00||||424.00|29.2|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|424.00||||424.00|212.42|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|424.00||||424.00|182.32|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|424.00||||424.00|381.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|424.00||||424.00|29.6|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|424.00||||424.00|182.32|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|424.00||||424.00|20.31|424|20.31 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|424.00||||424.00||| 42097033|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|424.00||||424.00||| 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|224.00||||224.00|78.62|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|224.00||||224.00|112.22|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|224.00||||224.00|14.95|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|224.00||||224.00|112|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|224.00||||224.00|95.42|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|224.00||||224.00|15.13|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|224.00||||224.00|15.66|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|224.00||||224.00|15.66|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|224.00||||224.00|20.79|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|224.00||||224.00|156|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|224.00||||224.00|96.32|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MULTIPLAN [1680]|HMA [168003]|224.00||||224.00|21.36|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|224.00||||224.00|96.32|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|224.00||||224.00|14.52|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|224.00||||224.00|20.47|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|224.00||||224.00|145.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|224.00||||224.00|15.66|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|224.00||||224.00|224|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|224.00||||224.00|17.91|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|224.00||||224.00|15.66|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|224.00||||224.00|107.41|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|224.00||||224.00|134.4|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|224.00||||224.00|14.24|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|224.00||||224.00|47.04|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|224.00||||224.00|14.41|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|UMR [2035]|UMR OPTIONS [203501]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|||224.00||||224.00|67.2|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|224.00||||224.00|168|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|224.00||||224.00|20.47|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|GEHA [1415]|GEHA [141500]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|224.00||||224.00|201.6|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|224.00||||224.00|16.28|224|14.24 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|224.00||||224.00||| 42097035|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ULTRASOUND THERAPY 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|224.00||||224.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81.00||||81.00|21.06|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81.00||||81.00|15.33|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81.00||||81.00|15.87|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81.00||||81.00|81|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81.00||||81.00|34.83|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81.00||||81.00|40.58|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81.00||||81.00|28.43|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81.00||||81.00|34.51|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81.00||||81.00|40.5|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|TRUSTMARK [2030]|STARMARK [203000]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81.00||||81.00|48.6|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|GEHA [1415]|GEHA [141500]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81.00||||81.00|16.49|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81.00||||81.00|50.22|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|CHAMPVA [1240]|CHAMP VA [124000]|81.00||||81.00|60.75|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|||81.00||||81.00|24.3|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81.00||||81.00|38.84|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81.00||||81.00|14.6|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81.00||||81.00|52.65|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|CORESOURCE [1315]|CORESOURCE [131500]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81.00||||81.00|81|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81.00||||81.00|21.06|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81.00||||81.00|15.87|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81.00||||81.00|17.01|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81.00||||81.00|50.3|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|UMR [2035]|UMR OPTIONS [203501]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|FIRST HEALTH [1375]|QUALCHOICE [137513]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81.00||||81.00|18.15|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81.00||||81.00|34.83|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|FMH BENEFIT SERVICES [1390]|FMH [139000]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHNET [1495]|HEALTHNET [149500]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MULTIPLAN [1680]|IHC HS [168011]|81.00||||81.00|72.9|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81.00||||81.00|50.22|81|14.6 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA [1015]|AETNA ACO WILCO [101532]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MULTIPLAN [1680]|HMA [168003]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81.00||||81.00||| 42097039|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MODALITY UNLISTED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81.00||||81.00||| 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|193.00||||193.00|96.5|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|193.00||||193.00|82.99|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|193.00||||193.00|31.73|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|193.00||||193.00|82.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|193.00||||193.00|33.24|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|193.00||||193.00|34.8|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|193.00||||193.00|156|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|193.00||||193.00|43.44|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MULTIPLAN [1680]|HMA [168003]|193.00||||193.00|45.33|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|193.00||||193.00|41.19|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|193.00||||193.00|30.82|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|193.00||||193.00|44.12|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|193.00||||193.00|193|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|193.00||||193.00|40.53|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|193.00||||193.00|33.24|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|193.00||||193.00|96.69|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|193.00||||193.00|115.8|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|193.00||||193.00|67.74|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|193.00||||193.00|125.45|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|193.00||||193.00|36.03|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UMR [2035]|UMR OPTIONS [203501]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|193.00||||193.00|92.54|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|||193.00||||193.00|57.9|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|193.00||||193.00|82.99|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|193.00||||193.00|36.03|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|193.00||||193.00|30.22|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|193.00||||193.00|33.15|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|193.00||||193.00|144.75|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|193.00||||193.00|43.44|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|GEHA [1415]|GEHA [141500]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|193.00||||193.00|37.45|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|193.00||||193.00|173.7|193|30.22 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|193.00||||193.00||| 42097110|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|193.00||||193.00||| 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|GEHA [1415]|GEHA [141500]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|203.00||||203.00|38.84|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203.00||||203.00|34.37|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203.00||||203.00|37.37|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|||203.00||||203.00|60.9|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203.00||||203.00|97.34|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203.00||||203.00|131.95|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203.00||||203.00|203|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|203.00||||203.00|49.81|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UMR [2035]|UMR OPTIONS [203501]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203.00||||203.00|35.34|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203.00||||203.00|87.29|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|203.00||||203.00|49.81|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203.00||||203.00|50.59|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203.00||||203.00|42.63|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|203.00||||203.00|152.25|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MULTIPLAN [1680]|HMA [168003]|203.00||||203.00|51.98|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|203.00||||203.00|156|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203.00||||203.00|36.09|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203.00||||203.00|38.12|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203.00||||203.00|37.37|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203.00||||203.00|87.29|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|203.00||||203.00|42.73|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|203.00||||203.00|101.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203.00||||203.00|71.25|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|203.00||||203.00|86.48|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203.00||||203.00|36.38|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203.00||||203.00|121.8|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203.00||||203.00|182.7|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203.00||||203.00|34.65|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203.00||||203.00|38.12|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203.00||||203.00|101.5|203|34.37 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|203.00||||203.00||| 42097112|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|203.00||||203.00||| 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191.00||||191.00|114.6|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191.00||||191.00|67.04|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191.00||||191.00|40.48|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191.00||||191.00|41.65|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191.00||||191.00|39.09|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|191.00||||191.00|81.37|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191.00||||191.00|41.65|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MULTIPLAN [1680]|IHC HS [168011]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MULTIPLAN [1680]|HMA [168003]|191.00||||191.00|56.79|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHNET [1495]|HEALTHNET [149500]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|FIRST HEALTH [1375]|QUALCHOICE [137513]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191.00||||191.00|38.62|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191.00||||191.00|40.11|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|191.00||||191.00|54.43|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191.00||||191.00|191|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191.00||||191.00|82.13|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191.00||||191.00|124.15|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191.00||||191.00|39.75|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|TRUSTMARK [2030]|STARMARK [203000]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|191.00||||191.00|156|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191.00||||191.00|91.58|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UMR [2035]|UMR OPTIONS [203501]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|191.00||||191.00|95.69|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|||191.00||||191.00|57.3|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191.00||||191.00|40.48|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|191.00||||191.00|46.28|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191.00||||191.00|82.13|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191.00||||191.00|37.86|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191.00||||191.00|95.5|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|FMH BENEFIT SERVICES [1390]|FMH [139000]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191.00||||191.00|37.23|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CHAMPVA [1240]|CHAMP VA [124000]|191.00||||191.00|143.25|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|191.00||||191.00|54.43|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CORESOURCE [1315]|CORESOURCE [131500]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|191.00||||191.00|42.07|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|GEHA [1415]|GEHA [141500]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191.00||||191.00|171.9|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191.00||||191.00|55.28|191|37.23 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA [1015]|AETNA ACO WILCO [101532]|191.00||||191.00||| 42097113|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|191.00||||191.00||| 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|222.00||||222.00|32.92|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|GEHA [1415]|GEHA [141500]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|222.00||||222.00|42.97|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|222.00||||222.00|166.5|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|||222.00||||222.00|66.6|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222.00||||222.00|106.45|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222.00||||222.00|29.13|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222.00||||222.00|222|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222.00||||222.00|43.64|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UMR [2035]|UMR OPTIONS [203501]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222.00||||222.00|30.49|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|222.00||||222.00|36.21|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222.00||||222.00|95.46|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|222.00||||222.00|42.97|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222.00||||222.00|46.62|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|222.00||||222.00|156|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222.00||||222.00|30.59|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222.00||||222.00|144.3|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222.00||||222.00|31.67|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222.00||||222.00|32.88|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222.00||||222.00|31.67|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222.00||||222.00|95.46|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|222.00||||222.00|111.22|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222.00||||222.00|77.92|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|222.00||||222.00|94.57|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222.00||||222.00|31.38|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222.00||||222.00|133.2|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222.00||||222.00|32.88|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222.00||||222.00|199.8|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222.00||||222.00|29.89|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222.00||||222.00|111|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MULTIPLAN [1680]|HMA [168003]|222.00||||222.00|44.84|222|29.13 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|222.00||||222.00||| 42097116|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|222.00||||222.00||| 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130.00||||130.00|31.32|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130.00||||130.00|65|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130.00||||130.00|55.9|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130.00||||130.00|31.32|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130.00||||130.00|27.69|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130.00||||130.00|45.63|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|130.00||||130.00|130|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130.00||||130.00|29.89|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|130.00||||130.00|65.13|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MULTIPLAN [1680]|IHC HS [168011]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|130.00||||130.00|40.93|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MULTIPLAN [1680]|HMA [168003]|130.00||||130.00|42.71|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|FMH BENEFIT SERVICES [1390]|FMH [139000]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|130.00||||130.00|32.78|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130.00||||130.00|29.04|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|HEALTHNET [1495]|HEALTHNET [149500]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130.00||||130.00|41.57|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130.00||||130.00|130|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130.00||||130.00|27.3|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|TRUSTMARK [2030]|STARMARK [203000]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130.00||||130.00|78|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130.00||||130.00|84.5|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|130.00||||130.00|55.38|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130.00||||130.00|28.67|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130.00||||130.00|62.34|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|UMR [2035]|UMR OPTIONS [203501]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|||130.00||||130.00|39|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130.00||||130.00|28.67|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130.00||||130.00|28.47|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130.00||||130.00|26.37|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|CHAMPVA [1240]|CHAMP VA [124000]|130.00||||130.00|97.5|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|FIRST HEALTH [1375]|QUALCHOICE [137513]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|130.00||||130.00|40.93|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|CORESOURCE [1315]|CORESOURCE [131500]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|GEHA [1415]|GEHA [141500]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130.00||||130.00|117|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|130.00||||130.00|29.8|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130.00||||130.00|55.9|130|26.37 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|AETNA [1015]|AETNA ACO WILCO [101532]|130.00||||130.00||| 42097124|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MASSAGE THERAPY BENEFIT NON-MC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|130.00||||130.00||| 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|248.00||||248.00|34.96|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248.00||||248.00|30.94|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|||248.00||||248.00|74.4|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248.00||||248.00|118.92|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248.00||||248.00|161.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248.00||||248.00|248|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248.00||||248.00|52.08|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248.00||||248.00|33.64|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UMR [2035]|UMR OPTIONS [203501]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248.00||||248.00|28.42|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248.00||||248.00|106.64|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|248.00||||248.00|38.46|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|GEHA [1415]|GEHA [141500]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|248.00||||248.00|186|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248.00||||248.00|40.68|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|248.00||||248.00|40.05|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MULTIPLAN [1680]|HMA [168003]|248.00||||248.00|41.79|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|248.00||||248.00|156|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248.00||||248.00|32.49|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248.00||||248.00|30.65|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248.00||||248.00|33.64|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|248.00||||248.00|40.05|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248.00||||248.00|106.64|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|248.00||||248.00|124.25|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248.00||||248.00|87.05|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|248.00||||248.00|105.65|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248.00||||248.00|29.25|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248.00||||248.00|148.8|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248.00||||248.00|223.2|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248.00||||248.00|30.65|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248.00||||248.00|124|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248.00||||248.00|27.86|248|27.86 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|248.00||||248.00||| 42097140|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|248.00||||248.00||| 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|456.00||||456.00|19.02|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|456.00||||456.00|228|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|456.00||||456.00|273.6|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|456.00||||456.00|196.08|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|456.00||||456.00|228.46|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|456.00||||456.00|160.06|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|456.00||||456.00|194.26|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|456.00||||456.00|22.34|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|456.00||||456.00|19.92|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|456.00||||456.00|156|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|TRUSTMARK [2030]|STARMARK [203000]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MULTIPLAN [1680]|IHC HS [168011]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|456.00||||456.00|26.03|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MULTIPLAN [1680]|HMA [168003]|456.00||||456.00|27.17|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHNET [1495]|HEALTHNET [149500]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|456.00||||456.00|18.47|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|456.00||||456.00|95.76|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|456.00||||456.00|296.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|456.00||||456.00|22.34|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|456.00||||456.00|20.55|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CHAMPVA [1240]|CHAMP VA [124000]|456.00||||456.00|342|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|GEHA [1415]|GEHA [141500]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CORESOURCE [1315]|CORESOURCE [131500]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|456.00||||456.00|23.22|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|456.00||||456.00|26.03|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|456.00||||456.00|21.58|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|||456.00||||456.00|136.8|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|456.00||||456.00|218.65|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|456.00||||456.00|456|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|456.00||||456.00|26.44|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|456.00||||456.00|19.92|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|456.00||||456.00|18.11|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UMR [2035]|UMR OPTIONS [203501]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|456.00||||456.00|196.08|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|456.00||||456.00|25.54|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|FIRST HEALTH [1375]|QUALCHOICE [137513]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|FMH BENEFIT SERVICES [1390]|FMH [139000]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|456.00||||456.00|410.4|456|18.11 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA [1015]|AETNA ACO WILCO [101532]|456.00||||456.00||| 42097150|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|456.00||||456.00||| 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|GEHA [1415]|GEHA [141500]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|270.00||||270.00|55.18|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|270.00||||270.00|129.47|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|270.00||||270.00|270|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|270.00||||270.00|39.15|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|270.00||||270.00|42.67|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|270.00||||270.00|55.18|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|270.00||||270.00|156|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|270.00||||270.00|36.05|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|270.00||||270.00|42.22|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|270.00||||270.00|37.32|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MULTIPLAN [1680]|HMA [168003]|270.00||||270.00|57.57|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|270.00||||270.00|116.1|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|270.00||||270.00|135.27|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|270.00||||270.00|94.77|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|270.00||||270.00|115.02|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|270.00||||270.00|40.3|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|270.00||||270.00|162|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|270.00||||270.00|135|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|270.00||||270.00|42.22|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|270.00||||270.00|116.1|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UMR [2035]|UMR OPTIONS [203501]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|270.00||||270.00|56.03|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|270.00||||270.00|175.5|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|270.00||||270.00|56.7|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|||270.00||||270.00|81|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|270.00||||270.00|37.32|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|270.00||||270.00|34.33|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|270.00||||270.00|202.5|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|270.00||||270.00|38.79|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|270.00||||270.00|38.38|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|270.00||||270.00|243|270|34.33 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|270.00||||270.00||| 42097530|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|270.00||||270.00||| 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198.00||||198.00|198|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198.00||||198.00|85.14|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198.00||||198.00|54.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198.00||||198.00|99|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198.00||||198.00|85.14|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198.00||||198.00|69.5|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|198.00||||198.00|84.35|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198.00||||198.00|32.53|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|198.00||||198.00|156|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198.00||||198.00|33.69|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MULTIPLAN [1680]|IHC HS [168011]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198.00||||198.00|118.8|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|198.00||||198.00|71.85|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MULTIPLAN [1680]|HMA [168003]|198.00||||198.00|74.97|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|198.00||||198.00|38.52|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHNET [1495]|HEALTHNET [149500]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198.00||||198.00|52.48|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|198.00||||198.00|99.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|TRUSTMARK [2030]|STARMARK [203000]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198.00||||198.00|50.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198.00||||198.00|54.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UMR [2035]|UMR OPTIONS [203501]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198.00||||198.00|72.97|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198.00||||198.00|41.58|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198.00||||198.00|128.7|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198.00||||198.00|94.94|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|||198.00||||198.00|59.4|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198.00||||198.00|33.69|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198.00||||198.00|49.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198.00||||198.00|30.98|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CHAMPVA [1240]|CHAMP VA [124000]|198.00||||198.00|148.5|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|198.00||||198.00|71.85|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CORESOURCE [1315]|CORESOURCE [131500]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|GEHA [1415]|GEHA [141500]|198.00||||198.00|178.2|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|198.00||||198.00|35.02|198|30.98 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA [1015]|AETNA ACO WILCO [101532]|198.00||||198.00||| 42097533|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|198.00||||198.00||| 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|285.00||||285.00|48.91|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|GEHA [1415]|GEHA [141500]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|285.00||||285.00|39.78|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|285.00||||285.00|48.16|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|285.00||||285.00|213.75|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|285.00||||285.00|35.19|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|285.00||||285.00|38.27|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|||285.00||||285.00|85.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|285.00||||285.00|136.66|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|285.00||||285.00|185.25|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|285.00||||285.00|285|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|285.00||||285.00|59.85|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|UMR [2035]|UMR OPTIONS [203501]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|285.00||||285.00|34.17|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|285.00||||285.00|122.55|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|285.00||||285.00|36.85|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|285.00||||285.00|38.27|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|285.00||||285.00|100.04|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|285.00||||285.00|36.85|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|285.00||||285.00|142.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|285.00||||285.00|171|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|285.00||||285.00|142.79|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|285.00||||285.00|122.55|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|285.00||||285.00|121.41|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|285.00||||285.00|36.95|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|285.00||||285.00|156|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MULTIPLAN [1680]|HMA [168003]|285.00||||285.00|50.25|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|285.00||||285.00|48.16|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|285.00||||285.00|256.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|285.00||||285.00|33.5|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|285.00||||285.00|43.76|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|285.00||||285.00|35.18|285|33.5 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|285.00||||285.00||| 42097535|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PT ADL 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|285.00||||285.00||| 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135.00||||135.00|67.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135.00||||135.00|81|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135.00||||135.00|33.9|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135.00||||135.00|58.05|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135.00||||135.00|67.64|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135.00||||135.00|47.39|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135.00||||135.00|57.51|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135.00||||135.00|35.52|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135.00||||135.00|35.52|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MULTIPLAN [1680]|HMA [168003]|135.00||||135.00|48.44|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135.00||||135.00|32.94|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UMR [2035]|UMR OPTIONS [203501]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135.00||||135.00|28.35|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135.00||||135.00|87.75|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135.00||||135.00|46.42|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135.00||||135.00|35.12|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|135.00||||135.00|101.25|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135.00||||135.00|36.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135.00||||135.00|135|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|GEHA [1415]|GEHA [141500]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135.00||||135.00|46.42|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135.00||||135.00|32.3|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135.00||||135.00|33.92|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135.00||||135.00|35.12|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|||135.00||||135.00|40.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135.00||||135.00|64.73|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135.00||||135.00|135|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135.00||||135.00|32.29|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135.00||||135.00|47.14|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135.00||||135.00|58.05|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135.00||||135.00|40.15|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135.00||||135.00|121.5|135|28.35 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|135.00||||135.00||| 42097537|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135.00||||135.00||| 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|263.00||||263.00|37.45|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|GEHA [1415]|GEHA [141500]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|263.00||||263.00|46.88|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|263.00||||263.00|197.25|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|||263.00||||263.00|78.9|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263.00||||263.00|126.11|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263.00||||263.00|263|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263.00||||263.00|47.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UMR [2035]|UMR OPTIONS [203501]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263.00||||263.00|33.26|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263.00||||263.00|113.09|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|263.00||||263.00|46.88|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MULTIPLAN [1680]|HMA [168003]|263.00||||263.00|48.92|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263.00||||263.00|55.23|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263.00||||263.00|33.15|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263.00||||263.00|170.95|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|263.00||||263.00|156|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263.00||||263.00|36.03|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263.00||||263.00|34.8|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263.00||||263.00|35.87|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263.00||||263.00|36.03|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263.00||||263.00|113.09|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|263.00||||263.00|41.19|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|263.00||||263.00|131.76|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263.00||||263.00|92.31|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|263.00||||263.00|112.04|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263.00||||263.00|34.24|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263.00||||263.00|157.8|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263.00||||263.00|35.87|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263.00||||263.00|236.7|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263.00||||263.00|32.61|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263.00||||263.00|131.5|263|32.61 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|263.00||||263.00||| 42097542|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|263.00||||263.00||| 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4317.00||||4317.00|421.76|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4317.00||||4317.00|174.64|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4317.00||||4317.00|1856.31|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4317.00||||4317.00|137.06|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4317.00||||4317.00|182.96|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4317.00||||4317.00|132.37|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4317.00||||4317.00|156|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4317.00||||4317.00|2162.82|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MULTIPLAN [1680]|IHC HS [168011]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4317.00||||4317.00|239.11|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MULTIPLAN [1680]|HMA [168003]|4317.00||||4317.00|249.48|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|HEALTHNET [1495]|HEALTHNET [149500]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4317.00||||4317.00|156.71|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4317.00||||4317.00|169.65|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4317.00||||4317.00|242.83|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4317.00||||4317.00|4317|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4317.00||||4317.00|1515.27|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4317.00||||4317.00|1839.04|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|TRUSTMARK [2030]|STARMARK [203000]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4317.00||||4317.00|2590.2|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4317.00||||4317.00|2806.05|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4317.00||||4317.00|2070|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|UMR [2035]|UMR OPTIONS [203501]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|||4317.00||||4317.00|1295.1|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4317.00||||4317.00|1856.31|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4317.00||||4317.00|137.06|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4317.00||||4317.00|182.96|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4317.00||||4317.00|166.32|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4317.00||||4317.00|126.07|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|CHAMPVA [1240]|CHAMP VA [124000]|4317.00||||4317.00|3237.75|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4317.00||||4317.00|239.11|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|CORESOURCE [1315]|CORESOURCE [131500]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4317.00||||4317.00|906.57|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|GEHA [1415]|GEHA [141500]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4317.00||||4317.00|3885.3|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4317.00||||4317.00|142.46|4317|126.07 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|AETNA [1015]|AETNA ACO WILCO [101532]|4317.00||||4317.00||| 42097597|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDE SELECTIVE 1ST 20 SQ CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4317.00||||4317.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4369.00||||4369.00|142.46|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CORESOURCE [1315]|CORESOURCE [131500]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4369.00||||4369.00|126.07|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|||4369.00||||4369.00|1310.7|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4369.00||||4369.00|2094.94|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4369.00||||4369.00|2839.85|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4369.00||||4369.00|4369|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4369.00||||4369.00|917.49|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UMR [2035]|UMR OPTIONS [203501]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4369.00||||4369.00|1878.67|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MULTIPLAN [1680]|IHC HS [168011]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHNET [1495]|HEALTHNET [149500]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CHAMPVA [1240]|CHAMP VA [124000]|4369.00||||4369.00|3276.75|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|TRUSTMARK [2030]|STARMARK [203000]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|GEHA [1415]|GEHA [141500]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4369.00||||4369.00|156|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4369.00||||4369.00|137.06|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4369.00||||4369.00|132.37|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4369.00||||4369.00|137.06|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4369.00||||4369.00|1878.67|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4369.00||||4369.00|156.71|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4369.00||||4369.00|2188.87|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4369.00||||4369.00|1533.52|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4369.00||||4369.00|1861.19|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4369.00||||4369.00|2621.4|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4369.00||||4369.00|3932.1|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4369.00||||4369.00|2184.5|4369|126.07 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA [1015]|AETNA ACO WILCO [101532]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MULTIPLAN [1680]|HMA [168003]|4369.00||||4369.00||| 42097598|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4369.00||||4369.00||| 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MULTIPLAN [1680]|IHC HS [168011]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MULTIPLAN [1680]|HMA [168003]|562.00||||562.00|249.48|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHNET [1495]|HEALTHNET [149500]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|FMH BENEFIT SERVICES [1390]|FMH [139000]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|FIRST HEALTH [1375]|QUALCHOICE [137513]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|562.00||||562.00|89.36|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|562.00||||562.00|241.66|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|562.00||||562.00|169.65|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UMR [2035]|UMR OPTIONS [203501]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|562.00||||562.00|242.83|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|562.00||||562.00|118.02|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|562.00||||562.00|562|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|562.00||||562.00|365.3|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|562.00||||562.00|269.48|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|||562.00||||562.00|168.6|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|562.00||||562.00|78.16|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|562.00||||562.00|239.11|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|562.00||||562.00|71.89|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CHAMPVA [1240]|CHAMP VA [124000]|562.00||||562.00|421.5|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|562.00||||562.00|239.11|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CORESOURCE [1315]|CORESOURCE [131500]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|GEHA [1415]|GEHA [141500]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|562.00||||562.00|81.24|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|562.00||||562.00|182.96|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|562.00||||562.00|421.76|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|562.00||||562.00|337.2|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|562.00||||562.00|174.64|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|562.00||||562.00|241.66|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|562.00||||562.00|281.56|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|562.00||||562.00|197.26|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|562.00||||562.00|239.41|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|562.00||||562.00|78.16|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|562.00||||562.00|182.96|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|562.00||||562.00|75.48|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|562.00||||562.00|166.32|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|562.00||||562.00|156|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|TRUSTMARK [2030]|STARMARK [203000]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|562.00||||562.00|505.8|562|71.89 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA [1015]|AETNA ACO WILCO [101532]|562.00||||562.00||| 42097602|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|562.00||||562.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|GEHA [1415]|GEHA [141500]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|648.00||||648.00|135.01|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CORESOURCE [1315]|CORESOURCE [131500]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CHAMPVA [1240]|CHAMP VA [124000]|648.00||||648.00|486|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|648.00||||648.00|119.48|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|||648.00||||648.00|194.4|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|648.00||||648.00|310.72|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|648.00||||648.00|648|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|648.00||||648.00|136.08|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UMR [2035]|UMR OPTIONS [203501]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|648.00||||648.00|278.64|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|648.00||||648.00|148.52|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHNET [1495]|HEALTHNET [149500]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MULTIPLAN [1680]|IHC HS [168011]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|648.00||||648.00|421.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|648.00||||648.00|129.9|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|TRUSTMARK [2030]|STARMARK [203000]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|648.00||||648.00|156|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|648.00||||648.00|125.46|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|648.00||||648.00|129.9|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|648.00||||648.00|278.64|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|648.00||||648.00|324.65|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|648.00||||648.00|227.45|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|648.00||||648.00|276.05|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|648.00||||648.00|388.8|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|648.00||||648.00|421.76|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|648.00||||648.00|583.2|648|119.48 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MULTIPLAN [1680]|HMA [168003]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA [1015]|AETNA ACO WILCO [101532]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|648.00||||648.00||| 42097605|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|648.00||||648.00||| 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1116.00||||1116.00|334.55|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1116.00||||1116.00|750.73|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1116.00||||1116.00|669.6|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1116.00||||1116.00|319.34|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1116.00||||1116.00|479.88|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1116.00||||1116.00|559.12|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1116.00||||1116.00|391.72|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1116.00||||1116.00|475.42|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1116.00||||1116.00|334.55|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1116.00||||1116.00|132.37|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1116.00||||1116.00|156|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MULTIPLAN [1680]|IHC HS [168011]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1116.00||||1116.00|437.23|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MULTIPLAN [1680]|HMA [168003]|1116.00||||1116.00|456.21|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHNET [1495]|HEALTHNET [149500]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1116.00||||1116.00|156.71|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1116.00||||1116.00|479.88|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1116.00||||1116.00|310.22|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|TRUSTMARK [2030]|STARMARK [203000]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UMR [2035]|UMR OPTIONS [203501]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1116.00||||1116.00|444.04|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1116.00||||1116.00|234.36|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1116.00||||1116.00|137.06|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1116.00||||1116.00|1116|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1116.00||||1116.00|725.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1116.00||||1116.00|535.12|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|||1116.00||||1116.00|334.8|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1116.00||||1116.00|137.06|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1116.00||||1116.00|304.14|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1116.00||||1116.00|126.07|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CHAMPVA [1240]|CHAMP VA [124000]|1116.00||||1116.00|837|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1116.00||||1116.00|437.23|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CORESOURCE [1315]|CORESOURCE [131500]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1116.00||||1116.00|142.46|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|GEHA [1415]|GEHA [141500]|1116.00||||1116.00|1004.4|1116|126.07 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA [1015]|AETNA ACO WILCO [101532]|1116.00||||1116.00||| 42097606|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1116.00||||1116.00||| 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|GEHA [1415]|GEHA [141500]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139.00||||139.00|39.78|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139.00||||139.00|49.09|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|139.00||||139.00|104.25|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.00||||139.00|35.19|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.00||||139.00|38.27|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|||139.00||||139.00|41.7|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.00||||139.00|66.65|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.00||||139.00|90.35|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.00||||139.00|139|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.00||||139.00|29.19|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UMR [2035]|UMR OPTIONS [203501]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.00||||139.00|34.83|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.00||||139.00|59.77|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139.00||||139.00|43.76|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.00||||139.00|49.86|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139.00||||139.00|49.09|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MULTIPLAN [1680]|HMA [168003]|139.00||||139.00|51.23|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139.00||||139.00|139|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.00||||139.00|36.95|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.00||||139.00|37.57|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.00||||139.00|38.27|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.00||||139.00|59.77|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139.00||||139.00|69.64|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.00||||139.00|48.79|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139.00||||139.00|59.21|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.00||||139.00|35.86|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.00||||139.00|83.4|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.00||||139.00|69.5|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.00||||139.00|37.57|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.00||||139.00|34.15|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.00||||139.00|125.1|139|29.19 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139.00||||139.00||| 42097750|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|139.00||||139.00||| 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.00||||242.00|121|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.00||||242.00|145.2|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.00||||242.00|104.06|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242.00||||242.00|121.24|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.00||||242.00|84.94|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.00||||242.00|39.65|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.00||||242.00|52.53|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.00||||242.00|38.3|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242.00||||242.00|68.65|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|HMA [168003]|242.00||||242.00|71.63|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242.00||||242.00|45.34|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.00||||242.00|104.06|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.00||||242.00|48.71|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UMR [2035]|UMR OPTIONS [203501]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242.00||||242.00|156|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.00||||242.00|69.72|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.00||||242.00|50.82|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.00||||242.00|242|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.00||||242.00|157.3|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242.00||||242.00|103.09|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.00||||242.00|50.14|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.00||||242.00|116.04|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|||242.00||||242.00|72.6|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.00||||242.00|39.65|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.00||||242.00|52.53|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.00||||242.00|47.75|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.00||||242.00|36.47|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|242.00||||242.00|181.5|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242.00||||242.00|68.65|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242.00||||242.00|41.21|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|GEHA [1415]|GEHA [141500]|242.00||||242.00|217.8|242|36.47 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|242.00||||242.00||| 42097760|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242.00||||242.00||| 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|GEHA [1415]|GEHA [141500]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242.00||||242.00|37.92|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242.00||||242.00|58.75|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.00||||242.00|33.55|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|||242.00||||242.00|72.6|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.00||||242.00|116.04|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.00||||242.00|157.3|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.00||||242.00|242|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.00||||242.00|59.67|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UMR [2035]|UMR OPTIONS [203501]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.00||||242.00|104.06|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242.00||||242.00|41.71|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.00||||242.00|41.69|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.00||||242.00|50.82|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242.00||||242.00|58.75|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|HMA [168003]|242.00||||242.00|61.31|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.00||||242.00|36.48|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242.00||||242.00|156|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.00||||242.00|35.23|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|242.00||||242.00|181.5|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.00||||242.00|44.96|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.00||||242.00|36.48|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.00||||242.00|104.06|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242.00||||242.00|121.24|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.00||||242.00|84.94|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242.00||||242.00|103.09|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.00||||242.00|42.91|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.00||||242.00|145.2|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.00||||242.00|121|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.00||||242.00|44.96|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.00||||242.00|40.87|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.00||||242.00|217.8|242|33.55 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242.00||||242.00||| 42097761|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|242.00||||242.00||| 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85.00||||85.00|56.06|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85.00||||85.00|42.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85.00||||85.00|51|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85.00||||85.00|53.51|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85.00||||85.00|36.55|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85.00||||85.00|29.84|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85.00||||85.00|36.21|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85.00||||85.00|57.93|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85.00||||85.00|56.06|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85.00||||85.00|55.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85.00||||85.00|85|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|TRUSTMARK [2030]|STARMARK [203000]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MULTIPLAN [1680]|IHC HS [168011]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85.00||||85.00|73.26|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MULTIPLAN [1680]|HMA [168003]|85.00||||85.00|76.44|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|FMH BENEFIT SERVICES [1390]|FMH [139000]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|HEALTHNET [1495]|HEALTHNET [149500]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|FIRST HEALTH [1375]|QUALCHOICE [137513]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85.00||||85.00|36.55|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85.00||||85.00|66.23|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85.00||||85.00|51.98|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|UMR [2035]|UMR OPTIONS [203501]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85.00||||85.00|74.4|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85.00||||85.00|17.85|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85.00||||85.00|85|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85.00||||85.00|42.59|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85.00||||85.00|55.25|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85.00||||85.00|40.76|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|||85.00||||85.00|25.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85.00||||85.00|57.93|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85.00||||85.00|50.96|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|CHAMPVA [1240]|CHAMP VA [124000]|85.00||||85.00|63.75|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85.00||||85.00|73.26|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|CORESOURCE [1315]|CORESOURCE [131500]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85.00||||85.00|60.21|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|GEHA [1415]|GEHA [141500]|85.00||||85.00|76.5|85|17.85 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|AETNA [1015]|AETNA ACO WILCO [101532]|85.00||||85.00||| 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85.00||||85.00||| 42097763|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN PT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85.00||||85.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|GEHA [1415]|GEHA [141500]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|164.00||||164.00|101.68|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CHAMPVA [1240]|CHAMP VA [124000]|164.00||||164.00|123|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|164.00||||164.00|41|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|164.00||||164.00|42.64|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|||164.00||||164.00|49.2|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|164.00||||164.00|78.64|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|164.00||||164.00|106.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|164.00||||164.00|34.44|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|164.00||||164.00|101.84|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UMR [2035]|UMR OPTIONS [203501]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|164.00||||164.00|70.52|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|FIRST HEALTH [1375]|QUALCHOICE [137513]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|FMH BENEFIT SERVICES [1390]|FMH [139000]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHNET [1495]|HEALTHNET [149500]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MULTIPLAN [1680]|IHC HS [168011]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|164.00||||164.00|101.68|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|164.00||||164.00|164|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|164.00||||164.00|42.64|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|TRUSTMARK [2030]|STARMARK [203000]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|164.00||||164.00|156|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CORESOURCE [1315]|CORESOURCE [131500]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|164.00||||164.00|69.86|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|164.00||||164.00|70.52|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|164.00||||164.00|82.16|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|164.00||||164.00|57.56|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|164.00||||164.00|98.4|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|164.00||||164.00|82|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|164.00||||164.00|147.6|164|34.44 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MULTIPLAN [1680]|HMA [168003]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA [1015]|AETNA ACO WILCO [101532]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|164.00||||164.00||| 42097799|EAP|0420 - PHYSICAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|164.00||||164.00||| 4210001|EAP||HH PT ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34 4210001|EAP||HH PT ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||139.73|34.93|69.87|29.34 4210001|EAP||HH PT ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34 4210001|EAP||HH PT ROUTINE VISIT|||||||139.73|41.92|69.87|29.34 4210001|EAP||HH PT ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73||| 4210001|EAP||HH PT ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|||||||139.73|41.92|69.87|29.34 4210002|EAP||HH PT INITIAL VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||139.73|34.93|69.87|29.34 4210002|EAP||HH PT INITIAL VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34 4210002|EAP||HH PT INITIAL VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34 4210002|EAP||HH PT INITIAL VISIT|GEHA [1415]|GEHA [141500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|UMR [2035]|UMR OPTIONS [203501]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MULTIPLAN [1680]|HMA [168003]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73||| 4210002|EAP||HH PT INITIAL VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||139.73|34.93|69.87|29.34 4210003|EAP||HH PTA ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34 4210003|EAP||HH PTA ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34 4210003|EAP||HH PTA ROUTINE VISIT|||||||139.73|41.92|69.87|29.34 4210003|EAP||HH PTA ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73||| 4210003|EAP||HH PTA ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|||||||139.73|41.92|69.87|29.34 4210004|EAP||HH PT MAINTENANCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||139.73|29.34|69.87|29.34 4210004|EAP||HH PT MAINTENANCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||139.73|34.93|69.87|29.34 4210004|EAP||HH PT MAINTENANCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||139.73|69.87|69.87|29.34 4210004|EAP||HH PT MAINTENANCE|GEHA [1415]|GEHA [141500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|CORESOURCE [1315]|CORESOURCE [131500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|CHAMPVA [1240]|CHAMP VA [124000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|UMR [2035]|UMR OPTIONS [203501]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MULTIPLAN [1680]|IHC HS [168011]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MULTIPLAN [1680]|HMA [168003]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|HEALTHNET [1495]|HEALTHNET [149500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|TRUSTMARK [2030]|STARMARK [203000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|AETNA [1015]|AETNA ACO WILCO [101532]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||139.73||| 4210004|EAP||HH PT MAINTENANCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||139.73||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.63||||34.63|14.89|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.63||||34.63|17.35|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.63||||34.63|14.75|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.63||||34.63|14.89|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.63||||34.63|17.35|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.63||||34.63|14.75|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.63||||34.63|14.89|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.63||||34.63|17.35|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.63||||34.63|12.16|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.63||||34.63|14.75|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.63||||34.63|20.78|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.63||||34.63|20.78|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.63||||34.63|14.89|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.63||||34.63|14.89|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.63||||34.63|14.89|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.63||||34.63|7.27|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.63||||34.63|7.27|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.63||||34.63|7.27|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.63||||34.63|22.51|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.63||||34.63|22.51|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.63||||34.63|22.51|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.63||||34.63|16.61|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.63||||34.63|16.61|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.63||||34.63|16.61|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|||34.63||||34.63|10.39|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|||34.63||||34.63|10.39|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.63||||34.63|20.78|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|||34.63||||34.63|10.39|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.63||||34.63|12.16|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.63||||34.63|12.16|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|34.63||||34.63|25.97|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|34.63||||34.63|25.97|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|34.63||||34.63|25.97|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|34.63||||34.63|31.17|31.17|7.27 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.63||||34.63||| 42162|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.63||||34.63||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|38.09||||38.09|28.57|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|38.09||||38.09|28.57|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|38.09||||38.09|28.57|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|||38.09||||38.09|11.43|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|||38.09||||38.09|11.43|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|||38.09||||38.09|11.43|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.09||||38.09|18.26|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.09||||38.09|18.26|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.09||||38.09|18.26|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.09||||38.09|24.76|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.09||||38.09|24.76|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.09||||38.09|8|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.09||||38.09|8|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.09||||38.09|16.38|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.09||||38.09|16.38|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.09||||38.09|16.38|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.09||||38.09|8|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.09||||38.09|24.76|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.09||||38.09|22.85|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.09||||38.09|22.85|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.09||||38.09|22.85|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.09||||38.09|16.38|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.09||||38.09|19.08|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.09||||38.09|13.37|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.09||||38.09|16.23|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.09||||38.09|16.38|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.09||||38.09|19.08|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.09||||38.09|13.37|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.09||||38.09|16.23|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.09||||38.09|16.38|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.09||||38.09|19.08|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.09||||38.09|13.37|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.09||||38.09|16.23|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.09||||38.09|34.28|34.28|8 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.09||||38.09||| 42163|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.09||||38.09|19.08|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.09||||38.09|13.37|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.09||||38.09|16.23|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.09||||38.09|19.08|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.09||||38.09|13.37|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.09||||38.09|16.23|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.09||||38.09|19.08|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.09||||38.09|13.37|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.09||||38.09|16.23|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.09||||38.09|22.85|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.09||||38.09|22.85|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.09||||38.09|22.85|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.09||||38.09|16.38|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.09||||38.09|16.38|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.09||||38.09|16.38|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.09||||38.09|8|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.09||||38.09|8|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.09||||38.09|8|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.09||||38.09|24.76|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.09||||38.09|24.76|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.09||||38.09|24.76|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.09||||38.09|18.26|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.09||||38.09|18.26|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.09||||38.09|18.26|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|||38.09||||38.09|11.43|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|||38.09||||38.09|11.43|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|||38.09||||38.09|11.43|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.09||||38.09|16.38|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.09||||38.09|16.38|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.09||||38.09|16.38|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|38.09||||38.09|28.57|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|38.09||||38.09|28.57|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|38.09||||38.09|28.57|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|38.09||||38.09|34.28|34.28|8 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.09||||38.09||| 42165|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.09||||38.09||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|GEHA [1415]|GEHA [141500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|34.63||||34.63|25.97|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|34.63||||34.63|25.97|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|||34.63||||34.63|10.39|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.63||||34.63|16.61|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.63||||34.63|22.51|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34.63||||34.63|22.51|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.63||||34.63|7.27|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34.63||||34.63|7.27|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.63||||34.63|14.89|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34.63||||34.63|14.89|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34.63||||34.63|16.61|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|||34.63||||34.63|10.39|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.63||||34.63|20.78|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34.63||||34.63|20.78|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.63||||34.63|14.89|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.63||||34.63|17.35|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.63||||34.63|12.16|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.63||||34.63|14.75|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34.63||||34.63|14.89|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34.63||||34.63|17.35|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34.63||||34.63|12.16|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34.63||||34.63|14.75|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|GEHA [1415]|GEHA [141500]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34.63||||34.63|31.17|31.17|7.27 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.63||||34.63||| 42166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREGABALIN 150 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34.63||||34.63||| 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|825.00||||825.00|92.57|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|825.00||||825.00|354.75|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|825.00||||825.00|413.33|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|825.00||||825.00|289.58|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|825.00||||825.00|351.45|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|825.00||||825.00|495|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|825.00||||825.00|88.36|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|825.00||||825.00|92.57|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|825.00||||825.00|29.01|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|825.00||||825.00|156|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|TRUSTMARK [2030]|STARMARK [203000]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MULTIPLAN [1680]|IHC HS [168011]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|825.00||||825.00|120.97|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|HEALTHNET [1495]|HEALTHNET [149500]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MULTIPLAN [1680]|HMA [168003]|825.00||||825.00|126.23|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|825.00||||825.00|354.75|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|825.00||||825.00|34.34|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|825.00||||825.00|85.83|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|UMR [2035]|UMR OPTIONS [203501]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|825.00||||825.00|122.86|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|825.00||||825.00|173.25|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|825.00||||825.00|30.04|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|825.00||||825.00|825|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|825.00||||825.00|536.25|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|825.00||||825.00|395.59|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|||825.00||||825.00|247.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|825.00||||825.00|412.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|825.00||||825.00|30.04|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|825.00||||825.00|84.15|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|825.00||||825.00|27.63|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|CHAMPVA [1240]|CHAMP VA [124000]|825.00||||825.00|618.75|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|825.00||||825.00|120.97|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|CORESOURCE [1315]|CORESOURCE [131500]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|825.00||||825.00|31.22|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|GEHA [1415]|GEHA [141500]|825.00||||825.00|742.5|825|27.63 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|AETNA [1015]|AETNA ACO WILCO [101532]|825.00||||825.00||| 42497161|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION LOW COMPLEXITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|825.00||||825.00||| 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|GEHA [1415]|GEHA [141500]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|CORESOURCE [1315]|CORESOURCE [131500]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|908.00||||908.00|120.97|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|CHAMPVA [1240]|CHAMP VA [124000]|908.00||||908.00|681|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|908.00||||908.00|60.06|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|908.00||||908.00|435.39|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|908.00||||908.00|590.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|908.00||||908.00|908|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|908.00||||908.00|190.68|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|908.00||||908.00|122.86|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|UMR [2035]|UMR OPTIONS [203501]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|908.00||||908.00|85.83|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|908.00||||908.00|68.67|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|908.00||||908.00|390.44|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|HEALTHNET [1495]|HEALTHNET [149500]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MULTIPLAN [1680]|IHC HS [168011]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|908.00||||908.00|120.97|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MULTIPLAN [1680]|HMA [168003]|908.00||||908.00|126.23|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|||908.00||||908.00|272.4|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|TRUSTMARK [2030]|STARMARK [203000]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|908.00||||908.00|156|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|908.00||||908.00|55.24|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|908.00||||908.00|58.01|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|908.00||||908.00|92.57|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|908.00||||908.00|62.42|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|908.00||||908.00|60.06|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|908.00||||908.00|88.36|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|908.00||||908.00|544.8|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|908.00||||908.00|390.44|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|908.00||||908.00|454.91|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|908.00||||908.00|318.71|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|908.00||||908.00|386.81|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|908.00||||908.00|454|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|908.00||||908.00|92.57|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|908.00||||908.00|84.15|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|908.00||||908.00|817.2|908|55.24 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|908.00||||908.00||| 42497162|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION MODERATE COMPLEXITY|AETNA [1015]|AETNA ACO WILCO [101532]|908.00||||908.00||| 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|998.00||||998.00|92.57|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|998.00||||998.00|499|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|998.00||||998.00|500|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|998.00||||998.00|350.3|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|998.00||||998.00|425.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|998.00||||998.00|88.36|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|998.00||||998.00|91.02|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|998.00||||998.00|92.57|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|998.00||||998.00|87.91|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|TRUSTMARK [2030]|STARMARK [203000]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|998.00||||998.00|120.97|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MULTIPLAN [1680]|HMA [168003]|998.00||||998.00|126.23|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|HEALTHNET [1495]|HEALTHNET [149500]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|998.00||||998.00|429.14|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|998.00||||998.00|104.06|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MULTIPLAN [1680]|IHC HS [168011]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|998.00||||998.00|85.83|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|UMR [2035]|UMR OPTIONS [203501]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|998.00||||998.00|156|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|998.00||||998.00|122.86|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|998.00||||998.00|209.58|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|998.00||||998.00|998|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|998.00||||998.00|598.8|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|998.00||||998.00|648.7|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|998.00||||998.00|478.54|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|||998.00||||998.00|299.4|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|998.00||||998.00|429.14|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|998.00||||998.00|91.02|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|998.00||||998.00|84.15|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|998.00||||998.00|83.72|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|CHAMPVA [1240]|CHAMP VA [124000]|998.00||||998.00|748.5|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|998.00||||998.00|120.97|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|CORESOURCE [1315]|CORESOURCE [131500]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|998.00||||998.00|94.6|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|GEHA [1415]|GEHA [141500]|998.00||||998.00|898.2|998|83.72 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|AETNA [1015]|AETNA ACO WILCO [101532]|998.00||||998.00||| 42497163|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT EVALUATION HIGH COMPLEXITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|998.00||||998.00||| 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|GEHA [1415]|GEHA [141500]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|316.00||||316.00|16.9|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|CORESOURCE [1315]|CORESOURCE [131500]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|CHAMPVA [1240]|CHAMP VA [124000]|316.00||||316.00|237|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|316.00||||316.00|14.96|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|316.00||||316.00|16.26|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|||316.00||||316.00|94.8|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|316.00||||316.00|151.52|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|316.00||||316.00|205.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|316.00||||316.00|316|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|316.00||||316.00|66.36|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|316.00||||316.00|84.01|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|UMR [2035]|UMR OPTIONS [203501]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|316.00||||316.00|58.69|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|316.00||||316.00|18.59|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|316.00||||316.00|135.88|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|HEALTHNET [1495]|HEALTHNET [149500]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MULTIPLAN [1680]|IHC HS [168011]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|316.00||||316.00|82.72|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MULTIPLAN [1680]|HMA [168003]|316.00||||316.00|86.31|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|TRUSTMARK [2030]|STARMARK [203000]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|316.00||||316.00|156|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|316.00||||316.00|82.72|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|316.00||||316.00|15.71|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|316.00||||316.00|63.29|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|316.00||||316.00|16.26|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|316.00||||316.00|60.42|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|316.00||||316.00|189.6|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|316.00||||316.00|135.88|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|316.00||||316.00|158.32|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|316.00||||316.00|110.92|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|316.00||||316.00|134.62|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|316.00||||316.00|158|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|316.00||||316.00|63.29|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|316.00||||316.00|57.54|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|316.00||||316.00|284.4|316|14.96 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|316.00||||316.00||| 42497164|EAP|0424 - PHYSICAL THERAPY-EVALUATION OR REEVALUATION|HC PT RE-EVALUATION EST PLAN|AETNA [1015]|AETNA ACO WILCO [101532]|316.00||||316.00||| 4300001|EAP||HH OT MAINTENANCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54 4300001|EAP||HH OT MAINTENANCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||140.68|35.17|70.34|29.54 4300001|EAP||HH OT MAINTENANCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54 4300001|EAP||HH OT MAINTENANCE|||||||140.68|42.2|70.34|29.54 4300001|EAP||HH OT MAINTENANCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MULTIPLAN [1680]|IHC HS [168011]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MULTIPLAN [1680]|HMA [168003]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|TRUSTMARK [2030]|STARMARK [203000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|UMR [2035]|UMR OPTIONS [203501]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|CHAMPVA [1240]|CHAMP VA [124000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68||| 4300001|EAP||HH OT MAINTENANCE|GEHA [1415]|GEHA [141500]|||||140.68||| 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|220.00||||220.00|22.5|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|GEHA [1415]|GEHA [141500]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CORESOURCE [1315]|CORESOURCE [131500]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|220.00||||220.00|19.39|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CHAMPVA [1240]|CHAMP VA [124000]|220.00||||220.00|165|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|220.00||||220.00|19.91|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|220.00||||220.00|21.65|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|||220.00||||220.00|66|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|220.00||||220.00|105.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|220.00||||220.00|143|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|220.00||||220.00|220|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|220.00||||220.00|46.2|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|220.00||||220.00|19.7|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UMR [2035]|UMR OPTIONS [203501]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|220.00||||220.00|13.76|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|220.00||||220.00|94.6|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|220.00||||220.00|24.76|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|FIRST HEALTH [1375]|QUALCHOICE [137513]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|FMH BENEFIT SERVICES [1390]|FMH [139000]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MULTIPLAN [1680]|IHC HS [168011]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|220.00||||220.00|19.39|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HEALTHNET [1495]|HEALTHNET [149500]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA [1015]|COVENTRY HEALTHCARE [101502]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|220.00||||220.00|57.2|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|TRUSTMARK [2030]|STARMARK [203000]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|220.00||||220.00|156|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|220.00||||220.00|20.91|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|220.00||||220.00|14.84|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|220.00||||220.00|21.65|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|220.00||||220.00|94.6|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|220.00||||220.00|110.22|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|220.00||||220.00|77.22|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|220.00||||220.00|93.72|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|220.00||||220.00|14.16|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|220.00||||220.00|132|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|220.00||||220.00|110|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|220.00||||220.00|14.84|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|220.00||||220.00|13.49|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|220.00||||220.00|198|220|13.49 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|MULTIPLAN [1680]|HMA [168003]|220.00||||220.00||| 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|220.00||||220.00||| 43000283|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECT STIM UNATTEND NON WOUND|AETNA [1015]|AETNA ACO WILCO [101532]|220.00||||220.00||| 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|728.00||||728.00|140.03|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|728.00||||728.00|321.78|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|728.00||||728.00|133.67|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|728.00||||728.00|313.04|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|728.00||||728.00|364.73|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|728.00||||728.00|255.53|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|728.00||||728.00|310.13|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|728.00||||728.00|93.71|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|728.00||||728.00|90.51|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|TRUSTMARK [2030]|STARMARK [203000]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|HEALTHNET [1495]|HEALTHNET [149500]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MULTIPLAN [1680]|IHC HS [168011]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|728.00||||728.00|183.01|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MULTIPLAN [1680]|HMA [168003]|728.00||||728.00|190.95|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|FMH BENEFIT SERVICES [1390]|FMH [139000]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|FIRST HEALTH [1375]|QUALCHOICE [137513]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|728.00||||728.00|107.14|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|728.00||||728.00|313.04|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|728.00||||728.00|129.85|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|UMR [2035]|UMR OPTIONS [203501]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|728.00||||728.00|185.86|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|728.00||||728.00|156|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|728.00||||728.00|140.03|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|728.00||||728.00|152.88|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|728.00||||728.00|728|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|728.00||||728.00|473.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|728.00||||728.00|349.08|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|||728.00||||728.00|218.4|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|728.00||||728.00|436.8|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|728.00||||728.00|93.71|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|728.00||||728.00|127.3|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|728.00||||728.00|86.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|CHAMPVA [1240]|CHAMP VA [124000]|728.00||||728.00|546|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|728.00||||728.00|183.01|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|CORESOURCE [1315]|CORESOURCE [131500]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|GEHA [1415]|GEHA [141500]|728.00||||728.00|655.2|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|728.00||||728.00|97.4|728|86.2 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|AETNA [1015]|AETNA ACO WILCO [101532]|728.00||||728.00||| 43029105|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT LONG ARM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|728.00||||728.00||| 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|HEALTHNET [1495]|HEALTHNET [149500]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|TRUSTMARK [2030]|STARMARK [203000]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1068.00||||1068.00|156|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1068.00||||1068.00|167.79|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1068.00||||1068.00|114.16|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1068.00||||1068.00|173.73|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MULTIPLAN [1680]|HMA [168003]|1068.00||||1068.00|155.68|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1068.00||||1068.00|459.24|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1068.00||||1068.00|535.07|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1068.00||||1068.00|374.87|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1068.00||||1068.00|454.97|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1068.00||||1068.00|108.97|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1068.00||||1068.00|640.8|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1068.00||||1068.00|254.52|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1068.00||||1068.00|114.16|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1068.00||||1068.00|1068|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1068.00||||1068.00|159.8|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1068.00||||1068.00|105.86|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1068.00||||1068.00|224.28|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1068.00||||1068.00|149.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1068.00||||1068.00|459.24|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|UMR [2035]|UMR OPTIONS [203501]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1068.00||||1068.00|173.73|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1068.00||||1068.00|198.62|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MULTIPLAN [1680]|IHC HS [168011]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1068.00||||1068.00|694.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|CORESOURCE [1315]|CORESOURCE [131500]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1068.00||||1068.00|103.78|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1068.00||||1068.00|151.52|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|CHAMPVA [1240]|CHAMP VA [124000]|1068.00||||1068.00|801|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1068.00||||1068.00|180.57|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1068.00||||1068.00|149.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|GEHA [1415]|GEHA [141500]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1068.00||||1068.00|512.11|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|||1068.00||||1068.00|320.4|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1068.00||||1068.00|961.2|1068|103.78 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|AETNA [1015]|AETNA ACO WILCO [101532]|1068.00||||1068.00||| 43029125|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM STATIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1068.00||||1068.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1850.00||||1850.00|254.52|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1850.00||||1850.00|887.08|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|CHAMPVA [1240]|CHAMP VA [124000]|1850.00||||1850.00|1387.5|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|TRUSTMARK [2030]|STARMARK [203000]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1850.00||||1850.00|388.5|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1850.00||||1850.00|1110|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1850.00||||1850.00|63.53|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1850.00||||1850.00|788.1|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1850.00||||1850.00|649.35|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1850.00||||1850.00|156|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1850.00||||1850.00|69.06|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1850.00||||1850.00|795.5|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|||1850.00||||1850.00|555|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1850.00||||1850.00|78.96|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1850.00||||1850.00|1202.5|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1850.00||||1850.00|795.5|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1850.00||||1850.00|66.71|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|CORESOURCE [1315]|CORESOURCE [131500]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1850.00||||1850.00|71.78|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|UMR [2035]|UMR OPTIONS [203501]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1850.00||||1850.00|1850|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|GEHA [1415]|GEHA [141500]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|HEALTHNET [1495]|HEALTHNET [149500]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1850.00||||1850.00|926.85|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MULTIPLAN [1680]|IHC HS [168011]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1850.00||||1850.00|1665|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1850.00||||1850.00|69.06|1850|63.53 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MULTIPLAN [1680]|HMA [168003]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|AETNA [1015]|AETNA ACO WILCO [101532]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1850.00||||1850.00||| 43029126|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT SHORT ARM DYNAMIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1850.00||||1850.00||| 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|571.00||||571.00|66.71|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|571.00||||571.00|245.53|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|571.00||||571.00|54.58|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|571.00||||571.00|286.07|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|571.00||||571.00|200.42|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|571.00||||571.00|156|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|571.00||||571.00|342.6|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|GEHA [1415]|GEHA [141500]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|571.00||||571.00|133.61|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|571.00||||571.00|69.06|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|571.00||||571.00|243.25|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|571.00||||571.00|71.78|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|571.00||||571.00|57.18|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|571.00||||571.00|57.18|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|571.00||||571.00|371.15|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|||571.00||||571.00|171.3|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|CHAMPVA [1240]|CHAMP VA [124000]|571.00||||571.00|428.25|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|571.00||||571.00|273.79|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|571.00||||571.00|74.72|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|571.00||||571.00|53.02|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|CORESOURCE [1315]|CORESOURCE [131500]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|571.00||||571.00|69.06|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|UMR [2035]|UMR OPTIONS [203501]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|HEALTHNET [1495]|HEALTHNET [149500]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|571.00||||571.00|245.53|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MULTIPLAN [1680]|IHC HS [168011]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|571.00||||571.00|78.96|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|571.00||||571.00|63.53|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|571.00||||571.00|571|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MULTIPLAN [1680]|HMA [168003]|571.00||||571.00|77.97|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|571.00||||571.00|51.98|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|571.00||||571.00|119.91|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|571.00||||571.00|75.89|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|TRUSTMARK [2030]|STARMARK [203000]|571.00||||571.00|513.9|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|571.00||||571.00|74.72|571|51.98 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|571.00||||571.00||| 43029130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY SPLINT FINGER STATIC|AETNA [1015]|AETNA ACO WILCO [101532]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|571.00||||571.00|200.42|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|571.00||||571.00|245.53|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|571.00||||571.00|286.07|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|571.00||||571.00|133.61|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|571.00||||571.00|243.25|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|571.00||||571.00|69.06|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|571.00||||571.00|342.6|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|571.00||||571.00|156|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|TRUSTMARK [2030]|STARMARK [203000]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|571.00||||571.00|371.15|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|571.00||||571.00|273.79|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|571.00||||571.00|119.91|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|UMR [2035]|UMR OPTIONS [203501]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|||571.00||||571.00|171.3|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|CORESOURCE [1315]|CORESOURCE [131500]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|571.00||||571.00|245.53|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MULTIPLAN [1680]|IHC HS [168011]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|571.00||||571.00|69.06|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|571.00||||571.00|66.71|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|GEHA [1415]|GEHA [141500]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|571.00||||571.00|78.96|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|571.00||||571.00|71.78|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|HEALTHNET [1495]|HEALTHNET [149500]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|CHAMPVA [1240]|CHAMP VA [124000]|571.00||||571.00|428.25|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|571.00||||571.00|571|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|571.00||||571.00|513.9|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|571.00||||571.00|63.53|571|63.53 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MULTIPLAN [1680]|HMA [168003]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|AETNA [1015]|AETNA ACO WILCO [101532]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|571.00||||571.00||| 43029131|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC APPLY FINGER SPLINT DYNAMIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|571.00||||571.00||| 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135.00||||135.00|92.13|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135.00||||135.00|92.13|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135.00||||135.00|47.06|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135.00||||135.00|47.39|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135.00||||135.00|67.64|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135.00||||135.00|58.05|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135.00||||135.00|81|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135.00||||135.00|57.51|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135.00||||135.00|49.3|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135.00||||135.00|49.3|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|GEHA [1415]|GEHA [141500]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135.00||||135.00|62.75|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135.00||||135.00|95.76|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CORESOURCE [1315]|CORESOURCE [131500]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135.00||||135.00|62.3|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|FIRST HEALTH [1375]|QUALCHOICE [137513]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CHAMPVA [1240]|CHAMP VA [124000]|135.00||||135.00|101.25|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135.00||||135.00|87.75|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135.00||||135.00|135|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135.00||||135.00|64.73|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135.00||||135.00|45.72|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|FMH BENEFIT SERVICES [1390]|FMH [139000]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135.00||||135.00|135|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MULTIPLAN [1680]|IHC HS [168011]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135.00||||135.00|62.3|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHNET [1495]|HEALTHNET [149500]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MULTIPLAN [1680]|HMA [168003]|135.00||||135.00|67.23|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UMR [2035]|UMR OPTIONS [203501]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|TRUSTMARK [2030]|STARMARK [203000]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135.00||||135.00|58.05|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135.00||||135.00|121.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|||135.00||||135.00|40.5|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135.00||||135.00|44.82|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135.00||||135.00|28.35|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135.00||||135.00|88.98|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135.00||||135.00|105.33|135|28.35 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135.00||||135.00||| 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135.00||||135.00||| 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135.00||||135.00||| 43090912|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG &/MNOMTRY 1ST 15 MIN CNTCT|AETNA [1015]|AETNA ACO WILCO [101532]|135.00||||135.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.00||||75.00|36.65|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.00||||75.00|31.95|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.00||||75.00|32.25|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.00||||75.00|26.33|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.00||||75.00|45|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHNET [1495]|HEALTHNET [149500]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.00||||75.00|48.75|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|TRUSTMARK [2030]|STARMARK [203000]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.00||||75.00|37.58|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MULTIPLAN [1680]|IHC HS [168011]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.00||||75.00|75|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.00||||75.00|15.75|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.00||||75.00|75|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.00||||75.00|35.96|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UMR [2035]|UMR OPTIONS [203501]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.00||||75.00|32.25|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CORESOURCE [1315]|CORESOURCE [131500]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.00||||75.00|37.94|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.00||||75.00|43.37|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CHAMPVA [1240]|CHAMP VA [124000]|75.00||||75.00|56.25|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.00||||75.00|37.94|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|||75.00||||75.00|22.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|GEHA [1415]|GEHA [141500]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.00||||75.00|67.5|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.00||||75.00|39.43|75|15.75 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MULTIPLAN [1680]|HMA [168003]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA [1015]|AETNA ACO WILCO [101532]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.00||||75.00||| 43090913|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC BFB TRAING W/EMG&/MNMTRY EA ADDL 15 MIN CNTCT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.00||||75.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|GEHA [1415]|GEHA [141500]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83.00||||83.00|21.58|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|CORESOURCE [1315]|CORESOURCE [131500]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|83.00||||83.00|51.46|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|83.00||||83.00|23.01|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83.00||||83.00|39.8|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|UMR [2035]|UMR OPTIONS [203501]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|83.00||||83.00|35.36|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|83.00||||83.00|83|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|||83.00||||83.00|24.9|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MULTIPLAN [1680]|IHC HS [168011]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHNET [1495]|HEALTHNET [149500]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83.00||||83.00|21.58|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|83.00||||83.00|51.46|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|83.00||||83.00|25.31|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|TRUSTMARK [2030]|STARMARK [203000]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83.00||||83.00|83|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.00||||83.00|35.69|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83.00||||83.00|53.95|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83.00||||83.00|49.8|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83.00||||83.00|22.14|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83.00||||83.00|51.54|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83.00||||83.00|35.69|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83.00||||83.00|20.36|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83.00||||83.00|74.7|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|CHAMPVA [1240]|CHAMP VA [124000]|83.00||||83.00|62.25|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83.00||||83.00|41.5|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83.00||||83.00|29.13|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83.00||||83.00|21.38|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83.00||||83.00|17.43|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|83.00||||83.00|41.58|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83.00||||83.00|22.14|83|17.43 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MULTIPLAN [1680]|HMA [168003]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|AETNA [1015]|AETNA ACO WILCO [101532]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83.00||||83.00||| 43097010|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC HOT/COLD PACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83.00||||83.00||| 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118.00||||118.00|59|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118.00||||118.00|41.42|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118.00||||118.00|59.12|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118.00||||118.00|50.74|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118.00||||118.00|70.8|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118.00||||118.00|6.47|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118.00||||118.00|50.27|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|FIRST HEALTH [1375]|QUALCHOICE [137513]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHNET [1495]|HEALTHNET [149500]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|TRUSTMARK [2030]|STARMARK [203000]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118.00||||118.00|118|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MULTIPLAN [1680]|HMA [168003]|118.00||||118.00|8.82|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118.00||||118.00|56.58|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|GEHA [1415]|GEHA [141500]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118.00||||118.00|9.17|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118.00||||118.00|6|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118.00||||118.00|50.74|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|||118.00||||118.00|35.4|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|UMR [2035]|UMR OPTIONS [203501]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118.00||||118.00|7.75|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118.00||||118.00|6.47|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118.00||||118.00|76.7|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118.00||||118.00|8.45|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118.00||||118.00|8.34|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118.00||||118.00|8.45|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|CHAMPVA [1240]|CHAMP VA [124000]|118.00||||118.00|88.5|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118.00||||118.00|8.58|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MULTIPLAN [1680]|IHC HS [168011]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118.00||||118.00|8.02|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118.00||||118.00|8.02|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118.00||||118.00|6.17|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118.00||||118.00|7.38|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|CORESOURCE [1315]|CORESOURCE [131500]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118.00||||118.00|118|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|FMH BENEFIT SERVICES [1390]|FMH [139000]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118.00||||118.00|106.2|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118.00||||118.00|5.88|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118.00||||118.00|24.78|118|5.88 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|AETNA [1015]|AETNA ACO WILCO [101532]|118.00||||118.00||| 43097018|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PARAFFIN BATH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118.00||||118.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|283.00||||283.00|135.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|UMR [2035]|UMR OPTIONS [203501]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|283.00||||283.00|19.32|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|283.00||||283.00|17.1|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|GEHA [1415]|GEHA [141500]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|283.00||||283.00|18.59|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|||283.00||||283.00|84.9|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|283.00||||283.00|183.95|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|283.00||||283.00|283|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|283.00||||283.00|21.26|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|283.00||||283.00|121.69|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|HEALTHNET [1495]|HEALTHNET [149500]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|FMH BENEFIT SERVICES [1390]|FMH [139000]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MULTIPLAN [1680]|IHC HS [168011]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|FIRST HEALTH [1375]|QUALCHOICE [137513]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|TRUSTMARK [2030]|STARMARK [203000]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|283.00||||283.00|120.56|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|283.00||||283.00|156|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|283.00||||283.00|17.95|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|283.00||||283.00|121.69|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|CHAMPVA [1240]|CHAMP VA [124000]|283.00||||283.00|212.25|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|CORESOURCE [1315]|CORESOURCE [131500]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|283.00||||283.00|141.78|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|283.00||||283.00|99.33|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|283.00||||283.00|18.59|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|283.00||||283.00|59.43|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|283.00||||283.00|169.8|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|283.00||||283.00|141.5|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|283.00||||283.00|254.7|283|17.1 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MULTIPLAN [1680]|HMA [168003]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|AETNA [1015]|AETNA ACO WILCO [101532]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|283.00||||283.00||| 43097022|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHIRLPOOL THERAPY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|283.00||||283.00||| 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|133.00||||133.00|56.66|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|133.00||||133.00|66.63|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133.00||||133.00|16.17|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133.00||||133.00|57.19|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133.00||||133.00|46.68|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133.00||||133.00|20.41|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133.00||||133.00|16.17|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MULTIPLAN [1680]|HMA [168003]|133.00||||133.00|22.05|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133.00||||133.00|15.44|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|133.00||||133.00|133|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|TRUSTMARK [2030]|STARMARK [203000]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHNET [1495]|HEALTHNET [149500]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MULTIPLAN [1680]|IHC HS [168011]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|133.00||||133.00|21.13|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|FMH BENEFIT SERVICES [1390]|FMH [139000]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133.00||||133.00|57.19|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|FIRST HEALTH [1375]|QUALCHOICE [137513]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UMR [2035]|UMR OPTIONS [203501]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133.00||||133.00|66.5|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133.00||||133.00|14.99|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133.00||||133.00|21.46|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133.00||||133.00|27.93|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133.00||||133.00|133|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133.00||||133.00|63.77|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133.00||||133.00|18.77|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133.00||||133.00|86.45|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|||133.00||||133.00|39.9|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133.00||||133.00|19.71|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133.00||||133.00|20.41|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CORESOURCE [1315]|CORESOURCE [131500]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133.00||||133.00|79.8|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|133.00||||133.00|21.13|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|GEHA [1415]|GEHA [141500]|133.00||||133.00|119.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|CHAMPVA [1240]|CHAMP VA [124000]|133.00||||133.00|99.75|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|133.00||||133.00|21.21|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|133.00||||133.00|14.7|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|133.00||||133.00|23.33|133|14.7 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|AETNA [1015]|AETNA ACO WILCO [101532]|133.00||||133.00||| 43097032|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ELECTRICAL STIM ATTENDED 15 MN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|133.00||||133.00||| 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|GEHA [1415]|GEHA [141500]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|424.00||||424.00|29.65|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|424.00||||424.00|275.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|||424.00||||424.00|127.2|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|424.00||||424.00|26.91|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|424.00||||424.00|203.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|424.00||||424.00|89.04|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|424.00||||424.00|148.82|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|424.00||||424.00|182.32|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|424.00||||424.00|180.62|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|424.00||||424.00|212.42|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|424.00||||424.00|29.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|424.00||||424.00|29.2|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|424.00||||424.00|29.2|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|424.00||||424.00|254.4|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|424.00||||424.00|20.72|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|424.00||||424.00|156|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UMR [2035]|UMR OPTIONS [203501]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|424.00||||424.00|25.89|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|424.00||||424.00|25|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|424.00||||424.00|22.34|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|424.00||||424.00|424|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|424.00||||424.00|212|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MULTIPLAN [1680]|HMA [168003]|424.00||||424.00|30.47|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|424.00||||424.00|318|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|424.00||||424.00|20.31|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|424.00||||424.00|23.81|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|424.00||||424.00|21.33|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|424.00||||424.00|182.32|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|424.00||||424.00|22.34|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|424.00||||424.00|25.89|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|424.00||||424.00|381.6|424|20.31 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|424.00||||424.00||| 43097033|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC IONTOPHORESIS 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|424.00||||424.00||| 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|224.00||||224.00|156|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|224.00||||224.00|15.66|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|224.00||||224.00|134.4|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|224.00||||224.00|15.66|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|224.00||||224.00|112|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|224.00||||224.00|96.32|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|224.00||||224.00|14.95|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|224.00||||224.00|112.22|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|224.00||||224.00|78.62|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|224.00||||224.00|15.66|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|224.00||||224.00|20.47|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|224.00||||224.00|20.79|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|224.00||||224.00|96.32|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|224.00||||224.00|14.52|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|UMR [2035]|UMR OPTIONS [203501]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|224.00||||224.00|47.04|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MULTIPLAN [1680]|HMA [168003]|224.00||||224.00|21.36|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|224.00||||224.00|15.13|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|224.00||||224.00|95.42|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|224.00||||224.00|145.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|224.00||||224.00|224|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|224.00||||224.00|14.41|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|224.00||||224.00|107.41|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|224.00||||224.00|17.91|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|||224.00||||224.00|67.2|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|GEHA [1415]|GEHA [141500]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|224.00||||224.00|16.28|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|224.00||||224.00|168|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|224.00||||224.00|20.47|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|224.00||||224.00|14.24|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|224.00||||224.00|201.6|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|224.00||||224.00|15.66|224|14.24 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|224.00||||224.00||| 43097035|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ULTRASOUND 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|224.00||||224.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81.00||||81.00|16.49|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81.00||||81.00|50.22|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|CORESOURCE [1315]|CORESOURCE [131500]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81.00||||81.00|14.6|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81.00||||81.00|21.06|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|||81.00||||81.00|24.3|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81.00||||81.00|34.51|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81.00||||81.00|81|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|UMR [2035]|UMR OPTIONS [203501]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81.00||||81.00|50.3|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81.00||||81.00|34.83|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|FIRST HEALTH [1375]|QUALCHOICE [137513]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MULTIPLAN [1680]|IHC HS [168011]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|HEALTHNET [1495]|HEALTHNET [149500]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81.00||||81.00|50.22|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81.00||||81.00|21.06|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81.00||||81.00|15.87|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81.00||||81.00|40.58|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81.00||||81.00|18.15|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|TRUSTMARK [2030]|STARMARK [203000]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81.00||||81.00|52.65|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81.00||||81.00|48.6|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81.00||||81.00|15.87|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|FMH BENEFIT SERVICES [1390]|FMH [139000]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81.00||||81.00|81|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81.00||||81.00|15.33|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81.00||||81.00|34.83|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81.00||||81.00|38.84|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|GEHA [1415]|GEHA [141500]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|CHAMPVA [1240]|CHAMP VA [124000]|81.00||||81.00|60.75|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81.00||||81.00|40.5|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81.00||||81.00|28.43|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81.00||||81.00|17.01|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81.00||||81.00|72.9|81|14.6 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MULTIPLAN [1680]|HMA [168003]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|AETNA [1015]|AETNA ACO WILCO [101532]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81.00||||81.00||| 43097039|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MODALITY UNLISTED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81.00||||81.00||| 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|193.00||||193.00|115.8|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|193.00||||193.00|31.73|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|193.00||||193.00|82.99|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|193.00||||193.00|82.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|193.00||||193.00|67.74|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|193.00||||193.00|36.03|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|193.00||||193.00|96.69|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|193.00||||193.00|33.24|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|193.00||||193.00|156|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|193.00||||193.00|33.24|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|193.00||||193.00|43.44|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|193.00||||193.00|41.19|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|193.00||||193.00|82.99|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|193.00||||193.00|30.82|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UMR [2035]|UMR OPTIONS [203501]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|193.00||||193.00|34.8|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|193.00||||193.00|44.12|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|193.00||||193.00|40.53|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MULTIPLAN [1680]|HMA [168003]|193.00||||193.00|45.33|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|193.00||||193.00|193|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|193.00||||193.00|92.54|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|193.00||||193.00|33.15|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|193.00||||193.00|125.45|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|193.00||||193.00|96.5|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|193.00||||193.00|36.03|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|193.00||||193.00|37.45|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|GEHA [1415]|GEHA [141500]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|193.00||||193.00|43.44|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|193.00||||193.00|144.75|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|||193.00||||193.00|57.9|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|193.00||||193.00|173.7|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|193.00||||193.00|30.22|193|30.22 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|193.00||||193.00||| 43097110|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC EXERCISE THERAPEUTIC 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|193.00||||193.00||| 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|GEHA [1415]|GEHA [141500]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|203.00||||203.00|49.81|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|203.00||||203.00|34.37|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|203.00||||203.00|38.84|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|203.00||||203.00|37.37|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|||203.00||||203.00|60.9|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UMR [2035]|UMR OPTIONS [203501]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|203.00||||203.00|87.29|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|203.00||||203.00|42.73|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|203.00||||203.00|49.81|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MULTIPLAN [1680]|HMA [168003]|203.00||||203.00|51.98|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|203.00||||203.00|35.34|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|203.00||||203.00|131.95|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|203.00||||203.00|36.38|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|203.00||||203.00|156|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|203.00||||203.00|97.34|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|203.00||||203.00|36.09|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|203.00||||203.00|38.12|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|203.00||||203.00|101.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|203.00||||203.00|71.25|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|203.00||||203.00|101.5|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|203.00||||203.00|152.25|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|203.00||||203.00|50.59|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|203.00||||203.00|121.8|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|203.00||||203.00|203|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|203.00||||203.00|86.48|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|203.00||||203.00|182.7|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|203.00||||203.00|34.65|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|203.00||||203.00|87.29|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|203.00||||203.00|38.12|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|203.00||||203.00|42.63|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|203.00||||203.00|37.37|203|34.37 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|203.00||||203.00||| 43097112|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEUROMUSCULAR RE-ED 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|203.00||||203.00||| 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|191.00||||191.00|54.43|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHNET [1495]|HEALTHNET [149500]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|FIRST HEALTH [1375]|QUALCHOICE [137513]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|191.00||||191.00|46.28|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191.00||||191.00|38.62|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UMR [2035]|UMR OPTIONS [203501]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191.00||||191.00|55.28|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|FMH BENEFIT SERVICES [1390]|FMH [139000]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191.00||||191.00|82.13|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MULTIPLAN [1680]|HMA [168003]|191.00||||191.00|56.79|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191.00||||191.00|40.11|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MULTIPLAN [1680]|IHC HS [168011]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191.00||||191.00|191|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191.00||||191.00|37.23|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191.00||||191.00|91.58|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|||191.00||||191.00|57.3|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191.00||||191.00|40.48|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CHAMPVA [1240]|CHAMP VA [124000]|191.00||||191.00|143.25|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|191.00||||191.00|42.07|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CORESOURCE [1315]|CORESOURCE [131500]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|191.00||||191.00|54.43|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191.00||||191.00|124.15|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|GEHA [1415]|GEHA [141500]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|191.00||||191.00|81.37|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191.00||||191.00|82.13|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191.00||||191.00|41.65|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191.00||||191.00|95.5|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191.00||||191.00|114.6|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191.00||||191.00|39.75|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|191.00||||191.00|95.69|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191.00||||191.00|67.04|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191.00||||191.00|40.48|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191.00||||191.00|41.65|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191.00||||191.00|39.09|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|191.00||||191.00|156|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|TRUSTMARK [2030]|STARMARK [203000]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191.00||||191.00|171.9|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|191.00||||191.00|37.86|191|37.23 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|191.00||||191.00||| 43097113|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC AQUATIC THERAPY/EXERCISE 15 MN|AETNA [1015]|AETNA ACO WILCO [101532]|191.00||||191.00||| 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|222.00||||222.00|32.92|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|GEHA [1415]|GEHA [141500]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|222.00||||222.00|42.97|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|222.00||||222.00|166.5|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|222.00||||222.00|29.13|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|||222.00||||222.00|66.6|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|222.00||||222.00|106.45|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|222.00||||222.00|222|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|222.00||||222.00|43.64|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|222.00||||222.00|30.49|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|222.00||||222.00|42.97|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MULTIPLAN [1680]|HMA [168003]|222.00||||222.00|44.84|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|222.00||||222.00|95.46|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|222.00||||222.00|144.3|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UMR [2035]|UMR OPTIONS [203501]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|222.00||||222.00|31.67|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|222.00||||222.00|36.21|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|222.00||||222.00|156|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|222.00||||222.00|46.62|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|222.00||||222.00|30.59|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|222.00||||222.00|32.88|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|222.00||||222.00|31.67|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|222.00||||222.00|95.46|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|222.00||||222.00|31.38|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|222.00||||222.00|32.88|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|222.00||||222.00|29.89|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|222.00||||222.00|111|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|222.00||||222.00|94.57|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|222.00||||222.00|77.92|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|222.00||||222.00|133.2|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|222.00||||222.00|111.22|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|222.00||||222.00|199.8|222|29.13 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|222.00||||222.00||| 43097116|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC GAIT TRAINING 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|222.00||||222.00||| 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72.00||||72.00|26.21|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72.00||||72.00|36.07|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72.00||||72.00|25.27|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72.00||||72.00|30.67|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72.00||||72.00|43.2|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72.00||||72.00|25.02|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72.00||||72.00|28.47|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72.00||||72.00|26.21|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72.00||||72.00|72|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|TRUSTMARK [2030]|STARMARK [203000]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MULTIPLAN [1680]|IHC HS [168011]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72.00||||72.00|33.12|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|FMH BENEFIT SERVICES [1390]|FMH [139000]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72.00||||72.00|32.55|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72.00||||72.00|30.96|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72.00||||72.00|24.31|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|FIRST HEALTH [1375]|QUALCHOICE [137513]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|UMR [2035]|UMR OPTIONS [203501]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MULTIPLAN [1680]|HMA [168003]|72.00||||72.00|35.75|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72.00||||72.00|33.36|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|HEALTHNET [1495]|HEALTHNET [149500]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72.00||||72.00|15.12|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72.00||||72.00|27.49|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72.00||||72.00|72|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72.00||||72.00|34.52|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72.00||||72.00|46.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|||72.00||||72.00|21.6|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72.00||||72.00|28.47|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72.00||||72.00|30.96|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72.00||||72.00|29.59|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|GEHA [1415]|GEHA [141500]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|CHAMPVA [1240]|CHAMP VA [124000]|72.00||||72.00|54|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72.00||||72.00|33.12|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72.00||||72.00|23.83|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|CORESOURCE [1315]|CORESOURCE [131500]|72.00||||72.00|64.8|72|15.12 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|AETNA [1015]|AETNA ACO WILCO [101532]|72.00||||72.00||| 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72.00||||72.00||| 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72.00||||72.00||| 43097129|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72.00||||72.00||| 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|CORESOURCE [1315]|CORESOURCE [131500]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69.00||||69.00|32.12|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|CHAMPVA [1240]|CHAMP VA [124000]|69.00||||69.00|51.75|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69.00||||69.00|27.25|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|||69.00||||69.00|20.7|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69.00||||69.00|33.09|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69.00||||69.00|69|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69.00||||69.00|14.49|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|UMR [2035]|UMR OPTIONS [203501]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69.00||||69.00|23.57|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69.00||||69.00|29.67|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69.00||||69.00|31.16|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|FMH BENEFIT SERVICES [1390]|FMH [139000]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MULTIPLAN [1680]|IHC HS [168011]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69.00||||69.00|32.12|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|FIRST HEALTH [1375]|QUALCHOICE [137513]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MULTIPLAN [1680]|HMA [168003]|69.00||||69.00|34.67|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|HEALTHNET [1495]|HEALTHNET [149500]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|TRUSTMARK [2030]|STARMARK [203000]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69.00||||69.00|44.85|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69.00||||69.00|32.35|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69.00||||69.00|69|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69.00||||69.00|26.31|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69.00||||69.00|25.42|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69.00||||69.00|24.22|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69.00||||69.00|29.67|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|GEHA [1415]|GEHA [141500]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69.00||||69.00|28.32|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69.00||||69.00|25.42|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69.00||||69.00|23.11|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69.00||||69.00|62.1|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69.00||||69.00|41.4|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69.00||||69.00|24.27|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69.00||||69.00|34.57|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69.00||||69.00|27.25|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69.00||||69.00|29.39|69|14.49 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69.00||||69.00||| 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69.00||||69.00||| 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|AETNA [1015]|AETNA ACO WILCO [101532]|69.00||||69.00||| 43097130|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69.00||||69.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|97.00||||97.00|48.6|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|97.00||||97.00|48.5|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|97.00||||97.00|41.71|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|97.00||||97.00|34.05|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|97.00||||97.00|41.32|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|97.00||||97.00|58.2|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|97.00||||97.00|19.17|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|97.00||||97.00|18.51|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MULTIPLAN [1680]|IHC HS [168011]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHNET [1495]|HEALTHNET [149500]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|FMH BENEFIT SERVICES [1390]|FMH [139000]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|FIRST HEALTH [1375]|QUALCHOICE [137513]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97.00||||97.00|41.71|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|97.00||||97.00|21.92|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UMR [2035]|UMR OPTIONS [203501]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|97.00||||97.00|97|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|97.00||||97.00|20.37|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|97.00||||97.00|97|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|97.00||||97.00|63.05|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97.00||||97.00|46.51|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|TRUSTMARK [2030]|STARMARK [203000]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|||97.00||||97.00|29.1|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|97.00||||97.00|19.17|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CHAMPVA [1240]|CHAMP VA [124000]|97.00||||97.00|72.75|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|97.00||||97.00|19.92|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|GEHA [1415]|GEHA [141500]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CORESOURCE [1315]|CORESOURCE [131500]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|97.00||||97.00|17.63|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|97.00||||97.00|87.3|97|17.63 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA [1015]|AETNA ACO WILCO [101532]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MULTIPLAN [1680]|HMA [168003]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|97.00||||97.00||| 43097139|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROCEDURE UNLISTED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|97.00||||97.00||| 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|GEHA [1415]|GEHA [141500]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|248.00||||248.00|34.96|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|248.00||||248.00|40.05|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|248.00||||248.00|30.94|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|||248.00||||248.00|74.4|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|248.00||||248.00|118.92|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|248.00||||248.00|161.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|248.00||||248.00|248|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|248.00||||248.00|40.05|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|248.00||||248.00|32.49|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|248.00||||248.00|30.65|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|248.00||||248.00|33.64|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|248.00||||248.00|29.25|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|248.00||||248.00|148.8|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|248.00||||248.00|106.64|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|248.00||||248.00|156|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|248.00||||248.00|124.25|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|248.00||||248.00|87.05|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|248.00||||248.00|33.64|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|248.00||||248.00|105.65|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|248.00||||248.00|124|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|248.00||||248.00|30.65|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MULTIPLAN [1680]|HMA [168003]|248.00||||248.00|41.79|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|248.00||||248.00|186|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|248.00||||248.00|38.46|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|248.00||||248.00|106.64|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|248.00||||248.00|28.42|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|248.00||||248.00|27.86|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|UMR [2035]|UMR OPTIONS [203501]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|248.00||||248.00|40.68|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|248.00||||248.00|223.2|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|248.00||||248.00|52.08|248|27.86 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|248.00||||248.00||| 43097140|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC MANUAL THERAPY 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|248.00||||248.00||| 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|456.00||||456.00|273.6|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|456.00||||456.00|19.92|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|456.00||||456.00|228|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|456.00||||456.00|196.08|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|456.00||||456.00|228.46|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|456.00||||456.00|160.06|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|456.00||||456.00|194.26|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|456.00||||456.00|19.02|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|456.00||||456.00|22.34|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|456.00||||456.00|19.92|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|456.00||||456.00|21.58|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|456.00||||456.00|156|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MULTIPLAN [1680]|HMA [168003]|456.00||||456.00|27.17|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|FMH BENEFIT SERVICES [1390]|FMH [139000]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|456.00||||456.00|25.54|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|456.00||||456.00|18.47|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|456.00||||456.00|26.44|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|456.00||||456.00|456|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|||456.00||||456.00|136.8|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|456.00||||456.00|218.65|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|456.00||||456.00|296.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|456.00||||456.00|20.55|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|456.00||||456.00|95.76|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CHAMPVA [1240]|CHAMP VA [124000]|456.00||||456.00|342|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|456.00||||456.00|22.34|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|456.00||||456.00|26.03|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CORESOURCE [1315]|CORESOURCE [131500]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|456.00||||456.00|23.22|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|UMR [2035]|UMR OPTIONS [203501]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|GEHA [1415]|GEHA [141500]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|456.00||||456.00|196.08|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|FIRST HEALTH [1375]|QUALCHOICE [137513]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|HEALTHNET [1495]|HEALTHNET [149500]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|456.00||||456.00|26.03|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|MULTIPLAN [1680]|IHC HS [168011]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|TRUSTMARK [2030]|STARMARK [203000]|456.00||||456.00|410.4|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|456.00||||456.00|18.11|456|18.11 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|AETNA [1015]|AETNA ACO WILCO [101532]|456.00||||456.00||| 43097150|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC PROCEDURE(S)/GROUP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|456.00||||456.00||| 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|GEHA [1415]|GEHA [141500]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|270.00||||270.00|38.79|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|270.00||||270.00|55.18|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|270.00||||270.00|34.33|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|270.00||||270.00|37.32|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|||270.00||||270.00|81|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|270.00||||270.00|129.47|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|270.00||||270.00|175.5|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|270.00||||270.00|56.03|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UMR [2035]|UMR OPTIONS [203501]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|270.00||||270.00|116.1|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|270.00||||270.00|55.18|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MULTIPLAN [1680]|HMA [168003]|270.00||||270.00|57.57|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|270.00||||270.00|270|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|270.00||||270.00|56.7|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|270.00||||270.00|39.15|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|270.00||||270.00|156|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|270.00||||270.00|36.05|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|270.00||||270.00|42.22|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|270.00||||270.00|162|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|270.00||||270.00|116.1|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|270.00||||270.00|202.5|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|270.00||||270.00|243|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|270.00||||270.00|135|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|270.00||||270.00|115.02|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|270.00||||270.00|94.77|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|270.00||||270.00|135.27|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|270.00||||270.00|42.22|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|270.00||||270.00|40.3|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|270.00||||270.00|37.32|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|270.00||||270.00|42.67|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|270.00||||270.00|38.38|270|34.33 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|270.00||||270.00||| 43097530|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC THERAPEUTIC ACTIVITY 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|270.00||||270.00||| 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198.00||||198.00|99|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198.00||||198.00|85.14|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198.00||||198.00|69.5|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|198.00||||198.00|84.35|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198.00||||198.00|118.8|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198.00||||198.00|52.48|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198.00||||198.00|33.69|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198.00||||198.00|54.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|198.00||||198.00|156|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MULTIPLAN [1680]|IHC HS [168011]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHNET [1495]|HEALTHNET [149500]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198.00||||198.00|85.14|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198.00||||198.00|50.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UMR [2035]|UMR OPTIONS [203501]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198.00||||198.00|72.97|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|198.00||||198.00|38.52|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198.00||||198.00|41.58|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198.00||||198.00|198|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198.00||||198.00|32.53|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198.00||||198.00|128.7|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198.00||||198.00|94.94|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|TRUSTMARK [2030]|STARMARK [203000]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|||198.00||||198.00|59.4|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198.00||||198.00|33.69|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198.00||||198.00|30.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CHAMPVA [1240]|CHAMP VA [124000]|198.00||||198.00|148.5|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|198.00||||198.00|99.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|GEHA [1415]|GEHA [141500]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|198.00||||198.00|35.02|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|CORESOURCE [1315]|CORESOURCE [131500]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198.00||||198.00|54.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|198.00||||198.00|71.85|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198.00||||198.00|178.2|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|198.00||||198.00|49.98|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|MULTIPLAN [1680]|HMA [168003]|198.00||||198.00|74.97|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|198.00||||198.00|71.85|198|30.98 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|AETNA [1015]|AETNA ACO WILCO [101532]|198.00||||198.00||| 43097533|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC SENSORY INTEG DIRECT 15MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|198.00||||198.00||| 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|GEHA [1415]|GEHA [141500]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|285.00||||285.00|48.16|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|285.00||||285.00|38.27|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|285.00||||285.00|136.66|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|285.00||||285.00|185.25|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|285.00||||285.00|34.17|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|285.00||||285.00|43.76|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|285.00||||285.00|48.16|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MULTIPLAN [1680]|HMA [168003]|285.00||||285.00|50.25|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|285.00||||285.00|156|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|UMR [2035]|UMR OPTIONS [203501]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|285.00||||285.00|36.95|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|285.00||||285.00|36.85|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|285.00||||285.00|48.91|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|285.00||||285.00|38.27|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|285.00||||285.00|59.85|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|285.00||||285.00|35.18|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|285.00||||285.00|171|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|285.00||||285.00|122.55|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|285.00||||285.00|285|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|285.00||||285.00|142.79|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|285.00||||285.00|100.04|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|285.00||||285.00|121.41|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|285.00||||285.00|122.55|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|285.00||||285.00|142.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|||285.00||||285.00|85.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|285.00||||285.00|36.85|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|285.00||||285.00|33.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|285.00||||285.00|35.19|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|285.00||||285.00|213.75|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|285.00||||285.00|39.78|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|285.00||||285.00|256.5|285|33.5 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|285.00||||285.00||| 43097535|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC OT ADL 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|285.00||||285.00||| 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135.00||||135.00|35.52|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135.00||||135.00|67.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135.00||||135.00|58.05|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135.00||||135.00|67.64|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135.00||||135.00|47.39|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135.00||||135.00|81|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135.00||||135.00|33.9|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135.00||||135.00|35.12|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135.00||||135.00|35.52|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135.00||||135.00|33.92|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135.00||||135.00|135|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MULTIPLAN [1680]|HMA [168003]|135.00||||135.00|48.44|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135.00||||135.00|40.15|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135.00||||135.00|58.05|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135.00||||135.00|32.94|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UMR [2035]|UMR OPTIONS [203501]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135.00||||135.00|47.14|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135.00||||135.00|46.42|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135.00||||135.00|28.35|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135.00||||135.00|135|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135.00||||135.00|87.75|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135.00||||135.00|64.73|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135.00||||135.00|57.51|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|||135.00||||135.00|40.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135.00||||135.00|35.12|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|GEHA [1415]|GEHA [141500]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135.00||||135.00|36.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135.00||||135.00|46.42|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|135.00||||135.00|101.25|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135.00||||135.00|32.3|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135.00||||135.00|32.29|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135.00||||135.00|121.5|135|28.35 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|135.00||||135.00||| 43097537|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC COMM/WORK REINTEGRATION 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135.00||||135.00||| 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|263.00||||263.00|37.45|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|263.00||||263.00|46.88|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|263.00||||263.00|197.25|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263.00||||263.00|33.15|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263.00||||263.00|36.03|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|||263.00||||263.00|78.9|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263.00||||263.00|126.11|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263.00||||263.00|170.95|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263.00||||263.00|263|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263.00||||263.00|55.23|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UMR [2035]|UMR OPTIONS [203501]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263.00||||263.00|113.09|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|263.00||||263.00|41.19|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|263.00||||263.00|46.88|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263.00||||263.00|33.26|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MULTIPLAN [1680]|HMA [168003]|263.00||||263.00|48.92|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263.00||||263.00|47.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|263.00||||263.00|156|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263.00||||263.00|34.8|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263.00||||263.00|35.87|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263.00||||263.00|113.09|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|GEHA [1415]|GEHA [141500]|263.00||||263.00|236.7|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263.00||||263.00|32.61|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263.00||||263.00|35.87|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263.00||||263.00|131.5|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|263.00||||263.00|112.04|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263.00||||263.00|92.31|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263.00||||263.00|157.8|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263.00||||263.00|34.24|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|263.00||||263.00|131.76|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263.00||||263.00|36.03|263|32.61 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|263.00||||263.00||| 43097542|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC WHEELCHAIR TRAIN/ASSESS 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|263.00||||263.00||| 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4317.00||||4317.00|421.76|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4317.00||||4317.00|1856.31|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4317.00||||4317.00|2162.82|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4317.00||||4317.00|1515.27|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4317.00||||4317.00|1839.04|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4317.00||||4317.00|2590.2|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4317.00||||4317.00|137.06|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4317.00||||4317.00|182.96|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4317.00||||4317.00|156|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MULTIPLAN [1680]|IHC HS [168011]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|HEALTHNET [1495]|HEALTHNET [149500]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4317.00||||4317.00|156.71|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4317.00||||4317.00|1856.31|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4317.00||||4317.00|169.65|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MULTIPLAN [1680]|HMA [168003]|4317.00||||4317.00|249.48|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|UMR [2035]|UMR OPTIONS [203501]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4317.00||||4317.00|242.83|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4317.00||||4317.00|239.11|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4317.00||||4317.00|906.57|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4317.00||||4317.00|4317|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4317.00||||4317.00|132.37|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4317.00||||4317.00|2806.05|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4317.00||||4317.00|174.64|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4317.00||||4317.00|2070|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|TRUSTMARK [2030]|STARMARK [203000]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|||4317.00||||4317.00|1295.1|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4317.00||||4317.00|137.06|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4317.00||||4317.00|166.32|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4317.00||||4317.00|182.96|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|CHAMPVA [1240]|CHAMP VA [124000]|4317.00||||4317.00|3237.75|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|GEHA [1415]|GEHA [141500]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|CORESOURCE [1315]|CORESOURCE [131500]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4317.00||||4317.00|239.11|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4317.00||||4317.00|142.46|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4317.00||||4317.00|126.07|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4317.00||||4317.00|3885.3|4317|126.07 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|AETNA [1015]|AETNA ACO WILCO [101532]|4317.00||||4317.00||| 43097597|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDE SELECT TOP APP <=20CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4317.00||||4317.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CHAMPVA [1240]|CHAMP VA [124000]|4369.00||||4369.00|3276.75|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|GEHA [1415]|GEHA [141500]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4369.00||||4369.00|142.46|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CORESOURCE [1315]|CORESOURCE [131500]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4369.00||||4369.00|126.07|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|||4369.00||||4369.00|1310.7|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4369.00||||4369.00|2094.94|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4369.00||||4369.00|4369|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHNET [1495]|HEALTHNET [149500]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MULTIPLAN [1680]|IHC HS [168011]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4369.00||||4369.00|1878.67|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4369.00||||4369.00|156.71|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4369.00||||4369.00|2839.85|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|TRUSTMARK [2030]|STARMARK [203000]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4369.00||||4369.00|137.06|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UMR [2035]|UMR OPTIONS [203501]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4369.00||||4369.00|156|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4369.00||||4369.00|917.49|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4369.00||||4369.00|132.37|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4369.00||||4369.00|1878.67|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4369.00||||4369.00|2188.87|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4369.00||||4369.00|1533.52|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4369.00||||4369.00|2184.5|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4369.00||||4369.00|1861.19|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4369.00||||4369.00|2621.4|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4369.00||||4369.00|137.06|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4369.00||||4369.00|3932.1|4369|126.07 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MULTIPLAN [1680]|HMA [168003]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|AETNA [1015]|AETNA ACO WILCO [101532]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4369.00||||4369.00||| 43097598|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT SELECTIVE >20CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4369.00||||4369.00||| 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|562.00||||562.00|337.2|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|562.00||||562.00|182.96|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|562.00||||562.00|421.76|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|562.00||||562.00|241.66|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|562.00||||562.00|281.56|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|562.00||||562.00|197.26|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|562.00||||562.00|239.41|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|562.00||||562.00|174.64|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|562.00||||562.00|78.16|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|562.00||||562.00|182.96|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|562.00||||562.00|75.48|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|562.00||||562.00|156|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|562.00||||562.00|239.11|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MULTIPLAN [1680]|IHC HS [168011]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MULTIPLAN [1680]|HMA [168003]|562.00||||562.00|249.48|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|FMH BENEFIT SERVICES [1390]|FMH [139000]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|562.00||||562.00|89.36|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|562.00||||562.00|241.66|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|FIRST HEALTH [1375]|QUALCHOICE [137513]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|562.00||||562.00|169.65|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UMR [2035]|UMR OPTIONS [203501]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHNET [1495]|HEALTHNET [149500]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|562.00||||562.00|242.83|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|562.00||||562.00|118.02|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|562.00||||562.00|562|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|TRUSTMARK [2030]|STARMARK [203000]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|562.00||||562.00|365.3|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|562.00||||562.00|269.48|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|||562.00||||562.00|168.6|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|562.00||||562.00|78.16|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CHAMPVA [1240]|CHAMP VA [124000]|562.00||||562.00|421.5|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|562.00||||562.00|239.11|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|CORESOURCE [1315]|CORESOURCE [131500]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|GEHA [1415]|GEHA [141500]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|562.00||||562.00|81.24|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|562.00||||562.00|71.89|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|562.00||||562.00|166.32|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|562.00||||562.00|505.8|562|71.89 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|AETNA [1015]|AETNA ACO WILCO [101532]|562.00||||562.00||| 43097602|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC DEBRIDEMENT NON-SELCTV /SESSN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|562.00||||562.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CHAMPVA [1240]|CHAMP VA [124000]|648.00||||648.00|486|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|648.00||||648.00|119.48|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|648.00||||648.00|129.9|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|||648.00||||648.00|194.4|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|648.00||||648.00|310.72|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|648.00||||648.00|421.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|648.00||||648.00|136.08|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UMR [2035]|UMR OPTIONS [203501]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|648.00||||648.00|278.64|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MULTIPLAN [1680]|IHC HS [168011]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HEALTHNET [1495]|HEALTHNET [149500]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|TRUSTMARK [2030]|STARMARK [203000]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|648.00||||648.00|648|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|648.00||||648.00|156|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|648.00||||648.00|148.52|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|648.00||||648.00|125.46|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|648.00||||648.00|278.64|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CORESOURCE [1315]|CORESOURCE [131500]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|648.00||||648.00|421.76|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|648.00||||648.00|276.05|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|648.00||||648.00|227.45|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|648.00||||648.00|324.65|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|648.00||||648.00|388.8|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|648.00||||648.00|129.9|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|GEHA [1415]|GEHA [141500]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|648.00||||648.00|583.2|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|648.00||||648.00|135.01|648|119.48 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MULTIPLAN [1680]|HMA [168003]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|AETNA [1015]|AETNA ACO WILCO [101532]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|648.00||||648.00||| 43097605|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX <= 50 CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|648.00||||648.00||| 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1116.00||||1116.00|334.55|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1116.00||||1116.00|750.73|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1116.00||||1116.00|479.88|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1116.00||||1116.00|391.72|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1116.00||||1116.00|475.42|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1116.00||||1116.00|669.6|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1116.00||||1116.00|137.06|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1116.00||||1116.00|334.55|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1116.00||||1116.00|156|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|TRUSTMARK [2030]|STARMARK [203000]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MULTIPLAN [1680]|IHC HS [168011]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MULTIPLAN [1680]|HMA [168003]|1116.00||||1116.00|456.21|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHNET [1495]|HEALTHNET [149500]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|FIRST HEALTH [1375]|QUALCHOICE [137513]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1116.00||||1116.00|156.71|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1116.00||||1116.00|479.88|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1116.00||||1116.00|310.22|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1116.00||||1116.00|437.23|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UMR [2035]|UMR OPTIONS [203501]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1116.00||||1116.00|444.04|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1116.00||||1116.00|234.36|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1116.00||||1116.00|132.37|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1116.00||||1116.00|319.34|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1116.00||||1116.00|1116|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1116.00||||1116.00|725.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1116.00||||1116.00|559.12|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1116.00||||1116.00|535.12|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|||1116.00||||1116.00|334.8|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1116.00||||1116.00|137.06|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1116.00||||1116.00|304.14|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1116.00||||1116.00|126.07|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CHAMPVA [1240]|CHAMP VA [124000]|1116.00||||1116.00|837|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1116.00||||1116.00|437.23|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|CORESOURCE [1315]|CORESOURCE [131500]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1116.00||||1116.00|142.46|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|GEHA [1415]|GEHA [141500]|1116.00||||1116.00|1004.4|1116|126.07 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|AETNA [1015]|AETNA ACO WILCO [101532]|1116.00||||1116.00||| 43097606|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC NEG PRESSURE WOUND TX > 50 CM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1116.00||||1116.00||| 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|GEHA [1415]|GEHA [141500]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139.00||||139.00|39.78|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139.00||||139.00|49.09|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|139.00||||139.00|104.25|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139.00||||139.00|35.19|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|||139.00||||139.00|41.7|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139.00||||139.00|66.65|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139.00||||139.00|139|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139.00||||139.00|29.19|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139.00||||139.00|49.86|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UMR [2035]|UMR OPTIONS [203501]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139.00||||139.00|59.77|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139.00||||139.00|43.76|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139.00||||139.00|34.83|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139.00||||139.00|49.09|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139.00||||139.00|90.35|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MULTIPLAN [1680]|HMA [168003]|139.00||||139.00|51.23|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139.00||||139.00|38.27|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139.00||||139.00|139|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139.00||||139.00|36.95|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139.00||||139.00|37.57|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139.00||||139.00|38.27|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139.00||||139.00|35.86|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139.00||||139.00|83.4|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139.00||||139.00|59.77|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139.00||||139.00|69.64|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139.00||||139.00|48.79|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139.00||||139.00|59.21|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139.00||||139.00|69.5|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139.00||||139.00|37.57|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139.00||||139.00|34.15|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139.00||||139.00|125.1|139|29.19 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139.00||||139.00||| 43097750|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PERFORMANCE TEST 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|139.00||||139.00||| 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.00||||242.00|52.53|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.00||||242.00|121|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.00||||242.00|104.06|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242.00||||242.00|121.24|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.00||||242.00|84.94|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242.00||||242.00|103.09|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.00||||242.00|145.2|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.00||||242.00|50.14|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.00||||242.00|39.65|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.00||||242.00|52.53|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.00||||242.00|38.3|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242.00||||242.00|156|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242.00||||242.00|68.65|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|HMA [168003]|242.00||||242.00|71.63|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242.00||||242.00|45.34|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.00||||242.00|104.06|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.00||||242.00|48.71|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UMR [2035]|UMR OPTIONS [203501]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.00||||242.00|69.72|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.00||||242.00|50.82|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.00||||242.00|242|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.00||||242.00|157.3|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.00||||242.00|116.04|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|||242.00||||242.00|72.6|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.00||||242.00|39.65|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.00||||242.00|47.75|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.00||||242.00|36.47|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|242.00||||242.00|181.5|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242.00||||242.00|68.65|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242.00||||242.00|41.21|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|GEHA [1415]|GEHA [141500]|242.00||||242.00|217.8|242|36.47 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|242.00||||242.00||| 43097760|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHOTIC MGMT&TRAINING INIT ENC 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242.00||||242.00||| 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|GEHA [1415]|GEHA [141500]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242.00||||242.00|37.92|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242.00||||242.00|58.75|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CHAMPVA [1240]|CHAMP VA [124000]|242.00||||242.00|181.5|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242.00||||242.00|33.55|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242.00||||242.00|36.48|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|||242.00||||242.00|72.6|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242.00||||242.00|116.04|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242.00||||242.00|157.3|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242.00||||242.00|50.82|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UMR [2035]|UMR OPTIONS [203501]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242.00||||242.00|41.69|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242.00||||242.00|104.06|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242.00||||242.00|41.71|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242.00||||242.00|59.67|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HEALTHNET [1495]|HEALTHNET [149500]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242.00||||242.00|242|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|IHC HS [168011]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242.00||||242.00|58.75|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MULTIPLAN [1680]|HMA [168003]|242.00||||242.00|61.31|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|TRUSTMARK [2030]|STARMARK [203000]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242.00||||242.00|156|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242.00||||242.00|35.23|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242.00||||242.00|44.96|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|CORESOURCE [1315]|CORESOURCE [131500]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242.00||||242.00|36.48|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242.00||||242.00|42.91|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242.00||||242.00|145.2|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242.00||||242.00|104.06|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242.00||||242.00|121.24|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242.00||||242.00|84.94|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242.00||||242.00|103.09|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242.00||||242.00|121|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242.00||||242.00|44.96|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242.00||||242.00|40.87|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242.00||||242.00|217.8|242|33.55 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242.00||||242.00||| 43097761|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC PROSTHETIC TRAINING INIT ENC 15 MIN|AETNA [1015]|AETNA ACO WILCO [101532]|242.00||||242.00||| 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85.00||||85.00|42.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85.00||||85.00|36.55|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85.00||||85.00|29.84|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85.00||||85.00|36.21|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85.00||||85.00|51|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85.00||||85.00|57.93|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85.00||||85.00|56.06|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85.00||||85.00|55.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|TRUSTMARK [2030]|STARMARK [203000]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MULTIPLAN [1680]|IHC HS [168011]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MULTIPLAN [1680]|HMA [168003]|85.00||||85.00|76.44|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|HEALTHNET [1495]|HEALTHNET [149500]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|FMH BENEFIT SERVICES [1390]|FMH [139000]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85.00||||85.00|73.26|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|FIRST HEALTH [1375]|QUALCHOICE [137513]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85.00||||85.00|36.55|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85.00||||85.00|66.23|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85.00||||85.00|51.98|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|UMR [2035]|UMR OPTIONS [203501]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85.00||||85.00|85|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85.00||||85.00|74.4|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85.00||||85.00|17.85|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85.00||||85.00|85|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85.00||||85.00|55.25|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85.00||||85.00|53.51|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85.00||||85.00|42.59|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85.00||||85.00|40.76|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|||85.00||||85.00|25.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85.00||||85.00|57.93|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85.00||||85.00|56.06|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85.00||||85.00|50.96|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|CHAMPVA [1240]|CHAMP VA [124000]|85.00||||85.00|63.75|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85.00||||85.00|73.26|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|CORESOURCE [1315]|CORESOURCE [131500]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85.00||||85.00|60.21|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|GEHA [1415]|GEHA [141500]|85.00||||85.00|76.5|85|17.85 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|AETNA [1015]|AETNA ACO WILCO [101532]|85.00||||85.00||| 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85.00||||85.00||| 43097763|EAP|0430 - OCCUPATIONAL THERAPY-GENERAL|HC ORTHC/PROSTC MGMT SBSQ ENC EA 15 MIN OT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85.00||||85.00||| 4310001|EAP||HH OT ROUTINE VISIT|||||||140.68|42.2|70.34|29.54 4310001|EAP||HH OT ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||140.68|35.17|70.34|29.54 4310001|EAP||HH OT ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54 4310001|EAP||HH OT ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54 4310001|EAP||HH OT ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68||| 4310001|EAP||HH OT ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54 4310002|EAP||HH OT INITIAL VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||140.68|35.17|70.34|29.54 4310002|EAP||HH OT INITIAL VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54 4310002|EAP||HH OT INITIAL VISIT|||||||140.68|42.2|70.34|29.54 4310002|EAP||HH OT INITIAL VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MULTIPLAN [1680]|HMA [168003]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|UMR [2035]|UMR OPTIONS [203501]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68||| 4310002|EAP||HH OT INITIAL VISIT|GEHA [1415]|GEHA [141500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|||||||140.68|42.2|70.34|29.54 4310003|EAP||HH OTA ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||140.68|29.54|70.34|29.54 4310003|EAP||HH OTA ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||140.68|35.17|70.34|29.54 4310003|EAP||HH OTA ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||140.68|70.34|70.34|29.54 4310003|EAP||HH OTA ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||140.68||| 4310003|EAP||HH OTA ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||140.68||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.48|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.48|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.48 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 4318|ERX|0258 - PHARMACY-IV SOLUTIONS|LACTATED RINGERS INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 432|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 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43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|GEHA [1415]|GEHA [141500]|888.00||||888.00|799.2|888|29.92 43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|AETNA [1015]|AETNA ACO WILCO [101532]|888.00||||888.00||| 43497165|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION LOW COMPLEXITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|888.00||||888.00||| 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|GEHA [1415]|GEHA [141500]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|977.00||||977.00|51.23|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|CORESOURCE [1315]|CORESOURCE 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[1020]|AETNA MEDICARE REPLACEMENT [102002]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|||977.00||||977.00|293.1|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|977.00||||977.00|468.47|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|977.00||||977.00|977|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|977.00||||977.00|129.56|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|UMR [2035]|UMR OPTIONS [203501]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|977.00||||977.00|56.35|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|977.00||||977.00|420.11|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|977.00||||977.00|90.51|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|HEALTHNET [1495]|HEALTHNET [149500]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MULTIPLAN [1680]|IHC HS [168011]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|977.00||||977.00|127.57|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MULTIPLAN [1680]|HMA [168003]|977.00||||977.00|133.11|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|977.00||||977.00|205.17|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|977.00||||977.00|635.05|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|977.00||||977.00|49.29|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|TRUSTMARK [2030]|STARMARK [203000]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|977.00||||977.00|156|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|977.00||||977.00|47.61|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|CHAMPVA [1240]|CHAMP VA [124000]|977.00||||977.00|732.75|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|977.00||||977.00|97.61|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|977.00||||977.00|49.29|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|977.00||||977.00|93.18|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|977.00||||977.00|586.2|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|977.00||||977.00|420.11|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|977.00||||977.00|489.48|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|977.00||||977.00|342.93|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|977.00||||977.00|416.2|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|977.00||||977.00|488.5|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|977.00||||977.00|97.61|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|977.00||||977.00|88.74|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|977.00||||977.00|879.3|977|45.34 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|977.00||||977.00||| 43497166|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION MODERATE COMPLEXITY|AETNA [1015]|AETNA ACO WILCO [101532]|977.00||||977.00||| 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1074.00||||1074.00|97.61|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1074.00||||1074.00|537|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1074.00||||1074.00|461.82|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1074.00||||1074.00|538.07|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1074.00||||1074.00|376.97|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1074.00||||1074.00|644.4|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1074.00||||1074.00|93.18|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1074.00||||1074.00|99.43|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1074.00||||1074.00|97.61|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1074.00||||1074.00|96.04|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1074.00||||1074.00|156|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MULTIPLAN [1680]|IHC HS [168011]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1074.00||||1074.00|127.57|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MULTIPLAN [1680]|HMA [168003]|1074.00||||1074.00|133.11|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|HEALTHNET [1495]|HEALTHNET [149500]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1074.00||||1074.00|461.82|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1074.00||||1074.00|113.68|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1074.00||||1074.00|90.51|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|TRUSTMARK [2030]|STARMARK [203000]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|UMR [2035]|UMR OPTIONS [203501]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1074.00||||1074.00|129.56|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1074.00||||1074.00|225.54|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1074.00||||1074.00|1074|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1074.00||||1074.00|698.1|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1074.00||||1074.00|457.52|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1074.00||||1074.00|514.98|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|||1074.00||||1074.00|322.2|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1074.00||||1074.00|99.43|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1074.00||||1074.00|88.74|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1074.00||||1074.00|91.47|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|CHAMPVA [1240]|CHAMP VA [124000]|1074.00||||1074.00|805.5|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1074.00||||1074.00|127.57|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|CORESOURCE [1315]|CORESOURCE [131500]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1074.00||||1074.00|103.35|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|GEHA [1415]|GEHA [141500]|1074.00||||1074.00|966.6|1074|88.74 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|AETNA [1015]|AETNA ACO WILCO [101532]|1074.00||||1074.00||| 43497167|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT EVALUATION HIGH COMPLEXITY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1074.00||||1074.00||| 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|GEHA [1415]|GEHA [141500]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|444.00||||444.00|61.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|444.00||||444.00|87.89|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|CHAMPVA [1240]|CHAMP VA [124000]|444.00||||444.00|333|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|444.00||||444.00|54.52|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|444.00||||444.00|59.27|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|||444.00||||444.00|133.2|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|444.00||||444.00|212.9|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|444.00||||444.00|288.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|444.00||||444.00|93.24|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|UMR [2035]|UMR OPTIONS [203501]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|444.00||||444.00|62.36|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|444.00||||444.00|67.77|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|444.00||||444.00|190.92|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|FIRST HEALTH [1375]|QUALCHOICE [137513]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|444.00||||444.00|89.26|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|HEALTHNET [1495]|HEALTHNET [149500]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|444.00||||444.00|444|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MULTIPLAN [1680]|IHC HS [168011]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|444.00||||444.00|87.89|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MULTIPLAN [1680]|HMA [168003]|444.00||||444.00|91.71|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|TRUSTMARK [2030]|STARMARK [203000]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|444.00||||444.00|156|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|444.00||||444.00|57.24|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|CORESOURCE [1315]|CORESOURCE [131500]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|444.00||||444.00|67.25|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|444.00||||444.00|59.27|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|444.00||||444.00|64.2|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|444.00||||444.00|266.4|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|444.00||||444.00|190.92|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|444.00||||444.00|222.44|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|444.00||||444.00|155.84|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|444.00||||444.00|189.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|444.00||||444.00|222|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|444.00||||444.00|67.25|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|444.00||||444.00|61.14|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|444.00||||444.00|399.6|444|54.52 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|444.00||||444.00||| 43497168|EAP|0434 - OCCUPATIONAL THERAPY-EVALUATION OR REEVALUA|HC OT RE-EVALUATION EST PLAN|AETNA [1015]|AETNA ACO WILCO [101532]|444.00||||444.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 435|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMITRIPTYLINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|GEHA [1415]|GEHA [141500]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|492.00||||492.00|80.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|492.00||||492.00|112.98|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|CHAMPVA [1240]|CHAMP VA [124000]|492.00||||492.00|369|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|492.00||||492.00|77.54|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|||492.00||||492.00|147.6|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|492.00||||492.00|235.91|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|492.00||||492.00|319.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|492.00||||492.00|103.32|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|UMR [2035]|UMR OPTIONS [203501]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|492.00||||492.00|80.16|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|492.00||||492.00|211.56|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|492.00||||492.00|88.65|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|FIRST HEALTH [1375]|QUALCHOICE [137513]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|FMH BENEFIT SERVICES [1390]|FMH [139000]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|HEALTHNET [1495]|HEALTHNET [149500]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|492.00||||492.00|114.74|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|492.00||||492.00|492|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MULTIPLAN [1680]|IHC HS [168011]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|492.00||||492.00|112.98|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MULTIPLAN [1680]|HMA [168003]|492.00||||492.00|117.89|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|TRUSTMARK [2030]|STARMARK [203000]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|492.00||||492.00|156|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|492.00||||492.00|71.32|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|492.00||||492.00|74.89|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|492.00||||492.00|86.45|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|492.00||||492.00|77.54|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|CORESOURCE [1315]|CORESOURCE [131500]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|492.00||||492.00|295.2|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|492.00||||492.00|82.52|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|492.00||||492.00|211.56|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|492.00||||492.00|246.49|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|492.00||||492.00|172.69|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|492.00||||492.00|209.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|492.00||||492.00|246|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|492.00||||492.00|86.45|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|492.00||||492.00|78.59|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|492.00||||492.00|442.8|492|71.32 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|492.00||||492.00||| 44092507|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH/LANGUAGE/VOICE|AETNA [1015]|AETNA ACO WILCO [101532]|492.00||||492.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|384.00||||384.00|254.52|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|384.00||||384.00|165.12|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|384.00||||384.00|134.78|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|384.00||||384.00|163.58|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|384.00||||384.00|69.06|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|384.00||||384.00|66.71|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|384.00||||384.00|156|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|TRUSTMARK [2030]|STARMARK [203000]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MULTIPLAN [1680]|IHC HS [168011]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|HEALTHNET [1495]|HEALTHNET [149500]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|FMH BENEFIT SERVICES [1390]|FMH [139000]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|FIRST HEALTH [1375]|QUALCHOICE [137513]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|384.00||||384.00|78.96|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|384.00||||384.00|165.12|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|UMR [2035]|UMR OPTIONS [203501]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|384.00||||384.00|80.64|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|384.00||||384.00|384|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|384.00||||384.00|249.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|384.00||||384.00|230.4|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|384.00||||384.00|192.38|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|384.00||||384.00|184.13|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|||384.00||||384.00|115.2|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|384.00||||384.00|69.06|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|384.00||||384.00|63.53|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|CHAMPVA [1240]|CHAMP VA [124000]|384.00||||384.00|288|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|CORESOURCE [1315]|CORESOURCE [131500]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|384.00||||384.00|71.78|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|GEHA [1415]|GEHA [141500]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|384.00||||384.00|345.6|384|63.53 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|AETNA [1015]|AETNA ACO WILCO [101532]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MULTIPLAN [1680]|HMA [168003]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|384.00||||384.00||| 44092520|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC LARYNGEAL FUNCTION STUDY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|384.00||||384.00||| 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|GEHA [1415]|GEHA [141500]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|835.00||||835.00|107.06|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|CORESOURCE [1315]|CORESOURCE [131500]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|835.00||||835.00|124.01|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|835.00||||835.00|94.74|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|||835.00||||835.00|250.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|835.00||||835.00|400.38|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|835.00||||835.00|542.75|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|835.00||||835.00|835|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|835.00||||835.00|125.94|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|UMR [2035]|UMR OPTIONS [203501]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|835.00||||835.00|359.05|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|835.00||||835.00|117.76|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|FIRST HEALTH [1375]|QUALCHOICE [137513]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|835.00||||835.00|87.99|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|FMH BENEFIT SERVICES [1390]|FMH [139000]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|835.00||||835.00|175.35|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|HEALTHNET [1495]|HEALTHNET [149500]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MULTIPLAN [1680]|IHC HS [168011]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|835.00||||835.00|124.01|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MULTIPLAN [1680]|HMA [168003]|835.00||||835.00|129.39|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|835.00||||835.00|103|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|TRUSTMARK [2030]|STARMARK [203000]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|835.00||||835.00|156|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|835.00||||835.00|99.48|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|CHAMPVA [1240]|CHAMP VA [124000]|835.00||||835.00|626.25|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|835.00||||835.00|94.89|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|835.00||||835.00|103|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|835.00||||835.00|501|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|835.00||||835.00|90.57|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|835.00||||835.00|359.05|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|835.00||||835.00|418.34|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|835.00||||835.00|293.09|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|835.00||||835.00|355.71|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|835.00||||835.00|417.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|835.00||||835.00|94.89|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|835.00||||835.00|86.26|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|835.00||||835.00|751.5|835|86.26 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|835.00||||835.00||| 44092526|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TREATMENT SWALLOW|AETNA [1015]|AETNA ACO WILCO [101532]|835.00||||835.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7.00||||7.00|3.5|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|7.00||||7.00|3.01|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|7.00||||7.00|3.51|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|7.00||||7.00|2.46|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7.00||||7.00|4.2|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|7.00||||7.00|7|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|TRUSTMARK [2030]|STARMARK [203000]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MULTIPLAN [1680]|IHC HS [168011]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|HEALTHNET [1495]|HEALTHNET [149500]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|FMH BENEFIT SERVICES [1390]|FMH [139000]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|FIRST HEALTH [1375]|QUALCHOICE [137513]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|7.00||||7.00|7|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.00||||7.00|3.01|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|UMR [2035]|UMR OPTIONS [203501]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|7.00||||7.00|41.79|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|7.00||||7.00|1.47|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|7.00||||7.00|7|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|7.00||||7.00|2.98|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7.00||||7.00|4.55|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.00||||7.00|3.36|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|||7.00||||7.00|2.1|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|7.00||||7.00|41.79|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|7.00||||7.00|7|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|CHAMPVA [1240]|CHAMP VA [124000]|7.00||||7.00|5.25|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|CORESOURCE [1315]|CORESOURCE [131500]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7.00||||7.00|43.44|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|GEHA [1415]|GEHA [141500]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|7.00||||7.00|6.3|43.44|1.47 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|MULTIPLAN [1680]|HMA [168003]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|AETNA [1015]|AETNA ACO WILCO [101532]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.00||||7.00||| 44092551|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC PURE TONE AIR ONLY SCREENING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|7.00||||7.00||| 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|GEHA [1415]|GEHA [141500]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|400.00||||400.00|43.44|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|400.00||||400.00|153.19|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|CHAMPVA [1240]|CHAMP VA [124000]|400.00||||400.00|300|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|400.00||||400.00|38.45|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|400.00||||400.00|41.79|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|||400.00||||400.00|120|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|400.00||||400.00|191.8|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|400.00||||400.00|260|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|400.00||||400.00|84|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|400.00||||400.00|155.58|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|UMR [2035]|UMR OPTIONS [203501]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|400.00||||400.00|108.69|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|400.00||||400.00|172|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|400.00||||400.00|47.78|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|FIRST HEALTH [1375]|QUALCHOICE [137513]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|FMH BENEFIT SERVICES [1390]|FMH [139000]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|HEALTHNET [1495]|HEALTHNET [149500]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MULTIPLAN [1680]|IHC HS [168011]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|400.00||||400.00|153.19|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MULTIPLAN [1680]|HMA [168003]|400.00||||400.00|159.84|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|400.00||||400.00|400|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|TRUSTMARK [2030]|STARMARK [203000]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|400.00||||400.00|156|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|400.00||||400.00|40.37|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|CORESOURCE [1315]|CORESOURCE [131500]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|400.00||||400.00|117.22|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|400.00||||400.00|41.79|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|400.00||||400.00|240|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|400.00||||400.00|111.89|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|400.00||||400.00|172|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|400.00||||400.00|200.4|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|400.00||||400.00|140.4|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|400.00||||400.00|170.4|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|400.00||||400.00|200|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|400.00||||400.00|117.22|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|400.00||||400.00|106.56|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|400.00||||400.00|360|400|38.45 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|400.00||||400.00||| 44092609|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC TX SPEECH GEN DEVICE PRG/MOD|AETNA [1015]|AETNA ACO WILCO [101532]|400.00||||400.00||| 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|908.00||||908.00|454|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|908.00||||908.00|390.44|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|908.00||||908.00|318.71|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|908.00||||908.00|386.81|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|908.00||||908.00|72.43|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|908.00||||908.00|544.8|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|908.00||||908.00|112.71|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|908.00||||908.00|75.88|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|908.00||||908.00|156|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|TRUSTMARK [2030]|STARMARK [203000]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MULTIPLAN [1680]|IHC HS [168011]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|908.00||||908.00|95.88|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MULTIPLAN [1680]|HMA [168003]|908.00||||908.00|103.47|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|HEALTHNET [1495]|HEALTHNET [149500]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|908.00||||908.00|128.86|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|908.00||||908.00|390.44|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|908.00||||908.00|70.36|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|UMR [2035]|UMR OPTIONS [203501]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|908.00||||908.00|96.57|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|908.00||||908.00|190.68|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|908.00||||908.00|108.87|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|908.00||||908.00|908|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|908.00||||908.00|590.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|908.00||||908.00|454.91|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|908.00||||908.00|435.39|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|||908.00||||908.00|272.4|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|908.00||||908.00|112.71|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|908.00||||908.00|75.88|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|908.00||||908.00|68.98|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|908.00||||908.00|103.68|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|CHAMPVA [1240]|CHAMP VA [124000]|908.00||||908.00|681|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|908.00||||908.00|95.88|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|CORESOURCE [1315]|CORESOURCE [131500]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|908.00||||908.00|117.15|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|GEHA [1415]|GEHA [141500]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|908.00||||908.00|817.2|908|68.98 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|AETNA [1015]|AETNA ACO WILCO [101532]|908.00||||908.00||| 44092612|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC EVAL SWALLOWING ENDOSCOPIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|908.00||||908.00||| 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|701.00||||701.00|80.69|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|CORESOURCE [1315]|CORESOURCE [131500]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|701.00||||701.00|142.89|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|701.00||||701.00|71.41|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|701.00||||701.00|77.63|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|||701.00||||701.00|210.3|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|701.00||||701.00|336.13|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|701.00||||701.00|701|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|701.00||||701.00|143.92|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|UMR [2035]|UMR OPTIONS [203501]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|701.00||||701.00|104.86|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|701.00||||701.00|301.43|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|701.00||||701.00|88.75|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|FIRST HEALTH [1375]|QUALCHOICE [137513]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|FMH BENEFIT SERVICES [1390]|FMH [139000]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|HEALTHNET [1495]|HEALTHNET [149500]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MULTIPLAN [1680]|IHC HS [168011]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|701.00||||701.00|142.89|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|701.00||||701.00|147.21|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|701.00||||701.00|455.65|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MULTIPLAN [1680]|HMA [168003]|701.00||||701.00|154.2|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|TRUSTMARK [2030]|STARMARK [203000]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|701.00||||701.00|156|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|701.00||||701.00|74.98|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|CHAMPVA [1240]|CHAMP VA [124000]|701.00||||701.00|525.75|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|701.00||||701.00|113.08|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|701.00||||701.00|77.63|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|701.00||||701.00|420.6|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|GEHA [1415]|GEHA [141500]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|701.00||||701.00|107.94|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|701.00||||701.00|301.43|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|701.00||||701.00|351.2|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|701.00||||701.00|246.05|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|701.00||||701.00|298.63|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|701.00||||701.00|350.5|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|701.00||||701.00|113.08|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|701.00||||701.00|102.8|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|701.00||||701.00|630.9|701|71.41 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|701.00||||701.00||| 44096105|EAP|0440 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GENERAL|HC APHASIA ASSESSMENT PER HOUR|AETNA [1015]|AETNA ACO WILCO [101532]|701.00||||701.00||| 4410001|EAP||HH SLP ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||151.85|37.96|75.93|31.89 4410001|EAP||HH SLP ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||151.85|31.89|75.93|31.89 4410001|EAP||HH SLP ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||151.85|75.93|75.93|31.89 4410001|EAP||HH SLP ROUTINE VISIT|||||||151.85|45.55|75.93|31.89 4410001|EAP||HH SLP ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||151.85||| 4410001|EAP||HH SLP ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|||||||151.85|45.55|75.93|31.89 4410002|EAP||HH SLP INITIAL VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||151.85|31.89|75.93|31.89 4410002|EAP||HH SLP INITIAL VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||151.85|37.96|75.93|31.89 4410002|EAP||HH SLP INITIAL VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||151.85|75.93|75.93|31.89 4410002|EAP||HH SLP INITIAL VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|GEHA [1415]|GEHA [141500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|UMR [2035]|UMR OPTIONS [203501]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MULTIPLAN [1680]|HMA [168003]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||151.85||| 4410002|EAP||HH SLP INITIAL VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||151.85|75.93|75.93|31.89 4410003|EAP||HH SLP MAINTENANCE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||151.85|37.96|75.93|31.89 4410003|EAP||HH SLP MAINTENANCE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||151.85|31.89|75.93|31.89 4410003|EAP||HH SLP MAINTENANCE|||||||151.85|45.55|75.93|31.89 4410003|EAP||HH SLP MAINTENANCE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|AETNA [1015]|AETNA ACO WILCO [101532]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|TRUSTMARK [2030]|STARMARK [203000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|HEALTHNET [1495]|HEALTHNET [149500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MULTIPLAN [1680]|HMA [168003]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MULTIPLAN [1680]|IHC HS [168011]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|UMR [2035]|UMR OPTIONS [203501]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|CHAMPVA [1240]|CHAMP VA [124000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|CORESOURCE [1315]|CORESOURCE [131500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|GEHA [1415]|GEHA [141500]|||||151.85||| 4410003|EAP||HH SLP MAINTENANCE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||151.85||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|||10.00||||10.00|3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|||10.00||||10.00|3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|||10.00||||10.00|3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|||10.00||||10.00|3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4420|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 25 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|||10.00||||10.00|3|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4421|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 50 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|||10.00||||10.00|3|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4422|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 75 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|||10.00||||10.00|3|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|||10.00||||10.00|3|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4423|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 100 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|||10.00||||10.00|3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|||10.00||||10.00|3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|||10.00||||10.00|3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|||10.00||||10.00|3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4424|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LEVOTHYROXINE 125 MCG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|485.00||||485.00|242.99|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|485.00||||485.00|118.9|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|485.00||||485.00|208.55|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|485.00||||485.00|81.12|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|485.00||||485.00|113.49|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|485.00||||485.00|242.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|485.00||||485.00|206.61|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|485.00||||485.00|291|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|485.00||||485.00|118.9|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MULTIPLAN [1680]|HMA [168003]|485.00||||485.00|162.14|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|HEALTHNET [1495]|HEALTHNET [149500]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|485.00||||485.00|155.39|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MULTIPLAN [1680]|IHC HS [168011]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|485.00||||485.00|156|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|485.00||||485.00|208.55|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|485.00||||485.00|110.25|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|485.00||||485.00|170.24|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|UMR [2035]|UMR OPTIONS [203501]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|485.00||||485.00|157.81|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|485.00||||485.00|101.85|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|485.00||||485.00|315.25|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|||485.00||||485.00|145.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|485.00||||485.00|74.62|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|TRUSTMARK [2030]|STARMARK [203000]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|485.00||||485.00|108.09|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|CHAMPVA [1240]|CHAMP VA [124000]|485.00||||485.00|363.75|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|CORESOURCE [1315]|CORESOURCE [131500]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|485.00||||485.00|81.12|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|GEHA [1415]|GEHA [141500]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|485.00||||485.00|155.39|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|485.00||||485.00|232.56|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|485.00||||485.00|78.35|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|485.00||||485.00|436.5|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|485.00||||485.00|485|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|485.00||||485.00|92.74|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|485.00||||485.00|84.31|485|74.62 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|AETNA [1015]|AETNA ACO WILCO [101532]|485.00||||485.00||| 44296125|EAP|0442 - SPEECH THERAPY-LANGUAGE PATHOLOGY-HOURLY CH|HC COGNITIVE TEST PER HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|485.00||||485.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|140.00||||140.00|36.74|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|140.00||||140.00|33.8|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|CORESOURCE [1315]|CORESOURCE [131500]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MULTIPLAN [1680]|IHC HS [168011]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|140.00||||140.00|91|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|140.00||||140.00|29.4|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|140.00||||140.00|42|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|UMR [2035]|UMR OPTIONS [203501]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|140.00||||140.00|60.2|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|140.00||||140.00|140|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|FIRST HEALTH [1375]|QUALCHOICE [137513]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|||140.00||||140.00|42|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|FMH BENEFIT SERVICES [1390]|FMH [139000]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|HEALTHNET [1495]|HEALTHNET [149500]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|140.00||||140.00|67.13|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|GEHA [1415]|GEHA [141500]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|140.00||||140.00|140|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|140.00||||140.00|59.64|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|140.00||||140.00|60.2|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|140.00||||140.00|49.14|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|CHAMPVA [1240]|CHAMP VA [124000]|140.00||||140.00|105|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|140.00||||140.00|70|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|140.00||||140.00|35.49|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|140.00||||140.00|38.19|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|140.00||||140.00|36.74|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|140.00||||140.00|70.14|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|TRUSTMARK [2030]|STARMARK [203000]|140.00||||140.00|126|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|140.00||||140.00|84|140|29.4 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|AETNA [1015]|AETNA ACO WILCO [101532]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MULTIPLAN [1680]|HMA [168003]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|140.00||||140.00||| 44392508|EAP|0443 - SPEECH THERAPY-LANGUAGE PATHOLOGY-GROUP RAT|HC SPEECH THERAPY GROUP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|140.00||||140.00||| 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|713.00||||713.00|357.21|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|713.00||||713.00|123.05|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|713.00||||713.00|250.26|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|713.00||||713.00|303.74|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|713.00||||713.00|356.5|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|713.00||||713.00|306.59|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|713.00||||713.00|123.05|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MULTIPLAN [1680]|HMA [168003]|713.00||||713.00|167.79|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|FMH BENEFIT SERVICES [1390]|FMH [139000]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|FIRST HEALTH [1375]|QUALCHOICE [137513]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|UMR [2035]|UMR OPTIONS [203501]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|713.00||||713.00|149.73|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|713.00||||713.00|713|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|713.00||||713.00|463.45|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|713.00||||713.00|163.32|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|713.00||||713.00|341.88|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|713.00||||713.00|160.81|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|TRUSTMARK [2030]|STARMARK [203000]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|713.00||||713.00|155.54|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|713.00||||713.00|143.07|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|713.00||||713.00|114.1|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|713.00||||713.00|177.83|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|713.00||||713.00|160.81|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|713.00||||713.00|150.23|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|HEALTHNET [1495]|HEALTHNET [149500]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|CHAMPVA [1240]|CHAMP VA [124000]|713.00||||713.00|534.75|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|CORESOURCE [1315]|CORESOURCE [131500]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|713.00||||713.00|427.8|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|713.00||||713.00|306.59|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|713.00||||713.00|111.86|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|GEHA [1415]|GEHA [141500]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|713.00||||713.00|156|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|713.00||||713.00|155.54|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|713.00||||713.00|117.45|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|||713.00||||713.00|213.9|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|MULTIPLAN [1680]|IHC HS [168011]|713.00||||713.00|641.7|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|713.00||||713.00|161.66|713|111.86 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|AETNA [1015]|AETNA ACO WILCO [101532]|713.00||||713.00||| 44492521|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVALUATION OF SPEECH FLUENCY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|713.00||||713.00||| 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|713.00||||713.00|143.07|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|713.00||||713.00|341.88|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|713.00||||713.00|463.45|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|713.00||||713.00|713|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|UMR [2035]|UMR OPTIONS [203501]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|713.00||||713.00|93.53|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|713.00||||713.00|306.59|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|713.00||||713.00|177.83|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|||713.00||||713.00|213.9|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|713.00||||713.00|155.54|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MULTIPLAN [1680]|IHC HS [168011]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|713.00||||713.00|131.83|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|HEALTHNET [1495]|HEALTHNET [149500]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MULTIPLAN [1680]|HMA [168003]|713.00||||713.00|137.55|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|CORESOURCE [1315]|CORESOURCE [131500]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|713.00||||713.00|149.73|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|TRUSTMARK [2030]|STARMARK [203000]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|713.00||||713.00|156|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|713.00||||713.00|150.23|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|713.00||||713.00|357.21|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|713.00||||713.00|100.87|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|713.00||||713.00|356.5|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|713.00||||713.00|155.54|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|713.00||||713.00|306.59|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|713.00||||713.00|250.26|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|713.00||||713.00|303.74|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|713.00||||713.00|96.29|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|713.00||||713.00|100.87|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|713.00||||713.00|427.8|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|713.00||||713.00|91.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|713.00||||713.00|133.88|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|713.00||||713.00|131.83|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|CHAMPVA [1240]|CHAMP VA [124000]|713.00||||713.00|534.75|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|713.00||||713.00|161.66|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|GEHA [1415]|GEHA [141500]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|713.00||||713.00|641.7|713|91.7 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|AETNA [1015]|AETNA ACO WILCO [101532]|713.00||||713.00||| 44492522|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SPEECH SOUND PRODUCTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|713.00||||713.00||| 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|713.00||||713.00|210.52|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|713.00||||713.00|306.59|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|713.00||||713.00|357.21|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|713.00||||713.00|250.26|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|713.00||||713.00|427.8|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|713.00||||713.00|200.95|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|713.00||||713.00|210.52|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|713.00||||713.00|150.23|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|TRUSTMARK [2030]|STARMARK [203000]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|HEALTHNET [1495]|HEALTHNET [149500]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|713.00||||713.00|275.13|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MULTIPLAN [1680]|HMA [168003]|713.00||||713.00|287.07|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MULTIPLAN [1680]|IHC HS [168011]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|713.00||||713.00|177.83|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|713.00||||713.00|156|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|713.00||||713.00|306.59|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|713.00||||713.00|195.21|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|713.00||||713.00|356.5|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|UMR [2035]|UMR OPTIONS [203501]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|713.00||||713.00|279.41|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|713.00||||713.00|303.74|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|713.00||||713.00|149.73|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|713.00||||713.00|713|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|713.00||||713.00|463.45|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|713.00||||713.00|341.88|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|713.00||||713.00|155.54|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|||713.00||||713.00|213.9|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|713.00||||713.00|155.54|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|713.00||||713.00|191.38|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|713.00||||713.00|143.07|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|CHAMPVA [1240]|CHAMP VA [124000]|713.00||||713.00|534.75|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|713.00||||713.00|275.13|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|CORESOURCE [1315]|CORESOURCE [131500]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|GEHA [1415]|GEHA [141500]|713.00||||713.00|641.7|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|713.00||||713.00|161.66|713|143.07 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|AETNA [1015]|AETNA ACO WILCO [101532]|713.00||||713.00||| 44492523|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC SPEECH SOUND LANG COMPREHEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|713.00||||713.00||| 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|GEHA [1415]|GEHA [141500]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|713.00||||713.00|161.66|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|CORESOURCE [1315]|CORESOURCE [131500]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|713.00||||713.00|129|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|CHAMPVA [1240]|CHAMP VA [124000]|713.00||||713.00|534.75|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|713.00||||713.00|143.07|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|713.00||||713.00|155.54|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|713.00||||713.00|341.88|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|713.00||||713.00|131.01|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|UMR [2035]|UMR OPTIONS [203501]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|713.00||||713.00|306.59|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|713.00||||713.00|149.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|713.00||||713.00|177.83|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|FIRST HEALTH [1375]|QUALCHOICE [137513]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|713.00||||713.00|91.52|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|713.00||||713.00|463.45|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|||713.00||||713.00|213.9|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|FMH BENEFIT SERVICES [1390]|FMH [139000]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MULTIPLAN [1680]|IHC HS [168011]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|713.00||||713.00|129|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MULTIPLAN [1680]|HMA [168003]|713.00||||713.00|134.6|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|713.00||||713.00|713|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|HEALTHNET [1495]|HEALTHNET [149500]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|713.00||||713.00|150.23|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|713.00||||713.00|94.22|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|713.00||||713.00|306.59|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|713.00||||713.00|98.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|713.00||||713.00|303.74|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|713.00||||713.00|250.26|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|713.00||||713.00|357.21|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|713.00||||713.00|427.8|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|713.00||||713.00|356.5|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|713.00||||713.00|155.54|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|713.00||||713.00|98.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|713.00||||713.00|89.73|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|713.00||||713.00|156|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|TRUSTMARK [2030]|STARMARK [203000]|713.00||||713.00|641.7|713|89.73 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|713.00||||713.00||| 44492524|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC BEHAVRAL QUALIT ANALYS VOICE|AETNA [1015]|AETNA ACO WILCO [101532]|713.00||||713.00||| 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MULTIPLAN [1680]|HMA [168003]|1258.00||||1258.00|109.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|TRUSTMARK [2030]|STARMARK [203000]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1258.00||||1258.00|112.71|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1258.00||||1258.00|630.26|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1258.00||||1258.00|80.08|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1258.00||||1258.00|540.94|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1258.00||||1258.00|441.56|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1258.00||||1258.00|535.91|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1258.00||||1258.00|629|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1258.00||||1258.00|754.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1258.00||||1258.00|76.44|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1258.00||||1258.00|80.08|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1258.00||||1258.00|108.87|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|HEALTHNET [1495]|HEALTHNET [149500]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MULTIPLAN [1680]|IHC HS [168011]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1258.00||||1258.00|101.19|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1258.00||||1258.00|128.86|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1258.00||||1258.00|540.94|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1258.00||||1258.00|74.26|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|UMR [2035]|UMR OPTIONS [203501]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1258.00||||1258.00|101.92|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1258.00||||1258.00|156|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1258.00||||1258.00|1258|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|||1258.00||||1258.00|377.4|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1258.00||||1258.00|103.68|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|CHAMPVA [1240]|CHAMP VA [124000]|1258.00||||1258.00|943.5|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1258.00||||1258.00|101.19|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|CORESOURCE [1315]|CORESOURCE [131500]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1258.00||||1258.00|112.71|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|GEHA [1415]|GEHA [141500]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1258.00||||1258.00|117.15|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1258.00||||1258.00|603.21|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1258.00||||1258.00|817.7|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1258.00||||1258.00|72.8|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1258.00||||1258.00|264.18|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1258.00||||1258.00|1132.2|1258|72.8 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|AETNA [1015]|AETNA ACO WILCO [101532]|1258.00||||1258.00||| 44492610|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW FUNCTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1258.00||||1258.00||| 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|822.00||||822.00|117.15|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|GEHA [1415]|GEHA [141500]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|822.00||||822.00|126.88|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|CHAMPVA [1240]|CHAMP VA [124000]|822.00||||822.00|616.5|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|822.00||||822.00|103.68|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|822.00||||822.00|112.71|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|822.00||||822.00|93.11|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|822.00||||822.00|353.46|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MULTIPLAN [1680]|IHC HS [168011]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|TRUSTMARK [2030]|STARMARK [203000]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|822.00||||822.00|112.71|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|822.00||||822.00|411|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|822.00||||822.00|411.82|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|822.00||||822.00|288.52|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|822.00||||822.00|350.17|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|822.00||||822.00|100.41|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|822.00||||822.00|353.46|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|822.00||||822.00|493.2|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|822.00||||822.00|95.84|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|822.00||||822.00|100.41|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|822.00||||822.00|108.87|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|822.00||||822.00|156|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|HEALTHNET [1495]|HEALTHNET [149500]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MULTIPLAN [1680]|HMA [168003]|822.00||||822.00|136.92|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|822.00||||822.00|126.88|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|822.00||||822.00|128.86|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|CORESOURCE [1315]|CORESOURCE [131500]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|822.00||||822.00|127.79|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|UMR [2035]|UMR OPTIONS [203501]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|822.00||||822.00|172.62|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|822.00||||822.00|822|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|822.00||||822.00|91.28|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|822.00||||822.00|534.3|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|822.00||||822.00|394.15|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|||822.00||||822.00|246.6|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|822.00||||822.00|739.8|822|91.28 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|822.00||||822.00||| 44492611|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC EVAL SWALLOW VIDEO/CINE|AETNA [1015]|AETNA ACO WILCO [101532]|822.00||||822.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|288.00||||288.00|123.84|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|288.00||||288.00|144.29|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|288.00||||288.00|101.09|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|288.00||||288.00|144|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|288.00||||288.00|172.8|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|HEALTHNET [1495]|HEALTHNET [149500]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|288.00||||288.00|128.86|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|UMR [2035]|UMR OPTIONS [203501]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|288.00||||288.00|60.48|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|288.00||||288.00|288|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|288.00||||288.00|187.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|288.00||||288.00|138.1|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|||288.00||||288.00|86.4|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|288.00||||288.00|123.84|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|288.00||||288.00|112.71|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|FIRST HEALTH [1375]|QUALCHOICE [137513]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|FMH BENEFIT SERVICES [1390]|FMH [139000]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|288.00||||288.00|122.69|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MULTIPLAN [1680]|IHC HS [168011]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|288.00||||288.00|103.68|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|CHAMPVA [1240]|CHAMP VA [124000]|288.00||||288.00|216|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|CORESOURCE [1315]|CORESOURCE [131500]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|GEHA [1415]|GEHA [141500]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|288.00||||288.00|117.15|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|TRUSTMARK [2030]|STARMARK [203000]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|288.00||||288.00|156|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|288.00||||288.00|108.87|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|288.00||||288.00|112.71|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|288.00||||288.00|259.2|288|60.48 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|AETNA [1015]|AETNA ACO WILCO [101532]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MULTIPLAN [1680]|HMA [168003]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|288.00||||288.00||| 44492614|EAP|0444 - SPEECH THERAPY-LANGUAGE PATHOLOGY-EVALUATIO|HC LARYNGEAL FLX FEE SENSORY TEST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|288.00||||288.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 450|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|||0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 45009999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED MISC CHARGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|GEHA [1415]|GEHA [141500]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|CORESOURCE [1315]|CORESOURCE [131500]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1235.00||||1235.00|297.39|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|CHAMPVA [1240]|CHAMP VA [124000]|1235.00||||1235.00|926.25|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1235.00||||1235.00|170.11|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|||1235.00||||1235.00|370.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1235.00||||1235.00|592.18|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1235.00||||1235.00|259.35|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1235.00||||1235.00|302.03|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1235.00||||1235.00|211|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1235.00||||1235.00|211.43|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1235.00||||1235.00|531.05|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|FIRST HEALTH [1375]|QUALCHOICE [137513]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1235.00||||1235.00|1235|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|UMR [2035]|UMR OPTIONS [203501]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|FMH BENEFIT SERVICES [1390]|FMH [139000]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1235.00||||1235.00|802.75|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1235.00||||1235.00|184.93|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MULTIPLAN [1680]|IHC HS [168011]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1235.00||||1235.00|297.39|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MULTIPLAN [1680]|HMA [168003]|1235.00||||1235.00|310.3|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|HEALTHNET [1495]|HEALTHNET [149500]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|TRUSTMARK [2030]|STARMARK [203000]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1235.00||||1235.00|178.62|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1235.00||||1235.00|217.21|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1235.00||||1235.00|741|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1235.00||||1235.00|531.05|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1235.00||||1235.00|433.49|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1235.00||||1235.00|526.11|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1235.00||||1235.00|618.74|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1235.00||||1235.00|533.01|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1235.00||||1235.00|192.21|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1235.00||||1235.00|184.93|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1235.00||||1235.00|206.87|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1235.00||||1235.00|227.55|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1235.00||||1235.00|227.55|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1235.00||||1235.00|212.59|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1235.00||||1235.00|1111.5|1235|170.11 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1235.00||||1235.00||| 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1235.00||||1235.00||| 45099283|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL III|AETNA [1015]|AETNA ACO WILCO [101532]|1235.00||||1235.00||| 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1977.00||||1977.00|368.35|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1977.00||||1977.00|861.37|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1977.00||||1977.00|850.11|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1977.00||||1977.00|693.93|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1977.00||||1977.00|842.2|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1977.00||||1977.00|1186.2|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1977.00||||1977.00|342.14|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1977.00||||1977.00|284.36|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1977.00||||1977.00|294.42|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MULTIPLAN [1680]|IHC HS [168011]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1977.00||||1977.00|481.4|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MULTIPLAN [1680]|HMA [168003]|1977.00||||1977.00|502.29|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|FMH BENEFIT SERVICES [1390]|FMH [139000]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|TRUSTMARK [2030]|STARMARK [203000]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|FIRST HEALTH [1375]|QUALCHOICE [137513]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1977.00||||1977.00|850.11|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1977.00||||1977.00|368.35|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1977.00||||1977.00|336.61|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1977.00||||1977.00|341.56|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|UMR [2035]|UMR OPTIONS [203501]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1977.00||||1977.00|488.9|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|HEALTHNET [1495]|HEALTHNET [149500]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1977.00||||1977.00|415.17|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1977.00||||1977.00|294.42|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1977.00||||1977.00|270.82|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|CHAMPVA [1240]|CHAMP VA [124000]|1977.00||||1977.00|1482.75|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1977.00||||1977.00|990.48|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1977.00||||1977.00|481.4|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1977.00||||1977.00|306.01|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|CORESOURCE [1315]|CORESOURCE [131500]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|||1977.00||||1977.00|593.1|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|GEHA [1415]|GEHA [141500]|1977.00||||1977.00|1779.3|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1977.00||||1977.00|1285.05|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1977.00||||1977.00|1977|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1977.00||||1977.00|947.97|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1977.00||||1977.00|334.86|1977|270.82 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|AETNA [1015]|AETNA ACO WILCO [101532]|1977.00||||1977.00||| 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1977.00||||1977.00||| 45099284|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL IV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1977.00||||1977.00||| 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|GEHA [1415]|GEHA [141500]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|CORESOURCE [1315]|CORESOURCE [131500]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3108.00||||3108.00|452.13|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3108.00||||3108.00|671.8|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3108.00||||3108.00|400.13|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3108.00||||3108.00|435|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|||3108.00||||3108.00|932.4|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3108.00||||3108.00|1490.29|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3108.00||||3108.00|701.14|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|UMR [2035]|UMR OPTIONS [203501]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3108.00||||3108.00|489.84|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3108.00||||3108.00|497.34|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3108.00||||3108.00|1336.44|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|FIRST HEALTH [1375]|QUALCHOICE [137513]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3108.00||||3108.00|2020.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|FMH BENEFIT SERVICES [1390]|FMH [139000]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MULTIPLAN [1680]|IHC HS [168011]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3108.00||||3108.00|690.39|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MULTIPLAN [1680]|HMA [168003]|3108.00||||3108.00|720.35|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3108.00||||3108.00|3108|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|HEALTHNET [1495]|HEALTHNET [149500]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3108.00||||3108.00|528.26|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3108.00||||3108.00|504.25|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3108.00||||3108.00|1557.11|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3108.00||||3108.00|1336.44|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3108.00||||3108.00|1324.01|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3108.00||||3108.00|1090.91|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3108.00||||3108.00|1864.8|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3108.00||||3108.00|1255.6|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|CHAMPVA [1240]|CHAMP VA [124000]|3108.00||||3108.00|2331|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3108.00||||3108.00|514.04|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3108.00||||3108.00|420.15|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3108.00||||3108.00|435|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3108.00||||3108.00|652.68|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|TRUSTMARK [2030]|STARMARK [203000]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3108.00||||3108.00|480.23|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3108.00||||3108.00|2797.2|3108|400.13 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3108.00||||3108.00||| 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|AETNA [1015]|AETNA ACO WILCO [101532]|3108.00||||3108.00||| 45099285|EAP|0450 - EMERGENCY ROOM-GENERAL|HC ER LEVEL V|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3108.00||||3108.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 45099999|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ED NO CHARGE|||0.00||||0.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 451|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 452|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMOXICILLIN 250 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|||10.00||||10.00|3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|||10.00||||10.00|3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|||10.00||||10.00|3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|||10.00||||10.00|3|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4526|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LISINOPRIL 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|||10.00||||10.00|3|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4528|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 150 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4529|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LITHIUM CARBONATE 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|||10.00||||10.00|3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|||10.00||||10.00|3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|||10.00||||10.00|3|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4560|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LOPERAMIDE 2 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4572|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|||10.00||||10.00|3|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|||10.00||||10.00|3|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4573|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LORAZEPAM 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|GEHA [1415]|GEHA [141500]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|430.00||||430.00|221.06|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|CORESOURCE [1315]|CORESOURCE [131500]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|CHAMPVA [1240]|CHAMP VA [124000]|430.00||||430.00|322.5|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|430.00||||430.00|212.69|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|||430.00||||430.00|129|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|430.00||||430.00|206.19|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|430.00||||430.00|279.5|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|430.00||||430.00|430|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|430.00||||430.00|90.3|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|UMR [2035]|UMR OPTIONS [203501]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|430.00||||430.00|243.17|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|430.00||||430.00|184.9|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|HEALTHNET [1495]|HEALTHNET [149500]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MULTIPLAN [1680]|IHC HS [168011]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|TRUSTMARK [2030]|STARMARK [203000]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|430.00||||430.00|195.64|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|430.00||||430.00|205.42|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|430.00||||430.00|212.69|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|430.00||||430.00|258|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|430.00||||430.00|184.9|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|430.00||||430.00|215.43|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|430.00||||430.00|150.93|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|430.00||||430.00|183.18|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|430.00||||430.00|324.96|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|430.00||||430.00|387|430|90.3 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MULTIPLAN [1680]|HMA [168003]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|AETNA [1015]|AETNA ACO WILCO [101532]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|430.00||||430.00||| 46094010|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT SIMPLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|430.00||||430.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|574.00||||574.00|574|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|574.00||||574.00|246.82|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|574.00||||574.00|287.57|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|574.00||||574.00|201.47|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|574.00||||574.00|244.52|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|574.00||||574.00|125.76|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|TRUSTMARK [2030]|STARMARK [203000]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MULTIPLAN [1680]|IHC HS [168011]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|HEALTHNET [1495]|HEALTHNET [149500]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|FMH BENEFIT SERVICES [1390]|FMH [139000]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|FIRST HEALTH [1375]|QUALCHOICE [137513]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|574.00||||574.00|246.82|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|574.00||||574.00|143.79|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|UMR [2035]|UMR OPTIONS [203501]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|574.00||||574.00|121.46|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|574.00||||574.00|120.54|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|574.00||||574.00|344.4|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|574.00||||574.00|574|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|574.00||||574.00|373.1|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|574.00||||574.00|275.23|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|||574.00||||574.00|172.2|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|574.00||||574.00|125.76|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|574.00||||574.00|115.67|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|CHAMPVA [1240]|CHAMP VA [124000]|574.00||||574.00|430.5|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|CORESOURCE [1315]|CORESOURCE [131500]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|574.00||||574.00|130.71|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|GEHA [1415]|GEHA [141500]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|574.00||||574.00|516.6|574|115.67 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|AETNA [1015]|AETNA ACO WILCO [101532]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MULTIPLAN [1680]|HMA [168003]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|574.00||||574.00||| 46094060|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC SPIROMETRY/PFT PRE & POST BRONCH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|574.00||||574.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|575.00||||575.00|221.06|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|CORESOURCE [1315]|CORESOURCE [131500]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|575.00||||575.00|195.64|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|||575.00||||575.00|172.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|575.00||||575.00|275.71|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|575.00||||575.00|575|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|UMR [2035]|UMR OPTIONS [203501]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|575.00||||575.00|243.17|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|575.00||||575.00|247.25|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|HEALTHNET [1495]|HEALTHNET [149500]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|575.00||||575.00|120.75|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MULTIPLAN [1680]|IHC HS [168011]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|575.00||||575.00|373.75|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|575.00||||575.00|212.69|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|TRUSTMARK [2030]|STARMARK [203000]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|575.00||||575.00|205.42|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|CHAMPVA [1240]|CHAMP VA [124000]|575.00||||575.00|431.25|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|GEHA [1415]|GEHA [141500]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|575.00||||575.00|212.69|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|575.00||||575.00|345|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|575.00||||575.00|247.25|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|575.00||||575.00|288.08|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|575.00||||575.00|201.83|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|575.00||||575.00|244.95|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|575.00||||575.00|324.96|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|575.00||||575.00|517.5|575|120.75 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MULTIPLAN [1680]|HMA [168003]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|AETNA [1015]|AETNA ACO WILCO [101532]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|575.00||||575.00||| 46094150|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC VITAL CAPACITY TOTAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|575.00||||575.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|243.00||||243.00|243|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|243.00||||243.00|104.49|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|243.00||||243.00|121.74|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|243.00||||243.00|85.29|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|243.00||||243.00|145.8|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|243.00||||243.00|217.1|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|243.00||||243.00|209.69|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MULTIPLAN [1680]|IHC HS [168011]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|HEALTHNET [1495]|HEALTHNET [149500]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|243.00||||243.00|104.49|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|243.00||||243.00|243|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|TRUSTMARK [2030]|STARMARK [203000]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|UMR [2035]|UMR OPTIONS [203501]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|243.00||||243.00|51.03|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|243.00||||243.00|243|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|243.00||||243.00|157.95|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|243.00||||243.00|103.52|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|243.00||||243.00|116.52|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|||243.00||||243.00|72.9|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|243.00||||243.00|217.1|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|243.00||||243.00|199.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|CHAMPVA [1240]|CHAMP VA [124000]|243.00||||243.00|182.25|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|CORESOURCE [1315]|CORESOURCE [131500]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|243.00||||243.00|225.65|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|GEHA [1415]|GEHA [141500]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|243.00||||243.00|218.7|243|51.03 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MULTIPLAN [1680]|HMA [168003]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|243.00||||243.00||| 46094610|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC ADMIN SURFACTANT THRU TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|243.00||||243.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|GEHA [1415]|GEHA [141500]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|849.00||||849.00|221.06|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|CHAMPVA [1240]|CHAMP VA [124000]|849.00||||849.00|636.75|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|849.00||||849.00|212.69|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|||849.00||||849.00|254.7|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|849.00||||849.00|407.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|849.00||||849.00|551.85|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|849.00||||849.00|178.29|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|UMR [2035]|UMR OPTIONS [203501]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|849.00||||849.00|243.17|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|849.00||||849.00|365.07|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|FIRST HEALTH [1375]|QUALCHOICE [137513]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|FMH BENEFIT SERVICES [1390]|FMH [139000]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|HEALTHNET [1495]|HEALTHNET [149500]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|849.00||||849.00|849|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MULTIPLAN [1680]|IHC HS [168011]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|TRUSTMARK [2030]|STARMARK [203000]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|849.00||||849.00|195.64|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|849.00||||849.00|205.42|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|CORESOURCE [1315]|CORESOURCE [131500]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|849.00||||849.00|212.69|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|849.00||||849.00|509.4|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|849.00||||849.00|365.07|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|849.00||||849.00|425.35|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|849.00||||849.00|298|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|849.00||||849.00|361.67|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|849.00||||849.00|603.08|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|849.00||||849.00|764.1|849|178.29 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MULTIPLAN [1680]|HMA [168003]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|AETNA [1015]|AETNA ACO WILCO [101532]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|849.00||||849.00||| 46094726|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PLETHYSMOG LUNG VOL W/ OR W/O AIRWAY RESIST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|849.00||||849.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|597.00||||597.00|324.96|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|597.00||||597.00|256.71|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|597.00||||597.00|209.55|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|597.00||||597.00|254.32|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|597.00||||597.00|212.69|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|TRUSTMARK [2030]|STARMARK [203000]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MULTIPLAN [1680]|IHC HS [168011]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|HEALTHNET [1495]|HEALTHNET [149500]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|FMH BENEFIT SERVICES [1390]|FMH [139000]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|FIRST HEALTH [1375]|QUALCHOICE [137513]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|597.00||||597.00|256.71|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|597.00||||597.00|243.17|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|UMR [2035]|UMR OPTIONS [203501]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|597.00||||597.00|125.37|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|597.00||||597.00|205.42|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|597.00||||597.00|358.2|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|597.00||||597.00|597|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|597.00||||597.00|388.05|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|597.00||||597.00|299.1|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|597.00||||597.00|286.26|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|||597.00||||597.00|179.1|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|597.00||||597.00|212.69|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|597.00||||597.00|195.64|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|CHAMPVA [1240]|CHAMP VA [124000]|597.00||||597.00|447.75|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|CORESOURCE [1315]|CORESOURCE [131500]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|597.00||||597.00|221.06|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|GEHA [1415]|GEHA [141500]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|597.00||||597.00|537.3|597|125.37 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|AETNA [1015]|AETNA ACO WILCO [101532]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MULTIPLAN [1680]|HMA [168003]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|597.00||||597.00||| 46094727|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULM FUNCTION LUNG VOLUME BY GAS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|597.00||||597.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|670.00||||670.00|82.32|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|CORESOURCE [1315]|CORESOURCE [131500]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|CHAMPVA [1240]|CHAMP VA [124000]|670.00||||670.00|502.5|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|670.00||||670.00|72.84|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|||670.00||||670.00|201|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|670.00||||670.00|321.27|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|670.00||||670.00|670|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|670.00||||670.00|140.7|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|UMR [2035]|UMR OPTIONS [203501]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|670.00||||670.00|90.55|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|670.00||||670.00|288.1|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|FIRST HEALTH [1375]|QUALCHOICE [137513]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|FMH BENEFIT SERVICES [1390]|FMH [139000]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|HEALTHNET [1495]|HEALTHNET [149500]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MULTIPLAN [1680]|IHC HS [168011]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|670.00||||670.00|435.5|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|670.00||||670.00|79.2|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|TRUSTMARK [2030]|STARMARK [203000]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|670.00||||670.00|76.49|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|670.00||||670.00|79.2|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|670.00||||670.00|402|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|GEHA [1415]|GEHA [141500]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|670.00||||670.00|288.1|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|670.00||||670.00|335.67|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|670.00||||670.00|235.17|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|670.00||||670.00|285.42|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|670.00||||670.00|335|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|670.00||||670.00|603|670|72.84 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MULTIPLAN [1680]|HMA [168003]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|AETNA [1015]|AETNA ACO WILCO [101532]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|670.00||||670.00||| 46094729|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CARBON MONOXIDE DIFF (DLCO)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|670.00||||670.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230.00||||230.00|115|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230.00||||230.00|98.9|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230.00||||230.00|115.23|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230.00||||230.00|80.73|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230.00||||230.00|97.98|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230.00||||230.00|138|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MULTIPLAN [1680]|IHC HS [168011]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|HEALTHNET [1495]|HEALTHNET [149500]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230.00||||230.00|98.9|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|UMR [2035]|UMR OPTIONS [203501]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|TRUSTMARK [2030]|STARMARK [203000]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230.00||||230.00|48.3|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230.00||||230.00|230|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230.00||||230.00|149.5|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230.00||||230.00|110.29|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|||230.00||||230.00|69|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|CHAMPVA [1240]|CHAMP VA [124000]|230.00||||230.00|172.5|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|CORESOURCE [1315]|CORESOURCE [131500]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|GEHA [1415]|GEHA [141500]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230.00||||230.00|207|230|48.3 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|AETNA [1015]|AETNA ACO WILCO [101532]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MULTIPLAN [1680]|HMA [168003]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230.00||||230.00||| 46094760|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY SINGLE DETERMINATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230.00||||230.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|GEHA [1415]|GEHA [141500]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|CHAMPVA [1240]|CHAMP VA [124000]|340.00||||340.00|255|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|||340.00||||340.00|102|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|340.00||||340.00|163.03|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|340.00||||340.00|221|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|340.00||||340.00|71.4|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|UMR [2035]|UMR OPTIONS [203501]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|340.00||||340.00|146.2|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|FIRST HEALTH [1375]|QUALCHOICE [137513]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|HEALTHNET [1495]|HEALTHNET [149500]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|340.00||||340.00|340|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MULTIPLAN [1680]|IHC HS [168011]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|TRUSTMARK [2030]|STARMARK [203000]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|CORESOURCE [1315]|CORESOURCE [131500]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|340.00||||340.00|204|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|340.00||||340.00|146.2|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|340.00||||340.00|170.34|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|340.00||||340.00|119.34|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|340.00||||340.00|144.84|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|340.00||||340.00|170|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|340.00||||340.00|306|340|71.4 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MULTIPLAN [1680]|HMA [168003]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|AETNA [1015]|AETNA ACO WILCO [101532]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|340.00||||340.00||| 46094761|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY MULTI DETERMINATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|340.00||||340.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|272.00||||272.00|272|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|272.00||||272.00|116.96|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|272.00||||272.00|95.47|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|272.00||||272.00|115.87|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|272.00||||272.00|85.55|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|272.00||||272.00|82.62|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|TRUSTMARK [2030]|STARMARK [203000]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MULTIPLAN [1680]|IHC HS [168011]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|HEALTHNET [1495]|HEALTHNET [149500]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|FMH BENEFIT SERVICES [1390]|FMH [139000]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|FIRST HEALTH [1375]|QUALCHOICE [137513]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|272.00||||272.00|116.96|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|272.00||||272.00|97.82|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|UMR [2035]|UMR OPTIONS [203501]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|272.00||||272.00|57.12|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|272.00||||272.00|272|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|272.00||||272.00|176.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|272.00||||272.00|163.2|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|272.00||||272.00|136.27|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|272.00||||272.00|130.42|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|||272.00||||272.00|81.6|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|272.00||||272.00|85.55|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|272.00||||272.00|78.68|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|CHAMPVA [1240]|CHAMP VA [124000]|272.00||||272.00|204|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|CORESOURCE [1315]|CORESOURCE [131500]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|272.00||||272.00|88.92|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|GEHA [1415]|GEHA [141500]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|272.00||||272.00|244.8|272|57.12 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|AETNA [1015]|AETNA ACO WILCO [101532]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MULTIPLAN [1680]|HMA [168003]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|272.00||||272.00||| 46094762|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULSE OXIMETRY OVERNIGHT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|272.00||||272.00||| 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|GEHA [1415]|GEHA [141500]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|884.00||||884.00|324.67|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|CORESOURCE [1315]|CORESOURCE [131500]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|884.00||||884.00|189.32|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|884.00||||884.00|287.32|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|||884.00||||884.00|265.2|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|884.00||||884.00|423.88|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|884.00||||884.00|574.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|884.00||||884.00|884|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|884.00||||884.00|192.27|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|UMR [2035]|UMR OPTIONS [203501]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|884.00||||884.00|357.14|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|884.00||||884.00|380.12|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|FIRST HEALTH [1375]|QUALCHOICE [137513]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|884.00||||884.00|134.33|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|FMH BENEFIT SERVICES [1390]|FMH [139000]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|884.00||||884.00|185.64|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|HEALTHNET [1495]|HEALTHNET [149500]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MULTIPLAN [1680]|IHC HS [168011]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|884.00||||884.00|189.32|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MULTIPLAN [1680]|HMA [168003]|884.00||||884.00|197.54|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|884.00||||884.00|312.37|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|TRUSTMARK [2030]|STARMARK [203000]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|884.00||||884.00|301.7|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|CHAMPVA [1240]|CHAMP VA [124000]|884.00||||884.00|663|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|884.00||||884.00|144.86|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|884.00||||884.00|312.37|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|884.00||||884.00|530.4|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|884.00||||884.00|138.28|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|884.00||||884.00|380.12|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|884.00||||884.00|442.88|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|884.00||||884.00|310.28|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|884.00||||884.00|376.58|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|884.00||||884.00|324.96|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|884.00||||884.00|144.86|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|884.00||||884.00|131.69|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|884.00||||884.00|795.6|884|131.69 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|884.00||||884.00||| 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|AETNA [1015]|AETNA ACO WILCO [101532]|884.00||||884.00||| 46094770|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC CO2 EXPIRED GAS BY INFRARED DET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|884.00||||884.00||| 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|334.00||||334.00|144.86|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|334.00||||334.00|324.96|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|334.00||||334.00|143.62|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|334.00||||334.00|167.33|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|334.00||||334.00|117.23|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|334.00||||334.00|138.28|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|334.00||||334.00|200.4|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|334.00||||334.00|212.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|334.00||||334.00|144.86|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|334.00||||334.00|205.42|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|TRUSTMARK [2030]|STARMARK [203000]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MULTIPLAN [1680]|IHC HS [168011]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|334.00||||334.00|189.32|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MULTIPLAN [1680]|HMA [168003]|334.00||||334.00|197.54|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|HEALTHNET [1495]|HEALTHNET [149500]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|FMH BENEFIT SERVICES [1390]|FMH [139000]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|FIRST HEALTH [1375]|QUALCHOICE [137513]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|334.00||||334.00|143.62|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|334.00||||334.00|243.17|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|334.00||||334.00|134.33|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|UMR [2035]|UMR OPTIONS [203501]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|334.00||||334.00|192.27|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|334.00||||334.00|70.14|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|334.00||||334.00|334|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|334.00||||334.00|217.1|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|334.00||||334.00|160.15|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|||334.00||||334.00|100.2|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|334.00||||334.00|212.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|334.00||||334.00|142.28|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|334.00||||334.00|131.69|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|334.00||||334.00|195.64|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|CHAMPVA [1240]|CHAMP VA [124000]|334.00||||334.00|250.5|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|334.00||||334.00|189.32|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|CORESOURCE [1315]|CORESOURCE [131500]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|334.00||||334.00|221.06|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|GEHA [1415]|GEHA [141500]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|334.00||||334.00|300.6|334|70.14 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|334.00||||334.00||| 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|AETNA [1015]|AETNA ACO WILCO [101532]|334.00||||334.00||| 46094799|EAP|0460 - PULMONARY FUNCTION-GENERAL|HC PULMONARY PROC UNLISTED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|334.00||||334.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|||10.00||||10.00|3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|||10.00||||10.00|3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|||10.00||||10.00|3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4712|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MAGNESIUM CITRATE ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1325.00||||1325.00|569.75|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1325.00||||1325.00|465.08|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1325.00||||1325.00|564.45|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1325.00||||1325.00|603.08|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1325.00||||1325.00|795|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1325.00||||1325.00|238.6|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1325.00||||1325.00|230.45|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MULTIPLAN [1680]|IHC HS [168011]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1325.00||||1325.00|569.75|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|HEALTHNET [1495]|HEALTHNET [149500]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1325.00||||1325.00|272.79|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|TRUSTMARK [2030]|STARMARK [203000]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|UMR [2035]|UMR OPTIONS [203501]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1325.00||||1325.00|278.25|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1325.00||||1325.00|1325|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1325.00||||1325.00|861.25|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1325.00||||1325.00|635.34|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1325.00||||1325.00|663.83|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|||1325.00||||1325.00|397.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1325.00||||1325.00|238.6|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1325.00||||1325.00|219.47|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|CHAMPVA [1240]|CHAMP VA [124000]|1325.00||||1325.00|993.75|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|CORESOURCE [1315]|CORESOURCE [131500]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1325.00||||1325.00|247.99|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|GEHA [1415]|GEHA [141500]|1325.00||||1325.00|1192.5|1325|219.47 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|AETNA [1015]|AETNA ACO WILCO [101532]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MULTIPLAN [1680]|HMA [168003]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1325.00||||1325.00||| 47192585|EAP|0471 - AUDIOLOGY-DIAGNOSTIC|HC EVOKED POTENTIAL AUDITORY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1325.00||||1325.00||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.38||||39.38|19.73|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.38||||39.38|13.82|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.38||||39.38|16.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.38||||39.38|19.73|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.38||||39.38|13.82|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.38||||39.38|16.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.38||||39.38|19.73|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.38||||39.38|13.82|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.38||||39.38|16.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.38||||39.38|19.73|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.38||||39.38|13.82|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.38||||39.38|16.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.38||||39.38|19.73|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.38||||39.38|13.82|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.38||||39.38|16.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.38||||39.38|23.63|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.38||||39.38|23.63|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.38||||39.38|23.63|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.38||||39.38|23.63|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.38||||39.38|23.63|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.38||||39.38|25.6|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.38||||39.38|18.88|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.38||||39.38|8.27|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|39.38||||39.38|29.54|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.38||||39.38|8.27|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|||39.38||||39.38|11.81|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.38||||39.38|3.9|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|||39.38||||39.38|11.81|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|39.38||||39.38|29.54|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|39.38||||39.38|13.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.38||||39.38|3.9|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.38||||39.38|18.88|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.38||||39.38|18.88|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|||39.38||||39.38|11.81|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.38||||39.38|25.6|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|39.38||||39.38|13.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|39.38||||39.38|29.54|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|39.38||||39.38|29.54|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.38||||39.38|3.9|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.38||||39.38|18.88|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.38||||39.38|3.9|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|39.38||||39.38|13.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|39.38||||39.38|29.54|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|39.38||||39.38|13.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.38||||39.38|18.88|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.38||||39.38|25.6|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|||39.38||||39.38|11.81|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.38||||39.38|8.27|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.38||||39.38|8.27|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.38||||39.38|16.93|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|39.38||||39.38|13.78|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.38||||39.38|3.9|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.38||||39.38|25.6|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.38||||39.38|8.27|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.38||||39.38|25.6|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|||39.38||||39.38|11.81|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.38||||39.38|35.44|35.44|3.9 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.38||||39.38||| 472|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.38||||39.38||| 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|UMR [2035]|UMR OPTIONS [203501]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|TRUSTMARK [2030]|STARMARK [203000]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1448.00||||1448.00|370.75|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|FIRST HEALTH [1375]|QUALCHOICE [137513]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|HEALTHNET [1495]|HEALTHNET [149500]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1448.00||||1448.00|941.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1448.00||||1448.00|1448|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1448.00||||1448.00|622.64|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1448.00||||1448.00|304.08|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1448.00||||1448.00|829.73|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1448.00||||1448.00|522.53|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MULTIPLAN [1680]|IHC HS [168011]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|FMH BENEFIT SERVICES [1390]|FMH [139000]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1448.00||||1448.00|982.19|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1448.00||||1448.00|530.68|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1448.00||||1448.00|892.9|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|CHAMPVA [1240]|CHAMP VA [124000]|1448.00||||1448.00|1086|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1448.00||||1448.00|522.53|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MULTIPLAN [1680]|HMA [168003]|1448.00||||1448.00|545.22|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|||1448.00||||1448.00|434.4|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|CORESOURCE [1315]|CORESOURCE [131500]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1448.00||||1448.00|694.32|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|GEHA [1415]|GEHA [141500]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1448.00||||1448.00|790.19|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1448.00||||1448.00|859.07|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1448.00||||1448.00|399.82|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1448.00||||1448.00|725.45|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1448.00||||1448.00|922.36|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1448.00||||1448.00|868.8|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1448.00||||1448.00|508.25|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1448.00||||1448.00|363.48|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1448.00||||1448.00|1303.2|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1448.00||||1448.00|859.07|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1448.00||||1448.00|381.65|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1448.00||||1448.00|622.64|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1448.00||||1448.00|616.85|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1448.00||||1448.00|399.82|1448|304.08 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1448.00||||1448.00||| 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|AETNA [1015]|AETNA ACO WILCO [101532]|1448.00||||1448.00||| 48008924|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST F/U OR LMTD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1448.00||||1448.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|1133.00||||1133.00|849.75|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|UMR [2035]|UMR OPTIONS [203501]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1133.00||||1133.00|543.27|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|GEHA [1415]|GEHA [141500]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1133.00||||1133.00|1133|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1133.00||||1133.00|859.07|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1133.00||||1133.00|790.19|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1133.00||||1133.00|892.9|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1133.00||||1133.00|487.19|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1133.00||||1133.00|982.19|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1133.00||||1133.00|237.93|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1133.00||||1133.00|736.45|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1133.00||||1133.00|1133|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1133.00||||1133.00|567.63|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1133.00||||1133.00|829.73|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1133.00||||1133.00|679.8|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1133.00||||1133.00|482.66|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|||1133.00||||1133.00|339.9|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1133.00||||1133.00|859.07|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1133.00||||1133.00|397.68|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1133.00||||1133.00|1019.7|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1133.00||||1133.00|487.19|1133|237.93 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MULTIPLAN [1680]|HMA [168003]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1133.00||||1133.00||| 48008925|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/WO CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1133.00||||1133.00||| 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1232.00||||1232.00|490.68|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1232.00||||1232.00|490.68|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|HEALTHNET [1495]|HEALTHNET [149500]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1232.00||||1232.00|786.34|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1232.00||||1232.00|1189.12|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1232.00||||1232.00|739.2|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1232.00||||1232.00|617.23|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1232.00||||1232.00|432.43|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1232.00||||1232.00|529.76|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1232.00||||1232.00|524.83|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1232.00||||1232.00|899.03|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1232.00||||1232.00|468.37|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1232.00||||1232.00|641.27|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1232.00||||1232.00|723.29|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|||1232.00||||1232.00|369.6|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MULTIPLAN [1680]|IHC HS [168011]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1232.00||||1232.00|454.99|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1232.00||||1232.00|529.76|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1232.00||||1232.00|258.72|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|TRUSTMARK [2030]|STARMARK [203000]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1232.00||||1232.00|759.47|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1232.00||||1232.00|786.34|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1232.00||||1232.00|641.27|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1232.00||||1232.00|800.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1232.00||||1232.00|651.26|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|CORESOURCE [1315]|CORESOURCE [131500]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|GEHA [1415]|GEHA [141500]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1232.00||||1232.00|817.3|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|CHAMPVA [1240]|CHAMP VA [124000]|1232.00||||1232.00|924|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1232.00||||1232.00|590.74|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|UMR [2035]|UMR OPTIONS [203501]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1232.00||||1232.00|446.07|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1232.00||||1232.00|1232|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|MULTIPLAN [1680]|HMA [168003]|1232.00||||1232.00|669.11|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1232.00||||1232.00|1108.8|1232|258.72 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1232.00||||1232.00||| 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1232.00||||1232.00||| 48093303|EAP|0480 - CARDIOLOGY-GENERAL|HC ECHO COMPLETE CONG CARD ANOMOLY|AETNA [1015]|AETNA ACO WILCO [101532]|1232.00||||1232.00||| 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1662.00||||1662.00|786.34|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|CORESOURCE [1315]|CORESOURCE [131500]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|GEHA [1415]|GEHA [141500]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1662.00||||1662.00|817.3|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1662.00||||1662.00|723.29|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|CHAMPVA [1240]|CHAMP VA [124000]|1662.00||||1662.00|1246.5|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1662.00||||1662.00|1080.3|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|||1662.00||||1662.00|498.6|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|UMR [2035]|UMR OPTIONS [203501]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1662.00||||1662.00|669.28|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1662.00||||1662.00|899.03|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|FIRST HEALTH [1375]|QUALCHOICE [137513]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1662.00||||1662.00|467.58|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1662.00||||1662.00|659.01|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MULTIPLAN [1680]|IHC HS [168011]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MULTIPLAN [1680]|HMA [168003]|1662.00||||1662.00|687.61|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|HEALTHNET [1495]|HEALTHNET [149500]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1662.00||||1662.00|796.93|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|TRUSTMARK [2030]|STARMARK [203000]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1662.00||||1662.00|759.47|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1662.00||||1662.00|504.25|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1662.00||||1662.00|504.25|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1662.00||||1662.00|997.2|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1662.00||||1662.00|714.66|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1662.00||||1662.00|583.36|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1662.00||||1662.00|786.34|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1662.00||||1662.00|1189.12|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1662.00||||1662.00|832.66|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1662.00||||1662.00|714.66|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|FMH BENEFIT SERVICES [1390]|FMH [139000]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1662.00||||1662.00|1662|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1662.00||||1662.00|708.01|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1662.00||||1662.00|481.33|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1662.00||||1662.00|659.01|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1662.00||||1662.00|458.41|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1662.00||||1662.00|1495.8|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1662.00||||1662.00|349.02|1662|349.02 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1662.00||||1662.00||| 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|AETNA [1015]|AETNA ACO WILCO [101532]|1662.00||||1662.00||| 48193318|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE MONITOR CARDIAC PUMP FUNCTN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1662.00||||1662.00||| 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1403.00||||1403.00|911.95|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1403.00||||1403.00|245.74|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|UMR [2035]|UMR OPTIONS [203501]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1403.00||||1403.00|313.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|GEHA [1415]|GEHA [141500]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1403.00||||1403.00|288.76|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1403.00||||1403.00|346.35|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|CHAMPVA [1240]|CHAMP VA [124000]|1403.00||||1403.00|1052.25|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1403.00||||1403.00|326.28|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1403.00||||1403.00|603.29|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1403.00||||1403.00|294.63|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|CORESOURCE [1315]|CORESOURCE [131500]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1403.00||||1403.00|1403|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|||1403.00||||1403.00|420.9|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1403.00||||1403.00|346.35|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1403.00||||1403.00|358.91|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MULTIPLAN [1680]|HMA [168003]|1403.00||||1403.00|361.38|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1403.00||||1403.00|672.74|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1403.00||||1403.00|351.74|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1403.00||||1403.00|603.29|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1403.00||||1403.00|597.68|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1403.00||||1403.00|841.8|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1403.00||||1403.00|603.08|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1403.00||||1403.00|265.01|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1403.00||||1403.00|252.97|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1403.00||||1403.00|313.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1403.00||||1403.00|303.2|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1403.00||||1403.00|492.45|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|TRUSTMARK [2030]|STARMARK [203000]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1403.00||||1403.00|702.9|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1403.00||||1403.00|265.01|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1403.00||||1403.00|240.92|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|HEALTHNET [1495]|HEALTHNET [149500]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|MULTIPLAN [1680]|IHC HS [168011]|1403.00||||1403.00|1262.7|1403|240.92 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1403.00||||1403.00||| 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1403.00||||1403.00||| 48293017|EAP|0482 - CARDIOLOGY-STRESS TEST|HC STRESS TEST TRACING ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|1403.00||||1403.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1799.00||||1799.00|892.9|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|GEHA [1415]|GEHA [141500]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|1799.00||||1799.00|1349.25|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1799.00||||1799.00|790.19|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1799.00||||1799.00|859.07|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1799.00||||1799.00|631.45|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1799.00||||1799.00|1799|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1799.00||||1799.00|862.62|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1799.00||||1799.00|829.73|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1799.00||||1799.00|377.79|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|UMR [2035]|UMR OPTIONS [203501]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1799.00||||1799.00|982.19|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1799.00||||1799.00|773.57|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1799.00||||1799.00|859.07|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1799.00||||1799.00|773.57|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1799.00||||1799.00|1653.46|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1799.00||||1799.00|901.3|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1799.00||||1799.00|1169.35|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1799.00||||1799.00|766.37|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|||1799.00||||1799.00|539.7|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1799.00||||1799.00|1079.4|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1799.00||||1799.00|1619.1|1799|377.79 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|MULTIPLAN [1680]|HMA [168003]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1799.00||||1799.00||| 48308921|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1799.00||||1799.00|766.37|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1799.00||||1799.00|829.73|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1799.00||||1799.00|859.07|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1799.00||||1799.00|631.45|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1799.00||||1799.00|1079.4|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1799.00||||1799.00|773.57|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|HEALTHNET [1495]|HEALTHNET [149500]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MULTIPLAN [1680]|IHC HS [168011]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1799.00||||1799.00|901.3|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|FIRST HEALTH [1375]|QUALCHOICE [137513]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|GEHA [1415]|GEHA [141500]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|TRUSTMARK [2030]|STARMARK [203000]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|CHAMPVA [1240]|CHAMP VA [124000]|1799.00||||1799.00|1349.25|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1799.00||||1799.00|1799|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|FMH BENEFIT SERVICES [1390]|FMH [139000]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1799.00||||1799.00|1169.35|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1799.00||||1799.00|859.07|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|||1799.00||||1799.00|539.7|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1799.00||||1799.00|862.62|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1799.00||||1799.00|377.79|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1799.00||||1799.00|790.19|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|CORESOURCE [1315]|CORESOURCE [131500]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|UMR [2035]|UMR OPTIONS [203501]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1799.00||||1799.00|1653.46|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1799.00||||1799.00|892.9|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1799.00||||1799.00|773.57|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1799.00||||1799.00|1619.1|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1799.00||||1799.00|982.19|1799|377.79 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|AETNA [1015]|AETNA ACO WILCO [101532]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MULTIPLAN [1680]|HMA [168003]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1799.00||||1799.00||| 48308922|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W CONT CONGENITAL F/U LTD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|CHAMPVA [1240]|CHAMP VA [124000]|1799.00||||1799.00|1349.25|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|CORESOURCE [1315]|CORESOURCE [131500]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|UMR [2035]|UMR OPTIONS [203501]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|||1799.00||||1799.00|539.7|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1799.00||||1799.00|862.62|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1799.00||||1799.00|1169.35|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1799.00||||1799.00|1799|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1799.00||||1799.00|377.79|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|TRUSTMARK [2030]|STARMARK [203000]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1799.00||||1799.00|773.57|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1799.00||||1799.00|449.75|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|FIRST HEALTH [1375]|QUALCHOICE [137513]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MULTIPLAN [1680]|IHC HS [168011]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|FMH BENEFIT SERVICES [1390]|FMH [139000]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1799.00||||1799.00|901.3|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|GEHA [1415]|GEHA [141500]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1799.00||||1799.00|773.57|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1799.00||||1799.00|899.5|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1799.00||||1799.00|1079.4|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1799.00||||1799.00|766.37|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1799.00||||1799.00|631.45|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|HEALTHNET [1495]|HEALTHNET [149500]|1799.00||||1799.00|1619.1|1799|377.79 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|AETNA [1015]|AETNA ACO WILCO [101532]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MULTIPLAN [1680]|HMA [168003]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1799.00||||1799.00||| 48308926|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TEE W OR W/O FOL W/CONT CONG|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1799.00||||1799.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MULTIPLAN [1680]|IHC HS [168011]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1133.00||||1133.00|567.63|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1133.00||||1133.00|679.8|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1133.00||||1133.00|1133|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1133.00||||1133.00|482.66|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1133.00||||1133.00|487.19|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1133.00||||1133.00|397.68|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1133.00||||1133.00|859.07|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|HEALTHNET [1495]|HEALTHNET [149500]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|TRUSTMARK [2030]|STARMARK [203000]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|CHAMPVA [1240]|CHAMP VA [124000]|1133.00||||1133.00|849.75|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1133.00||||1133.00|982.19|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1133.00||||1133.00|487.19|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|UMR [2035]|UMR OPTIONS [203501]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1133.00||||1133.00|237.93|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1133.00||||1133.00|736.45|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1133.00||||1133.00|859.07|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1133.00||||1133.00|790.19|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|CORESOURCE [1315]|CORESOURCE [131500]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1133.00||||1133.00|892.9|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1133.00||||1133.00|543.27|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|GEHA [1415]|GEHA [141500]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1133.00||||1133.00|829.73|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1133.00||||1133.00|1019.7|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1133.00||||1133.00|1133|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|||1133.00||||1133.00|339.9|1133|237.93 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|AETNA [1015]|AETNA ACO WILCO [101532]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|MULTIPLAN [1680]|HMA [168003]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1133.00||||1133.00||| 48308928|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST STRESS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1133.00||||1133.00||| 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|GEHA [1415]|GEHA [141500]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1133.00||||1133.00|892.9|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|||1133.00||||1133.00|339.9|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1133.00||||1133.00|1133|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1133.00||||1133.00|237.93|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1133.00||||1133.00|982.19|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1133.00||||1133.00|931.65|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MULTIPLAN [1680]|HMA [168003]|1133.00||||1133.00|972.09|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|HEALTHNET [1495]|HEALTHNET [149500]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|TRUSTMARK [2030]|STARMARK [203000]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1133.00||||1133.00|680.46|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1133.00||||1133.00|679.8|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1133.00||||1133.00|487.19|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1133.00||||1133.00|1133|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1133.00||||1133.00|482.66|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1133.00||||1133.00|661.02|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1133.00||||1133.00|397.68|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1133.00||||1133.00|859.07|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1133.00||||1133.00|829.73|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MULTIPLAN [1680]|IHC HS [168011]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1133.00||||1133.00|567.63|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|FIRST HEALTH [1375]|QUALCHOICE [137513]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|UMR [2035]|UMR OPTIONS [203501]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1133.00||||1133.00|946.16|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1133.00||||1133.00|487.19|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1133.00||||1133.00|712.86|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1133.00||||1133.00|543.27|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1133.00||||1133.00|790.19|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1133.00||||1133.00|859.07|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|CORESOURCE [1315]|CORESOURCE [131500]|1133.00||||1133.00|1019.7|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1133.00||||1133.00|931.65|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|CHAMPVA [1240]|CHAMP VA [124000]|1133.00||||1133.00|849.75|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1133.00||||1133.00|648.06|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1133.00||||1133.00|736.45|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1133.00||||1133.00|712.86|1133|237.93 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|AETNA [1015]|AETNA ACO WILCO [101532]|1133.00||||1133.00||| 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1133.00||||1133.00||| 48308929|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC TTE W OR W/WO CONTRAST COMP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1133.00||||1133.00||| 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1842.00||||1842.00|659.01|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1842.00||||1842.00|1189.12|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1842.00||||1842.00|784.69|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1842.00||||1842.00|792.06|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1842.00||||1842.00|504.25|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1842.00||||1842.00|594.95|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1842.00||||1842.00|1105.2|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1842.00||||1842.00|481.33|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1842.00||||1842.00|574.62|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MULTIPLAN [1680]|HMA [168003]|1842.00||||1842.00|687.61|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1842.00||||1842.00|680.22|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1842.00||||1842.00|792.06|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|UMR [2035]|UMR OPTIONS [203501]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1842.00||||1842.00|386.82|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1842.00||||1842.00|1197.3|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|||1842.00||||1842.00|552.6|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1842.00||||1842.00|467.58|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1842.00||||1842.00|646.54|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1842.00||||1842.00|594.95|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1842.00||||1842.00|504.25|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1842.00||||1842.00|1842|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1842.00||||1842.00|922.84|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1842.00||||1842.00|883.24|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|1842.00||||1842.00|1381.5|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1842.00||||1842.00|547.24|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1842.00||||1842.00|659.01|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1842.00||||1842.00|458.41|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1842.00||||1842.00|618.38|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|GEHA [1415]|GEHA [141500]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1842.00||||1842.00|1657.8|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1842.00||||1842.00|669.28|1842|386.82 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|1842.00||||1842.00||| 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1842.00||||1842.00||| 48393306|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W/ DOPPLER COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1842.00||||1842.00||| 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|725.00||||725.00|311.75|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|725.00||||725.00|226.26|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|UMR [2035]|UMR OPTIONS [203501]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|725.00||||725.00|347.64|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|725.00||||725.00|323.87|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|725.00||||725.00|320.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|725.00||||725.00|398.79|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MULTIPLAN [1680]|IHC HS [168011]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|725.00||||725.00|244.01|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|725.00||||725.00|254.48|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MULTIPLAN [1680]|HMA [168003]|725.00||||725.00|332.74|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|TRUSTMARK [2030]|STARMARK [203000]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|725.00||||725.00|311.75|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|725.00||||725.00|348.8|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|725.00||||725.00|232.92|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|725.00||||725.00|244.01|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|725.00||||725.00|336.88|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|725.00||||725.00|435|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|725.00||||725.00|551.1|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|725.00||||725.00|318.9|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|725.00||||725.00|363.23|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|725.00||||725.00|308.85|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|||725.00||||725.00|217.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|725.00||||725.00|471.25|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|725.00||||725.00|221.83|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|725.00||||725.00|725|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|725.00||||725.00|152.25|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|725.00||||725.00|348.8|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|725.00||||725.00|318.9|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|725.00||||725.00|543.75|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|725.00||||725.00|362.53|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|GEHA [1415]|GEHA [141500]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|725.00||||725.00|652.5|725|152.25 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|725.00||||725.00||| 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|725.00||||725.00||| 48393308|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO 2D W M-MODE LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|725.00||||725.00||| 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2527.00||||2527.00|659.01|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2527.00||||2527.00|817.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|GEHA [1415]|GEHA [141500]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|CORESOURCE [1315]|CORESOURCE [131500]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|CHAMPVA [1240]|CHAMP VA [124000]|2527.00||||2527.00|1895.25|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2527.00||||2527.00|723.29|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2527.00||||2527.00|786.34|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|||2527.00||||2527.00|758.1|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2527.00||||2527.00|504.25|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2527.00||||2527.00|1266.03|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2527.00||||2527.00|1076.5|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2527.00||||2527.00|1516.2|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2527.00||||2527.00|481.33|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2527.00||||2527.00|759.47|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MULTIPLAN [1680]|IHC HS [168011]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2527.00||||2527.00|659.01|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MULTIPLAN [1680]|HMA [168003]|2527.00||||2527.00|687.61|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|HEALTHNET [1495]|HEALTHNET [149500]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|FMH BENEFIT SERVICES [1390]|FMH [139000]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|TRUSTMARK [2030]|STARMARK [203000]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|FIRST HEALTH [1375]|QUALCHOICE [137513]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2527.00||||2527.00|899.03|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2527.00||||2527.00|504.25|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2527.00||||2527.00|1086.61|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2527.00||||2527.00|467.58|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2527.00||||2527.00|786.34|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2527.00||||2527.00|886.98|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|UMR [2035]|UMR OPTIONS [203501]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2527.00||||2527.00|1189.12|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2527.00||||2527.00|669.28|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2527.00||||2527.00|1086.61|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2527.00||||2527.00|530.67|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2527.00||||2527.00|2527|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2527.00||||2527.00|458.41|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2527.00||||2527.00|2274.3|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2527.00||||2527.00|1642.55|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2527.00||||2527.00|1211.7|2527|458.41 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2527.00||||2527.00||| 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2527.00||||2527.00||| 48393312|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE COMPLETE W/PF|AETNA [1015]|AETNA ACO WILCO [101532]|2527.00||||2527.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|762.00||||762.00|267.46|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|762.00||||762.00|327.66|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|UMR [2035]|UMR OPTIONS [203501]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|CORESOURCE [1315]|CORESOURCE [131500]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|CHAMPVA [1240]|CHAMP VA [124000]|762.00||||762.00|571.5|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|762.00||||762.00|618.38|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|GEHA [1415]|GEHA [141500]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|762.00||||762.00|594.95|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|762.00||||762.00|365.38|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|762.00||||762.00|495.3|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|762.00||||762.00|762|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|762.00||||762.00|160.02|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|762.00||||762.00|680.22|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|HEALTHNET [1495]|HEALTHNET [149500]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MULTIPLAN [1680]|IHC HS [168011]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|||762.00||||762.00|228.6|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|TRUSTMARK [2030]|STARMARK [203000]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|762.00||||762.00|574.62|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|762.00||||762.00|547.24|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|762.00||||762.00|594.95|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|762.00||||762.00|457.2|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|762.00||||762.00|762|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|762.00||||762.00|327.66|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|762.00||||762.00|381.76|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|762.00||||762.00|324.61|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|762.00||||762.00|685.8|762|160.02 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MULTIPLAN [1680]|HMA [168003]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|762.00||||762.00||| 48393313|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO TEE PROBE PLACEMENT ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|762.00||||762.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|784.00||||784.00|392.78|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|784.00||||784.00|392|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|TRUSTMARK [2030]|STARMARK [203000]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|HEALTHNET [1495]|HEALTHNET [149500]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|784.00||||784.00|337.12|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|UMR [2035]|UMR OPTIONS [203501]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|||784.00||||784.00|235.2|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|GEHA [1415]|GEHA [141500]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|CORESOURCE [1315]|CORESOURCE [131500]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|CHAMPVA [1240]|CHAMP VA [124000]|784.00||||784.00|588|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|784.00||||784.00|375.93|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|784.00||||784.00|509.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|784.00||||784.00|784|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|784.00||||784.00|164.64|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|FMH BENEFIT SERVICES [1390]|FMH [139000]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MULTIPLAN [1680]|IHC HS [168011]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|FIRST HEALTH [1375]|QUALCHOICE [137513]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|784.00||||784.00|705.6|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|784.00||||784.00|470.4|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|784.00||||784.00|333.98|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|784.00||||784.00|275.18|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|784.00||||784.00|337.12|784|164.64 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|AETNA [1015]|AETNA ACO WILCO [101532]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MULTIPLAN [1680]|HMA [168003]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|784.00||||784.00||| 48393320|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO DOPPLER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|784.00||||784.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|167.00||||167.00|80.08|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|||167.00||||167.00|50.1|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|167.00||||167.00|167|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|167.00||||167.00|35.07|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|UMR [2035]|UMR OPTIONS [203501]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MULTIPLAN [1680]|IHC HS [168011]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|167.00||||167.00|71.81|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|TRUSTMARK [2030]|STARMARK [203000]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|167.00||||167.00|108.55|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|167.00||||167.00|100.2|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|167.00||||167.00|83.5|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|GEHA [1415]|GEHA [141500]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|167.00||||167.00|71.81|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|167.00||||167.00|125.25|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|167.00||||167.00|83.67|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|167.00||||167.00|58.62|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|167.00||||167.00|71.14|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|167.00||||167.00|150.3|167|35.07 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MULTIPLAN [1680]|HMA [168003]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|167.00||||167.00||| 48393321|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHOCARD DOPPLER FOLLOW UP/LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|167.00||||167.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|686.00||||686.00|343.69|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|686.00||||686.00|240.79|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|686.00||||686.00|292.24|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|686.00||||686.00|411.6|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|TRUSTMARK [2030]|STARMARK [203000]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|AETNA [1015]|COVENTRY HEALTHCARE [101502]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MULTIPLAN [1680]|IHC HS [168011]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|HEALTHNET [1495]|HEALTHNET [149500]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|FMH BENEFIT SERVICES [1390]|FMH [139000]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|FIRST HEALTH [1375]|QUALCHOICE [137513]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|686.00||||686.00|686|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|686.00||||686.00|445.9|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|686.00||||686.00|328.94|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|||686.00||||686.00|205.8|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|686.00||||686.00|144.06|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|686.00||||686.00|343|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|UMR [2035]|UMR OPTIONS [203501]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|CHAMPVA [1240]|CHAMP VA [124000]|686.00||||686.00|514.5|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|686.00||||686.00|294.98|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|CORESOURCE [1315]|CORESOURCE [131500]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|686.00||||686.00|294.98|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|GEHA [1415]|GEHA [141500]|686.00||||686.00|617.4|686|144.06 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|AETNA [1015]|AETNA ACO WILCO [101532]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|MULTIPLAN [1680]|HMA [168003]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|686.00||||686.00||| 48393325|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO COLOR FLOW VELOCITY MAPPING|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|686.00||||686.00||| 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1988.00||||1988.00|1988|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|GEHA [1415]|GEHA [141500]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|CORESOURCE [1315]|CORESOURCE [131500]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1988.00||||1988.00|659.01|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|CHAMPVA [1240]|CHAMP VA [124000]|1988.00||||1988.00|1491|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1988.00||||1988.00|594.95|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|||1988.00||||1988.00|596.4|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1988.00||||1988.00|953.25|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1988.00||||1988.00|1292.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1988.00||||1988.00|417.48|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1988.00||||1988.00|669.28|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1988.00||||1988.00|467.58|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1988.00||||1988.00|854.84|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1988.00||||1988.00|680.22|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|FIRST HEALTH [1375]|QUALCHOICE [137513]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MULTIPLAN [1680]|HMA [168003]|1988.00||||1988.00|687.61|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|UMR [2035]|UMR OPTIONS [203501]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1988.00||||1988.00|504.25|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1988.00||||1988.00|1192.8|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1988.00||||1988.00|995.99|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1988.00||||1988.00|846.89|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1988.00||||1988.00|504.25|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1988.00||||1988.00|697.79|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1988.00||||1988.00|854.84|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1988.00||||1988.00|1189.12|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1988.00||||1988.00|481.33|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1988.00||||1988.00|547.24|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1988.00||||1988.00|574.62|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1988.00||||1988.00|594.95|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1988.00||||1988.00|618.38|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|TRUSTMARK [2030]|STARMARK [203000]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1988.00||||1988.00|458.41|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1988.00||||1988.00|659.01|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|MULTIPLAN [1680]|IHC HS [168011]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|HEALTHNET [1495]|HEALTHNET [149500]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|FMH BENEFIT SERVICES [1390]|FMH [139000]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1988.00||||1988.00|1789.2|1988|417.48 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1988.00||||1988.00||| 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|AETNA [1015]|AETNA ACO WILCO [101532]|1988.00||||1988.00||| 48393350|EAP|0483 - CARDIOLOGY-ECHOCARDIOLOGY|HC ECHO REST & STRESS W/PF|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1988.00||||1988.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|||10.00||||10.00|3|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4870|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103.36||||103.36|67.18|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103.36||||103.36|44.44|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103.36||||103.36|62.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103.36||||103.36|44.44|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103.36||||103.36|51.78|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103.36||||103.36|36.28|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103.36||||103.36|44.03|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103.36||||103.36|21.71|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103.36||||103.36|49.56|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|||103.36||||103.36|31.01|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|103.36||||103.36|77.52|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103.36||||103.36|93.02|93.02|21.71 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103.36||||103.36||| 4952|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103.36||||103.36||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|||10.00||||10.00|3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|||10.00||||10.00|3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|||10.00||||10.00|3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4953|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4954|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHADONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|||10.00||||10.00|3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|||10.00||||10.00|3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|||10.00||||10.00|3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|||10.00||||10.00|3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|||10.00||||10.00|3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|||10.00||||10.00|3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|||10.00||||10.00|3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|||10.00||||10.00|3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|||10.00||||10.00|3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOCARBAMOL 750 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.72||||11.72|5.04|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.72||||11.72|4.11|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.72||||11.72|4.99|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.72||||11.72|5.04|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.72||||11.72|5.87|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.72||||11.72|4.11|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.72||||11.72|4.99|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.72||||11.72|7.03|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.72||||11.72|5.04|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.72||||11.72|5.04|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.72||||11.72|0.16|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.72||||11.72|0.16|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.72||||11.72|2.46|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.72||||11.72|2.46|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.72||||11.72|7.62|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.72||||11.72|7.62|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.72||||11.72|5.62|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.72||||11.72|7.03|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.72||||11.72|5.62|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|||11.72||||11.72|3.52|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|||11.72||||11.72|3.52|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.72||||11.72|5.87|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|11.72||||11.72|8.79|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|11.72||||11.72|8.79|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|11.72||||11.72|10.55|10.55|0.16 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.72||||11.72||| 4973|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHOTREXATE SODIUM 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.72||||11.72||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|||10.00||||10.00|3|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4986|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|||10.00||||10.00|3|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|||10.00||||10.00|3|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METHYLPHENIDATE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|||10.00||||10.00|3|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.27|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.27|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|||10.00||||10.00|3|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.27 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 4993|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|||10.00||||10.00|3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|||10.00||||10.00|3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|||10.00||||10.00|3|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5005|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5006|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|||10.00||||10.00|3|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|||10.00||||10.00|3|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5009|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOPROLOL TARTRATE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|||10.00||||10.00|3|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5015|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|||10.00||||10.00|3|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5016|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METRONIDAZOLE 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|||90.00||||90.00|27|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 5018|ERX|0250 - PHARMACY-GENERAL|METRONIDAZOLE 500 MG/100 ML-SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|||10.00||||10.00|3|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5086|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ORAL REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|||10.00||||10.00|3|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5087|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINERAL OIL ENEMA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|290.00||||290.00|120.49|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|290.00||||290.00|145|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|290.00||||290.00|124.7|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|290.00||||290.00|145.29|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|290.00||||290.00|101.79|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|290.00||||290.00|174|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|290.00||||290.00|115.01|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|290.00||||290.00|120.49|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|290.00||||290.00|109.35|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|TRUSTMARK [2030]|STARMARK [203000]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|AETNA [1015]|COVENTRY HEALTHCARE [101502]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|290.00||||290.00|26.71|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MULTIPLAN [1680]|IHC HS [168011]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|290.00||||290.00|157.47|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MULTIPLAN [1680]|HMA [168003]|290.00||||290.00|164.31|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|FMH BENEFIT SERVICES [1390]|FMH [139000]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|HEALTHNET [1495]|HEALTHNET [149500]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|FIRST HEALTH [1375]|QUALCHOICE [137513]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|290.00||||290.00|129.44|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|290.00||||290.00|124.7|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|290.00||||290.00|111.73|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|UMR [2035]|UMR OPTIONS [203501]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|290.00||||290.00|60.9|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|290.00||||290.00|290|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|290.00||||290.00|113.22|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|290.00||||290.00|123.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|290.00||||290.00|188.5|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|290.00||||290.00|139.06|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|||290.00||||290.00|87|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|290.00||||290.00|113.22|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|290.00||||290.00|109.54|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|290.00||||290.00|104.14|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|CHAMPVA [1240]|CHAMP VA [124000]|290.00||||290.00|217.5|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|290.00||||290.00|157.47|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|CORESOURCE [1315]|CORESOURCE [131500]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|290.00||||290.00|117.68|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|GEHA [1415]|GEHA [141500]|290.00||||290.00|261|290|26.71 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|290.00||||290.00||| 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|AETNA [1015]|AETNA ACO WILCO [101532]|290.00||||290.00||| 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|290.00||||290.00||| 51099201|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 NEW|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|290.00||||290.00||| 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|GEHA [1415]|GEHA [141500]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|286.00||||286.00|117.68|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|286.00||||286.00|157.47|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|CHAMPVA [1240]|CHAMP VA [124000]|286.00||||286.00|214.5|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|286.00||||286.00|104.14|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|286.00||||286.00|113.22|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|||286.00||||286.00|85.8|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|286.00||||286.00|137.14|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|286.00||||286.00|185.9|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|286.00||||286.00|286|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|286.00||||286.00|60.06|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|UMR [2035]|UMR OPTIONS [203501]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|286.00||||286.00|111.73|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|286.00||||286.00|122.98|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|286.00||||286.00|129.44|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|FIRST HEALTH [1375]|QUALCHOICE [137513]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|FMH BENEFIT SERVICES [1390]|FMH [139000]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|HEALTHNET [1495]|HEALTHNET [149500]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MULTIPLAN [1680]|IHC HS [168011]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|286.00||||286.00|157.47|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MULTIPLAN [1680]|HMA [168003]|286.00||||286.00|164.31|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|286.00||||286.00|9.23|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|TRUSTMARK [2030]|STARMARK [203000]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|286.00||||286.00|109.35|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|CORESOURCE [1315]|CORESOURCE [131500]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|286.00||||286.00|120.49|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|286.00||||286.00|113.22|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|286.00||||286.00|115.01|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|286.00||||286.00|171.6|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|286.00||||286.00|122.98|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|286.00||||286.00|143.29|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|286.00||||286.00|100.39|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|286.00||||286.00|121.84|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|286.00||||286.00|143|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|286.00||||286.00|120.49|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|286.00||||286.00|109.54|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|286.00||||286.00|257.4|286|9.23 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|286.00||||286.00||| 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|286.00||||286.00||| 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|AETNA [1015]|AETNA ACO WILCO [101532]|286.00||||286.00||| 51099211|EAP|0510 - CLINIC-GENERAL CLASSIFICATION|HC CLINIC VISIT LEVEL 1 EST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|286.00||||286.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5111|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOCYCLINE 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5115|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MINOXIDIL 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|||3744.00||||3744.00|1123.2|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3744.00||||3744.00|842.56|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3744.00||||3744.00|1795.25|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|CHAMPVA [1240]|CHAMP VA [124000]|3744.00||||3744.00|2808|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|CORESOURCE [1315]|CORESOURCE [131500]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|GEHA [1415]|GEHA [141500]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|HEALTHNET [1495]|HEALTHNET [149500]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3744.00||||3744.00|1314.14|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3744.00||||3744.00|1875.74|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3744.00||||3744.00|1609.92|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|FIRST HEALTH [1375]|QUALCHOICE [137513]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3744.00||||3744.00|2433.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3744.00||||3744.00|3744|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3744.00||||3744.00|1594.94|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|UMR [2035]|UMR OPTIONS [203501]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3744.00||||3744.00|1609.92|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3744.00||||3744.00|786.24|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3744.00||||3744.00|1828.14|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3744.00||||3744.00|2246.4|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3744.00||||3744.00|842.56|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MULTIPLAN [1680]|IHC HS [168011]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|TRUSTMARK [2030]|STARMARK [203000]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|FMH BENEFIT SERVICES [1390]|FMH [139000]|3744.00||||3744.00|3369.6|3744|786.24 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MULTIPLAN [1680]|HMA [168003]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3744.00||||3744.00||| 51162324|EAP|0511 - CLINIC-CHRONIC PAIN CENTER|HC INJ EPIDURAL CONT CERVICAL/THOR|AETNA [1015]|AETNA ACO WILCO [101532]|3744.00||||3744.00||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|CORESOURCE [1315]|CORESOURCE [131500]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|CHAMPVA [1240]|CHAMP VA [124000]|38.50||||38.50|28.88|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38.50||||38.50|13.51|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|GEHA [1415]|GEHA [141500]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38.50||||38.50|18.46|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|IHC HS [168011]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|||38.50||||38.50|11.55|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38.50||||38.50|16.56|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38.50||||38.50|25.03|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|TRUSTMARK [2030]|STARMARK [203000]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|HEALTHNET [1495]|HEALTHNET [149500]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38.50||||38.50|23.1|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38.50||||38.50|16.4|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38.50||||38.50|8.09|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38.50||||38.50|19.29|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38.50||||38.50|16.56|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|UMR [2035]|UMR OPTIONS [203501]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38.50||||38.50|34.65|34.65|8.09 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|AETNA ACO WILCO [101532]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|HMA [168003]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38.50||||38.50||| 5176|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 10 MG/5 ML ORAL SOLUTION REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38.50||||38.50||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|||10.00||||10.00|3|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5178|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MORPHINE 15 MG IMMEDIATE RELEASE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61.43||||61.43|39.93|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|61.43||||61.43|46.07|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61.43||||61.43|12.9|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|||61.43||||61.43|18.43|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61.43||||61.43|30.78|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61.43||||61.43|36.86|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61.43||||61.43|26.41|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61.43||||61.43|26.17|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61.43||||61.43|21.56|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61.43||||61.43|29.46|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61.43||||61.43|26.41|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61.43||||61.43|55.29|55.29|12.9 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61.43||||61.43||| 5333|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61.43||||61.43||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|491.55||||491.55|211.37|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|491.55||||491.55|368.66|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|491.55||||491.55|172.53|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|491.55||||491.55|246.27|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|491.55||||491.55|209.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|491.55||||491.55|294.93|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|491.55||||491.55|294.93|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|491.55||||491.55|172.53|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|491.55||||491.55|246.27|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|491.55||||491.55|235.7|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|491.55||||491.55|211.37|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|491.55||||491.55|211.37|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|491.55||||491.55|235.7|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|||491.55||||491.55|147.46|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|491.55||||491.55|103.23|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|||491.55||||491.55|147.46|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|491.55||||491.55|211.37|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|491.55||||491.55|319.51|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|491.55||||491.55|209.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|491.55||||491.55|319.51|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|491.55||||491.55|103.23|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|491.55||||491.55|368.66|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|491.55||||491.55|442.4|442.4|103.23 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|491.55||||491.55||| 5334|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 10 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|491.55||||491.55||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|||90.80||||90.80|27.24|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.80||||90.80|43.54|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|90.80||||90.80|68.1|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.80||||90.80|59.02|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.80||||90.80|19.07|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.80||||90.80|31.87|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.80||||90.80|54.48|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.80||||90.80|45.49|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.80||||90.80|38.68|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.80||||90.80|39.04|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.80||||90.80|39.04|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|90.80||||90.80|81.72|81.72|19.07 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|90.80||||90.80||| 5335|ERX|0250 - PHARMACY-GENERAL|NAFCILLIN 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.80||||90.80||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.32||||63.32|41.16|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.32||||63.32|30.36|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.32||||63.32|41.16|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.32||||63.32|30.36|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|63.32||||63.32|47.49|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|63.32||||63.32|47.49|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.32||||63.32|30.36|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|||63.32||||63.32|19|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.32||||63.32|41.16|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|63.32||||63.32|47.49|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|||63.32||||63.32|19|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|||63.32||||63.32|19|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.32||||63.32|27.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.32||||63.32|31.72|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.32||||63.32|22.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.32||||63.32|26.97|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.32||||63.32|27.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.32||||63.32|31.72|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.32||||63.32|31.72|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.32||||63.32|37.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.32||||63.32|37.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.32||||63.32|26.97|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|63.32||||63.32|22.16|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|63.32||||63.32|22.16|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|63.32||||63.32|22.16|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.32||||63.32|37.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.32||||63.32|27.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.32||||63.32|27.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.32||||63.32|26.97|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.32||||63.32|22.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.32||||63.32|27.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.32||||63.32|22.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.32||||63.32|13.3|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.32||||63.32|11.69|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.32||||63.32|11.69|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.32||||63.32|11.69|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.32||||63.32|13.3|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.32||||63.32|13.3|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.32||||63.32|27.23|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|63.32||||63.32|56.99|56.99|11.69 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.32||||63.32||| 5373|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|NALOXONE 0.4 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.32||||63.32||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|||10.00||||10.00|3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|||10.00||||10.00|3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|||10.00||||10.00|3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5391|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NAPROXEN 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5472|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEOMYCIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5510001|EAP||HH RN INITIAL VISIT|||||||127.81|38.34|38.34|26.84 5510001|EAP||HH RN INITIAL VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84 5510001|EAP||HH RN INITIAL VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||127.81|31.95|38.34|26.84 5510001|EAP||HH RN INITIAL VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|UMR [2035]|UMR OPTIONS [203501]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|GEHA [1415]|GEHA [141500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MULTIPLAN [1680]|HMA [168003]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81||| 5510001|EAP||HH RN INITIAL VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84 5510002|EAP||HH RN ROUTINE VISIT|||||||127.81|38.34|38.34|26.84 5510002|EAP||HH RN ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||127.81|31.95|38.34|26.84 5510002|EAP||HH RN ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81||| 5510002|EAP||HH RN ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|||||||127.81|38.34|63.91|26.84 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|63.91|26.84 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||127.81|31.95|63.91|26.84 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|63.91|63.91|26.84 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|GEHA [1415]|GEHA [141500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|CHAMPVA [1240]|CHAMP VA [124000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MULTIPLAN [1680]|HMA [168003]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MULTIPLAN [1680]|IHC HS [168011]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|TRUSTMARK [2030]|STARMARK [203000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|UMR [2035]|UMR OPTIONS [203501]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||127.81||| 5510003|EAP||HH RN MANAGEMENT AND EVALUATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||127.81|31.95|38.34|26.84 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|||||||127.81|38.34|38.34|26.84 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|TRUSTMARK [2030]|STARMARK [203000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MULTIPLAN [1680]|IHC HS [168011]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MULTIPLAN [1680]|HMA [168003]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|UMR [2035]|UMR OPTIONS [203501]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|CHAMPVA [1240]|CHAMP VA [124000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|GEHA [1415]|GEHA [141500]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81||| 5510004|EAP||HH RN OBSERVATION AND ASSESSMENT|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|||||||127.81|38.34|38.34|26.84 5510005|EAP||HH RN TRAINING AND EDUCATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|38.34|26.84 5510005|EAP||HH RN TRAINING AND EDUCATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||127.81|31.95|38.34|26.84 5510005|EAP||HH RN TRAINING AND EDUCATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|CHAMPVA [1240]|CHAMP VA [124000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MULTIPLAN [1680]|IHC HS [168011]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MULTIPLAN [1680]|HMA [168003]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|GEHA [1415]|GEHA [141500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|TRUSTMARK [2030]|STARMARK [203000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|UMR [2035]|UMR OPTIONS [203501]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||127.81||| 5510005|EAP||HH RN TRAINING AND EDUCATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||127.81|63.91|63.91|26.84 5510006|EAP||Hh/hspc Lpn Routine Visit|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||127.81|31.95|63.91|26.84 5510006|EAP||Hh/hspc Lpn Routine Visit|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||127.81|26.84|63.91|26.84 5510006|EAP||Hh/hspc Lpn Routine Visit|||||||127.81|38.34|63.91|26.84 5510006|EAP||Hh/hspc Lpn Routine Visit|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|AETNA [1015]|AETNA ACO WILCO [101532]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|HEALTHNET [1495]|HEALTHNET [149500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MULTIPLAN [1680]|IHC HS [168011]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|UMR [2035]|UMR OPTIONS [203501]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|TRUSTMARK [2030]|STARMARK [203000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MULTIPLAN [1680]|HMA [168003]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|GEHA [1415]|GEHA [141500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|CHAMPVA [1240]|CHAMP VA [124000]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|CORESOURCE [1315]|CORESOURCE [131500]|||||127.81||| 5510006|EAP||Hh/hspc Lpn Routine Visit|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||127.81||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|||10.00||||10.00|3|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5542|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIACIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5558|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NIFEDIPINE 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12.15||||12.15|7.9|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12.15||||12.15|2.55|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.15||||12.15|5.22|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.15||||12.15|5.83|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|||12.15||||12.15|3.64|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|12.15||||12.15|9.11|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12.15||||12.15|5.22|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12.15||||12.15|6.09|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12.15||||12.15|4.26|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12.15||||12.15|5.18|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12.15||||12.15|10.94|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12.15||||12.15|7.29|10.94|2.55 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.15||||12.15||| 5593|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.15||||12.15||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|||10.00||||10.00|3|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5595|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5600001|EAP||HH MSW INITIAL VISIT|||||||204.87|61.46|102.44|43.02 5600001|EAP||HH MSW INITIAL VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||204.87|43.02|102.44|43.02 5600001|EAP||HH MSW INITIAL VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||204.87|51.22|102.44|43.02 5600001|EAP||HH MSW INITIAL VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||204.87|102.44|102.44|43.02 5600001|EAP||HH MSW INITIAL VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|GEHA [1415]|GEHA [141500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MULTIPLAN [1680]|HMA [168003]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|UMR [2035]|UMR OPTIONS [203501]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||204.87||| 5600001|EAP||HH MSW INITIAL VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||204.87||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|||10.00||||10.00|3|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|||10.00||||10.00|3|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5604|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|||10.00||||10.00|3|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5606|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NITROGLYCERIN 2 % TRANSDERMAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5610001|EAP||HH MSW ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||204.87|51.22|102.44|43.02 5610001|EAP||HH MSW ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||204.87|43.02|102.44|43.02 5610001|EAP||HH MSW ROUTINE VISIT|||||||204.87|61.46|102.44|43.02 5610001|EAP||HH MSW ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||204.87|102.44|102.44|43.02 5610001|EAP||HH MSW ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||204.87||| 5610001|EAP||HH MSW ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||204.87||| 5710001|EAP||HH HHA VISIT|||||||57.88|17.36|28.94|12.15 5710001|EAP||HH HHA VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||57.88|12.15|28.94|12.15 5710001|EAP||HH HHA VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||57.88|14.47|28.94|12.15 5710001|EAP||HH HHA VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||57.88|28.94|28.94|12.15 5710001|EAP||HH HHA VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||57.88||| 5710001|EAP||HH HHA VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||57.88||| 5710001|EAP||HH HHA VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||57.88||| 5710001|EAP||HH HHA VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||57.88||| 5710001|EAP||HH HHA VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||57.88||| 5710001|EAP||HH HHA VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||57.88||| 5710001|EAP||HH HHA VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||57.88||| 5710001|EAP||HH HHA VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||57.88||| 5710001|EAP||HH HHA VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||57.88||| 5710001|EAP||HH HHA VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||57.88||| 5710001|EAP||HH HHA VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||57.88||| 5710001|EAP||HH HHA VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||57.88||| 5710001|EAP||HH HHA VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||57.88||| 5710001|EAP||HH HHA VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||57.88||| 5710001|EAP||HH HHA VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||57.88||| 5710001|EAP||HH HHA VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||57.88||| 5710001|EAP||HH HHA VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||57.88||| 5710001|EAP||HH HHA VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||57.88||| 5710001|EAP||HH HHA VISIT|UMR [2035]|UMR OPTIONS [203501]|||||57.88||| 5710001|EAP||HH HHA VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||57.88||| 5710001|EAP||HH HHA VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||57.88||| 5710001|EAP||HH HHA VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||57.88||| 5710001|EAP||HH HHA VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||57.88||| 5710001|EAP||HH HHA VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||57.88||| 5710001|EAP||HH HHA VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||57.88||| 5710001|EAP||HH HHA VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||57.88||| 5710001|EAP||HH HHA VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||57.88||| 5710001|EAP||HH HHA VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||57.88||| 5710001|EAP||HH HHA VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||57.88||| 5710001|EAP||HH HHA VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||57.88||| 5710001|EAP||HH HHA VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||57.88||| 5710001|EAP||HH HHA VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||57.88||| 5710001|EAP||HH HHA VISIT|MULTIPLAN [1680]|HMA [168003]|||||57.88||| 5710001|EAP||HH HHA VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||57.88||| 5710001|EAP||HH HHA VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||57.88||| 5710001|EAP||HH HHA VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||57.88||| 5710001|EAP||HH HHA VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||57.88||| 5710001|EAP||HH HHA VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||57.88||| 5710001|EAP||HH HHA VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||57.88||| 5710001|EAP||HH HHA VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||57.88||| 5710001|EAP||HH HHA VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||57.88||| 5710001|EAP||HH HHA VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||57.88||| 5710001|EAP||HH HHA VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||57.88||| 5710001|EAP||HH HHA VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||57.88||| 5710001|EAP||HH HHA VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||57.88||| 5710001|EAP||HH HHA VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||57.88||| 5710001|EAP||HH HHA VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||57.88||| 5710001|EAP||HH HHA VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||57.88||| 5710001|EAP||HH HHA VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||57.88||| 5710001|EAP||HH HHA VISIT|GEHA [1415]|GEHA [141500]|||||57.88||| 5710001|EAP||HH HHA VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||57.88||| 5710001|EAP||HH HHA VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||57.88||| 5710001|EAP||HH HHA VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||57.88||| 5710001|EAP||HH HHA VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||57.88||| 5710001|EAP||HH HHA VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||57.88||| 5710001|EAP||HH HHA VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||57.88||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59.20||||59.20|25.46|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59.20||||59.20|20.78|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59.20||||59.20|25.22|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59.20||||59.20|35.52|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59.20||||59.20|25.46|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59.20||||59.20|12.43|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59.20||||59.20|29.66|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59.20||||59.20|38.48|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59.20||||59.20|28.39|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|||59.20||||59.20|17.76|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|59.20||||59.20|44.4|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|GEHA [1415]|GEHA [141500]|59.20||||59.20|53.28|53.28|12.43 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59.20||||59.20||| 5749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59.20||||59.20||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|53.49||||53.49|40.12|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|||10.00||||10.00|3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|||10.00||||10.00|3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|||10.00||||10.00|3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.49||||53.49|25.65|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.49||||53.49|23|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53.49||||53.49|11.23|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53.49||||53.49|34.77|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|||53.49||||53.49|16.05|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53.49||||53.49|32.09|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53.49||||53.49|23|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53.49||||53.49|26.8|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53.49||||53.49|18.77|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53.49||||53.49|22.79|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53.49||||53.49|48.14|48.14|2.1 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.49||||53.49||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.49||||53.49||| 5800001|EAP||HH INITIAL RT VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||150.00|37.5|45|31.5 5800001|EAP||HH INITIAL RT VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||150.00|31.5|45|31.5 5800001|EAP||HH INITIAL RT VISIT|||||||150.00|45|45|31.5 5800001|EAP||HH INITIAL RT VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MULTIPLAN [1680]|HMA [168003]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|UMR [2035]|UMR OPTIONS [203501]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||150.00||| 5800001|EAP||HH INITIAL RT VISIT|GEHA [1415]|GEHA [141500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|||||||150.00|45|45|31.5 5810001|EAP||HH RT ROUTINE VISIT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|||||150.00|37.5|45|31.5 5810001|EAP||HH RT ROUTINE VISIT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|||||150.00|31.5|45|31.5 5810001|EAP||HH RT ROUTINE VISIT|GEHA [1415]|GEHA [141500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|CORESOURCE [1315]|CORESOURCE [131500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|UMR [2035]|UMR OPTIONS [203501]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|FIRST HEALTH [1375]|QUALCHOICE [137513]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MULTIPLAN [1680]|IHC HS [168011]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MULTIPLAN [1680]|HMA [168003]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|HEALTHNET [1495]|HEALTHNET [149500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|AETNA [1015]|AETNA ACO WILCO [101532]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|TRUSTMARK [2030]|STARMARK [203000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|CHAMPVA [1240]|CHAMP VA [124000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|||||150.00||| 5810001|EAP||HH RT ROUTINE VISIT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|||||150.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|||10.00||||10.00|3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5938|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYBUTYNIN CHLORIDE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|||10.00||||10.00|3|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|||10.00||||10.00|3|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5940|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|||10.00||||10.00|3|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|||10.00||||10.00|3|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 5943|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OXYMETAZOLINE 0.05 % NASAL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|202.52||||202.52|151.89|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|||202.52||||202.52|60.76|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.52||||202.52|97.11|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|202.52||||202.52|97.11|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.52||||202.52|131.64|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|202.52||||202.52|131.64|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202.52||||202.52|42.53|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|202.52||||202.52|42.53|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202.52||||202.52|39.64|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|202.52||||202.52|39.64|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.52||||202.52|87.08|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|202.52||||202.52|87.08|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|202.52||||202.52|70.88|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|202.52||||202.52|70.88|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|||202.52||||202.52|60.76|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202.52||||202.52|121.51|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|202.52||||202.52|121.51|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202.52||||202.52|87.08|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|202.52||||202.52|101.46|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202.52||||202.52|71.08|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|202.52||||202.52|86.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|202.52||||202.52|87.08|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|202.52||||202.52|101.46|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|202.52||||202.52|71.08|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|202.52||||202.52|86.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|202.52||||202.52|151.89|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|202.52||||202.52|182.27|182.27|39.64 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202.52||||202.52||| 6085|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|202.52||||202.52||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66.46||||66.46|28.58|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66.46||||66.46|33.3|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66.46||||66.46|28.31|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66.46||||66.46|28.58|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66.46||||66.46|33.3|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66.46||||66.46|23.33|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66.46||||66.46|28.31|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66.46||||66.46|39.88|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66.46||||66.46|39.88|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|66.46||||66.46|23.26|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.46||||66.46|28.58|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.46||||66.46|28.58|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|66.46||||66.46|23.26|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66.46||||66.46|10.49|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66.46||||66.46|10.49|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66.46||||66.46|13.96|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66.46||||66.46|13.96|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66.46||||66.46|43.2|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66.46||||66.46|43.2|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.46||||66.46|31.87|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.46||||66.46|31.87|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|||66.46||||66.46|19.94|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|||66.46||||66.46|19.94|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66.46||||66.46|23.33|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|66.46||||66.46|49.85|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|66.46||||66.46|49.85|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|66.46||||66.46|59.81|59.81|10.49 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66.46||||66.46||| 6086|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66.46||||66.46||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|||10.00||||10.00|3|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|||10.00||||10.00|3|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6093|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PENICILLIN V POTASSIUM 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3803.00||||3803.00|399.82|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3803.00||||3803.00|1635.29|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3803.00||||3803.00|1905.3|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3803.00||||3803.00|1620.08|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3803.00||||3803.00|1901.5|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3803.00||||3803.00|2281.8|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3803.00||||3803.00|381.65|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3803.00||||3803.00|399.82|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3803.00||||3803.00|807.65|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3803.00||||3803.00|522.53|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3803.00||||3803.00|412.4|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3803.00||||3803.00|1635.29|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3803.00||||3803.00|370.75|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3803.00||||3803.00|274.93|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3803.00||||3803.00|530.68|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3803.00||||3803.00|798.63|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3803.00||||3803.00|3803|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3803.00||||3803.00|1823.54|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3803.00||||3803.00|1334.85|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3803.00||||3803.00|2471.95|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|||3803.00||||3803.00|1140.9|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3803.00||||3803.00|706.36|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3803.00||||3803.00|363.48|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3803.00||||3803.00|2852.25|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3803.00||||3803.00|522.53|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3803.00||||3803.00|3422.7|3803|274.93 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3803.00||||3803.00||| 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3803.00||||3803.00||| 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3803.00||||3803.00||| 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3803.00||||3803.00||| 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3803.00||||3803.00||| 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3803.00||||3803.00||| 61008902|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA ABDOMEN W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3803.00||||3803.00||| 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3480.00||||3480.00|522.53|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3480.00||||3480.00|2610|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3480.00||||3480.00|706.36|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|||3480.00||||3480.00|1044|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3480.00||||3480.00|2262|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3480.00||||3480.00|1668.66|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3480.00||||3480.00|3480|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3480.00||||3480.00|730.8|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3480.00||||3480.00|530.68|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3480.00||||3480.00|370.75|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3480.00||||3480.00|1496.4|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3480.00||||3480.00|522.53|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3480.00||||3480.00|407|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3480.00||||3480.00|271.33|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3480.00||||3480.00|807.65|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3480.00||||3480.00|399.82|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3480.00||||3480.00|381.65|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3480.00||||3480.00|2088|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3480.00||||3480.00|1740|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3480.00||||3480.00|1496.4|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3480.00||||3480.00|1743.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3480.00||||3480.00|1482.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3480.00||||3480.00|1221.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3480.00||||3480.00|363.48|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3480.00||||3480.00|399.82|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3480.00||||3480.00|3132|3480|271.33 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3480.00||||3480.00||| 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3480.00||||3480.00||| 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3480.00||||3480.00||| 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3480.00||||3480.00||| 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3480.00||||3480.00||| 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3480.00||||3480.00||| 61008911|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA CHEST W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3480.00||||3480.00||| 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2587.00||||2587.00|399.82|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2587.00||||2587.00|1112.41|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2587.00||||2587.00|908.04|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2587.00||||2587.00|1102.06|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2587.00||||2587.00|1293.5|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2587.00||||2587.00|381.65|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2587.00||||2587.00|273.62|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2587.00||||2587.00|807.65|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2587.00||||2587.00|522.53|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2587.00||||2587.00|410.43|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2587.00||||2587.00|1112.41|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2587.00||||2587.00|370.75|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2587.00||||2587.00|530.68|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2587.00||||2587.00|399.82|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2587.00||||2587.00|543.27|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2587.00||||2587.00|2587|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2587.00||||2587.00|1552.2|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2587.00||||2587.00|1240.47|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2587.00||||2587.00|1681.55|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|||2587.00||||2587.00|776.1|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2587.00||||2587.00|1296.09|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2587.00||||2587.00|706.36|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2587.00||||2587.00|363.48|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2587.00||||2587.00|1940.25|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2587.00||||2587.00|522.53|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|GEHA [1415]|GEHA [141500]|2587.00||||2587.00|2328.3|2587|273.62 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2587.00||||2587.00||| 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2587.00||||2587.00||| 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2587.00||||2587.00||| 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2587.00||||2587.00||| 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2587.00||||2587.00||| 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2587.00||||2587.00||| 61008920|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRA PELVIS W & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2587.00||||2587.00||| 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|GEHA [1415]|GEHA [141500]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|CORESOURCE [1315]|CORESOURCE [131500]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2693.00||||2693.00|318.9|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|CHAMPVA [1240]|CHAMP VA [124000]|2693.00||||2693.00|2019.75|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2693.00||||2693.00|424.15|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2693.00||||2693.00|461.12|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|||2693.00||||2693.00|807.9|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2693.00||||2693.00|1750.45|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2693.00||||2693.00|2693|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2693.00||||2693.00|565.53|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2693.00||||2693.00|323.87|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|UMR [2035]|UMR OPTIONS [203501]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2693.00||||2693.00|226.26|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2693.00||||2693.00|527.2|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2693.00||||2693.00|1157.99|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|FIRST HEALTH [1375]|QUALCHOICE [137513]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|FMH BENEFIT SERVICES [1390]|FMH [139000]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MULTIPLAN [1680]|IHC HS [168011]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2693.00||||2693.00|318.9|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MULTIPLAN [1680]|HMA [168003]|2693.00||||2693.00|332.74|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|HEALTHNET [1495]|HEALTHNET [149500]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2693.00||||2693.00|1291.29|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|AETNA [1015]|AETNA ACO WILCO [101532]|2693.00||||2693.00|807.65|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|TRUSTMARK [2030]|STARMARK [203000]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2693.00||||2693.00|445.37|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2693.00||||2693.00|244.01|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2693.00||||2693.00|461.12|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2693.00||||2693.00|479.28|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2693.00||||2693.00|232.92|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2693.00||||2693.00|1615.8|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2693.00||||2693.00|551.1|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2693.00||||2693.00|1157.99|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2693.00||||2693.00|1349.19|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2693.00||||2693.00|945.24|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2693.00||||2693.00|1147.22|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2693.00||||2693.00|244.01|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2693.00||||2693.00|221.83|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2693.00||||2693.00|2423.7|2693|221.83 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2693.00||||2693.00||| 61070336|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI TMJ(S)|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2693.00||||2693.00||| 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3218.00||||3218.00|244.01|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3218.00||||3218.00|1612.22|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3218.00||||3218.00|1129.52|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3218.00||||3218.00|1370.87|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3218.00||||3218.00|551.1|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3218.00||||3218.00|1930.8|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3218.00||||3218.00|232.92|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3218.00||||3218.00|244.01|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3218.00||||3218.00|445.37|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3218.00||||3218.00|807.65|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3218.00||||3218.00|332.74|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3218.00||||3218.00|318.9|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3218.00||||3218.00|1383.74|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3218.00||||3218.00|527.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3218.00||||3218.00|226.26|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3218.00||||3218.00|323.87|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3218.00||||3218.00|675.78|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3218.00||||3218.00|3218|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3218.00||||3218.00|461.12|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3218.00||||3218.00|2091.7|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3218.00||||3218.00|1543.03|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|||3218.00||||3218.00|965.4|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3218.00||||3218.00|1383.74|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3218.00||||3218.00|461.12|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3218.00||||3218.00|221.83|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3218.00||||3218.00|424.15|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3218.00||||3218.00|2413.5|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3218.00||||3218.00|318.9|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|GEHA [1415]|GEHA [141500]|3218.00||||3218.00|2896.2|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3218.00||||3218.00|479.28|3218|221.83 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3218.00||||3218.00||| 61070540|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3218.00||||3218.00||| 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3659.00||||3659.00|734.17|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|GEHA [1415]|GEHA [141500]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3659.00||||3659.00|522.53|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3659.00||||3659.00|2744.25|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3659.00||||3659.00|706.36|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|||3659.00||||3659.00|1097.7|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3659.00||||3659.00|1754.49|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3659.00||||3659.00|2378.35|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3659.00||||3659.00|3659|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3659.00||||3659.00|768.39|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3659.00||||3659.00|530.68|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3659.00||||3659.00|370.75|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3659.00||||3659.00|807.59|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3659.00||||3659.00|1573.37|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3659.00||||3659.00|522.53|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MULTIPLAN [1680]|HMA [168003]|3659.00||||3659.00|545.22|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3659.00||||3659.00|807.65|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3659.00||||3659.00|649.73|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3659.00||||3659.00|353.69|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3659.00||||3659.00|682.23|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3659.00||||3659.00|399.82|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3659.00||||3659.00|706.36|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3659.00||||3659.00|381.65|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3659.00||||3659.00|2195.4|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3659.00||||3659.00|922.36|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3659.00||||3659.00|1573.37|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3659.00||||3659.00|1833.16|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3659.00||||3659.00|1284.31|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3659.00||||3659.00|1558.73|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3659.00||||3659.00|399.82|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3659.00||||3659.00|363.48|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3659.00||||3659.00|3293.1|3659|353.69 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3659.00||||3659.00||| 61070543|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ORBIT/FACE/NECK W/WO CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3659.00||||3659.00||| 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3350.00||||3350.00|244.01|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3350.00||||3350.00|1440.5|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3350.00||||3350.00|1678.35|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3350.00||||3350.00|1427.1|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3350.00||||3350.00|551.1|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3350.00||||3350.00|232.92|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3350.00||||3350.00|461.12|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3350.00||||3350.00|244.01|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3350.00||||3350.00|445.37|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3350.00||||3350.00|807.65|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3350.00||||3350.00|318.9|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3350.00||||3350.00|332.74|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3350.00||||3350.00|1440.5|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3350.00||||3350.00|527.2|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3350.00||||3350.00|226.26|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3350.00||||3350.00|323.87|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3350.00||||3350.00|703.5|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3350.00||||3350.00|3350|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3350.00||||3350.00|2010|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3350.00||||3350.00|2177.5|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3350.00||||3350.00|1606.33|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|||3350.00||||3350.00|1005|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3350.00||||3350.00|1175.85|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3350.00||||3350.00|461.12|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3350.00||||3350.00|221.83|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3350.00||||3350.00|424.15|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3350.00||||3350.00|2512.5|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3350.00||||3350.00|318.9|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|GEHA [1415]|GEHA [141500]|3350.00||||3350.00|3015|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3350.00||||3350.00|479.28|3350|221.83 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3350.00||||3350.00||| 61071550|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3350.00||||3350.00||| 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3769.00||||3769.00|734.17|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3769.00||||3769.00|2826.75|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3769.00||||3769.00|649.73|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3769.00||||3769.00|706.36|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|||3769.00||||3769.00|1130.7|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3769.00||||3769.00|1807.24|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3769.00||||3769.00|2449.85|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3769.00||||3769.00|791.49|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3769.00||||3769.00|530.68|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3769.00||||3769.00|370.75|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3769.00||||3769.00|807.59|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3769.00||||3769.00|1620.67|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3769.00||||3769.00|522.53|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3769.00||||3769.00|3769|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3769.00||||3769.00|545.22|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3769.00||||3769.00|807.65|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3769.00||||3769.00|522.53|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3769.00||||3769.00|682.23|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3769.00||||3769.00|399.82|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3769.00||||3769.00|706.36|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3769.00||||3769.00|381.65|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3769.00||||3769.00|2261.4|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3769.00||||3769.00|922.36|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3769.00||||3769.00|1620.67|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3769.00||||3769.00|1888.27|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3769.00||||3769.00|1322.92|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3769.00||||3769.00|1605.59|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3769.00||||3769.00|399.82|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3769.00||||3769.00|363.48|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3769.00||||3769.00|3392.1|3769|363.48 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3769.00||||3769.00||| 61071552|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI CHEST W & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3769.00||||3769.00||| 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3386.00||||3386.00|1455.98|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3386.00||||3386.00|807.59|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3386.00||||3386.00|370.75|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3386.00||||3386.00|711.06|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3386.00||||3386.00|3386|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3386.00||||3386.00|530.68|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3386.00||||3386.00|2200.9|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3386.00||||3386.00|1623.59|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|||3386.00||||3386.00|1015.8|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3386.00||||3386.00|706.36|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3386.00||||3386.00|649.73|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3386.00||||3386.00|2539.5|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3386.00||||3386.00|522.53|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3386.00||||3386.00|734.17|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3386.00||||3386.00|706.36|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3386.00||||3386.00|682.23|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3386.00||||3386.00|922.36|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3386.00||||3386.00|2031.6|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3386.00||||3386.00|545.22|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3386.00||||3386.00|1696.39|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3386.00||||3386.00|1188.49|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3386.00||||3386.00|399.82|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3386.00||||3386.00|399.82|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3386.00||||3386.00|1455.98|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3386.00||||3386.00|381.65|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3386.00||||3386.00|522.53|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3386.00||||3386.00|807.65|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3386.00||||3386.00|1442.44|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3386.00||||3386.00|3047.4|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3386.00||||3386.00|363.48|3386|363.48 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3386.00||||3386.00||| 61072197|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI PELVIS W & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3386.00||||3386.00||| 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2776.00||||2776.00|244.01|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|||2776.00||||2776.00|832.8|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2776.00||||2776.00|318.9|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2776.00||||2776.00|479.28|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2776.00||||2776.00|318.9|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2776.00||||2776.00|461.12|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2776.00||||2776.00|527.2|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2776.00||||2776.00|974.38|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2776.00||||2776.00|244.01|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2776.00||||2776.00|332.74|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2776.00||||2776.00|551.1|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2776.00||||2776.00|1804.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2776.00||||2776.00|323.87|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2776.00||||2776.00|226.26|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2776.00||||2776.00|1182.58|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2776.00||||2776.00|445.37|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2776.00||||2776.00|1665.6|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2776.00||||2776.00|582.96|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2776.00||||2776.00|461.12|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2776.00||||2776.00|424.15|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2776.00||||2776.00|1331.09|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2776.00||||2776.00|1193.68|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2776.00||||2776.00|221.83|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2776.00||||2776.00|2776|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|GEHA [1415]|GEHA [141500]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2776.00||||2776.00|232.92|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2776.00||||2776.00|1193.68|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2776.00||||2776.00|1390.78|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2776.00||||2776.00|2498.4|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2776.00||||2776.00|2082|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2776.00||||2776.00|807.65|2776|221.83 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2776.00||||2776.00||| 61073218|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXTR W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2776.00||||2776.00||| 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3745.00||||3745.00|786.45|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|CORESOURCE [1315]|CORESOURCE [131500]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3745.00||||3745.00|3745|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3745.00||||3745.00|2434.25|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|UMR [2035]|UMR OPTIONS [203501]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3745.00||||3745.00|522.53|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|GEHA [1415]|GEHA [141500]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|CHAMPVA [1240]|CHAMP VA [124000]|3745.00||||3745.00|2808.75|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3745.00||||3745.00|530.68|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3745.00||||3745.00|706.36|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|||3745.00||||3745.00|1123.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3745.00||||3745.00|734.17|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3745.00||||3745.00|922.36|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3745.00||||3745.00|682.23|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3745.00||||3745.00|1314.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|AETNA [1015]|AETNA ACO WILCO [101532]|3745.00||||3745.00|807.65|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3745.00||||3745.00|1610.35|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3745.00||||3745.00|1795.73|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3745.00||||3745.00|2247|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3745.00||||3745.00|706.36|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3745.00||||3745.00|1876.25|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3745.00||||3745.00|522.53|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3745.00||||3745.00|649.73|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3745.00||||3745.00|381.65|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MULTIPLAN [1680]|HMA [168003]|3745.00||||3745.00|545.22|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3745.00||||3745.00|807.59|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3745.00||||3745.00|399.82|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|FMH BENEFIT SERVICES [1390]|FMH [139000]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MULTIPLAN [1680]|IHC HS [168011]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3745.00||||3745.00|1595.37|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3745.00||||3745.00|1610.35|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3745.00||||3745.00|399.82|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|HEALTHNET [1495]|HEALTHNET [149500]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3745.00||||3745.00|363.48|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|FIRST HEALTH [1375]|QUALCHOICE [137513]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3745.00||||3745.00|370.75|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|TRUSTMARK [2030]|STARMARK [203000]|3745.00||||3745.00|3370.5|3745|363.48 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3745.00||||3745.00||| 61073220|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT W W/O CONT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3745.00||||3745.00||| 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3076.00||||3076.00|1474.94|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3076.00||||3076.00|3076|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|GEHA [1415]|GEHA [141500]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3076.00||||3076.00|318.9|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3076.00||||3076.00|2307|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3076.00||||3076.00|1999.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3076.00||||3076.00|527.2|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3076.00||||3076.00|807.65|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3076.00||||3076.00|424.15|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3076.00||||3076.00|220.17|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3076.00||||3076.00|1322.68|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3076.00||||3076.00|226.65|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3076.00||||3076.00|479.28|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3076.00||||3076.00|645.96|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3076.00||||3076.00|323.78|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3076.00||||3076.00|323.87|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3076.00||||3076.00|445.37|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3076.00||||3076.00|221.83|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3076.00||||3076.00|461.12|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3076.00||||3076.00|1845.6|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3076.00||||3076.00|1322.68|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3076.00||||3076.00|1310.38|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3076.00||||3076.00|310.31|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3076.00||||3076.00|237.44|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3076.00||||3076.00|237.44|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3076.00||||3076.00|1541.08|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3076.00||||3076.00|1079.68|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3076.00||||3076.00|461.12|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3076.00||||3076.00|551.1|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|||3076.00||||3076.00|922.8|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3076.00||||3076.00|2768.4|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3076.00||||3076.00|215.86|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3076.00||||3076.00|221.83|3076|215.86 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3076.00||||3076.00||| 61073221|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3076.00||||3076.00||| 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3409.00||||3409.00|559.36|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3409.00||||3409.00|1634.62|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3409.00||||3409.00|715.89|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3409.00||||3409.00|3409|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3409.00||||3409.00|931.65|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|GEHA [1415]|GEHA [141500]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3409.00||||3409.00|581.38|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3409.00||||3409.00|2215.85|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3409.00||||3409.00|2556.75|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3409.00||||3409.00|514.51|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3409.00||||3409.00|946.16|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3409.00||||3409.00|680.46|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3409.00||||3409.00|1452.23|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3409.00||||3409.00|1196.56|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3409.00||||3409.00|1465.87|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3409.00||||3409.00|1707.91|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3409.00||||3409.00|1653.46|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3409.00||||3409.00|807.65|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3409.00||||3409.00|2045.4|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3409.00||||3409.00|712.86|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3409.00||||3409.00|559.36|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3409.00||||3409.00|712.86|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|||3409.00||||3409.00|1022.7|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3409.00||||3409.00|931.65|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3409.00||||3409.00|972.09|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3409.00||||3409.00|661.02|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3409.00||||3409.00|1465.87|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3409.00||||3409.00|648.06|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3409.00||||3409.00|639.53|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3409.00||||3409.00|3068.1|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3409.00||||3409.00|540.25|3409|514.51 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3409.00||||3409.00||| 61073222|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3409.00||||3409.00||| 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3647.00||||3647.00|734.17|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|GEHA [1415]|GEHA [141500]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3647.00||||3647.00|649.73|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3647.00||||3647.00|2735.25|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|||3647.00||||3647.00|1094.1|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3647.00||||3647.00|545.22|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3647.00||||3647.00|706.36|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3647.00||||3647.00|2188.2|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3647.00||||3647.00|922.36|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3647.00||||3647.00|522.53|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3647.00||||3647.00|765.87|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3647.00||||3647.00|370.75|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3647.00||||3647.00|1568.21|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3647.00||||3647.00|807.59|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3647.00||||3647.00|522.53|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3647.00||||3647.00|530.68|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3647.00||||3647.00|399.82|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3647.00||||3647.00|807.65|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3647.00||||3647.00|2370.55|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3647.00||||3647.00|1748.74|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3647.00||||3647.00|1568.21|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3647.00||||3647.00|399.82|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3647.00||||3647.00|1280.1|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3647.00||||3647.00|1553.62|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3647.00||||3647.00|1827.15|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3647.00||||3647.00|706.36|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3647.00||||3647.00|381.65|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3647.00||||3647.00|682.23|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3647.00||||3647.00|363.48|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3647.00||||3647.00|3282.3|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3647.00||||3647.00|3647|3647|363.48 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3647.00||||3647.00||| 61073223|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC UPPER EXT JOINT W/&W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3647.00||||3647.00||| 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3097.00||||3097.00|215.86|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3097.00||||3097.00|551.1|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3097.00||||3097.00|244.01|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3097.00||||3097.00|1858.2|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3097.00||||3097.00|1087.05|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3097.00||||3097.00|1551.6|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3097.00||||3097.00|1319.32|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3097.00||||3097.00|445.37|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3097.00||||3097.00|244.01|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3097.00||||3097.00|323.87|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3097.00||||3097.00|332.74|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3097.00||||3097.00|318.9|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3097.00||||3097.00|226.26|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3097.00||||3097.00|221.83|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3097.00||||3097.00|461.12|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|||3097.00||||3097.00|929.1|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3097.00||||3097.00|650.37|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3097.00||||3097.00|1485.01|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3097.00||||3097.00|3097|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3097.00||||3097.00|807.65|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3097.00||||3097.00|1331.71|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3097.00||||3097.00|2013.05|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3097.00||||3097.00|2322.75|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3097.00||||3097.00|527.2|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3097.00||||3097.00|1331.71|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3097.00||||3097.00|461.12|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|GEHA [1415]|GEHA [141500]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3097.00||||3097.00|318.9|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3097.00||||3097.00|479.28|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3097.00||||3097.00|424.15|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3097.00||||3097.00|232.92|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3097.00||||3097.00|2787.3|3097|215.86 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3097.00||||3097.00||| 61073718|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW EXTR W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3097.00||||3097.00||| 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3477.00||||3477.00|734.17|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3477.00||||3477.00|3477|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3477.00||||3477.00|2607.75|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3477.00||||3477.00|2260.05|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|||3477.00||||3477.00|1043.1|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3477.00||||3477.00|730.17|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3477.00||||3477.00|530.68|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3477.00||||3477.00|370.75|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3477.00||||3477.00|1495.11|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3477.00||||3477.00|807.59|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3477.00||||3477.00|545.22|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3477.00||||3477.00|2086.2|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3477.00||||3477.00|399.82|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3477.00||||3477.00|922.36|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3477.00||||3477.00|682.23|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3477.00||||3477.00|1667.22|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3477.00||||3477.00|1495.11|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3477.00||||3477.00|706.36|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3477.00||||3477.00|1481.2|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3477.00||||3477.00|1220.43|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3477.00||||3477.00|649.73|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3477.00||||3477.00|522.53|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3477.00||||3477.00|399.82|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3477.00||||3477.00|807.65|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3477.00||||3477.00|522.53|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3477.00||||3477.00|1741.98|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3477.00||||3477.00|706.36|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3477.00||||3477.00|3129.3|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3477.00||||3477.00|363.48|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3477.00||||3477.00|381.65|3477|363.48 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3477.00||||3477.00||| 61073720|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC LOWER EXTREMITY W & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3477.00||||3477.00||| 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3198.00||||3198.00|318.9|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3198.00||||3198.00|2398.5|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3198.00||||3198.00|479.28|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|GEHA [1415]|GEHA [141500]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3198.00||||3198.00|215.86|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3198.00||||3198.00|424.15|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3198.00||||3198.00|445.37|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3198.00||||3198.00|232.92|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3198.00||||3198.00|221.83|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3198.00||||3198.00|237.44|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3198.00||||3198.00|1375.14|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3198.00||||3198.00|1122.5|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3198.00||||3198.00|1362.35|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3198.00||||3198.00|551.1|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3198.00||||3198.00|461.12|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3198.00||||3198.00|237.44|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3198.00||||3198.00|221.83|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3198.00||||3198.00|671.58|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3198.00||||3198.00|215.86|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3198.00||||3198.00|1602.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3198.00||||3198.00|215.86|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3198.00||||3198.00|215.86|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3198.00||||3198.00|323.78|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3198.00||||3198.00|215.86|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3198.00||||3198.00|1375.14|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3198.00||||3198.00|527.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3198.00||||3198.00|807.65|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3198.00||||3198.00|220.17|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3198.00||||3198.00|310.31|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3198.00||||3198.00|221.83|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3198.00||||3198.00|215.86|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3198.00||||3198.00|1918.8|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3198.00||||3198.00|1533.44|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3198.00||||3198.00|215.86|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3198.00||||3198.00|2078.7|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3198.00||||3198.00|323.87|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3198.00||||3198.00|3198|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|||3198.00||||3198.00|959.4|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3198.00||||3198.00|461.12|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3198.00||||3198.00|221.83|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3198.00||||3198.00|2878.2|3198|215.86 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3198.00||||3198.00||| 61073721|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3198.00||||3198.00||| 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|||3546.00||||3546.00|1063.8|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3546.00||||3546.00|581.38|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|GEHA [1415]|GEHA [141500]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3546.00||||3546.00|931.65|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3546.00||||3546.00|2659.5|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3546.00||||3546.00|514.51|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3546.00||||3546.00|2304.9|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3546.00||||3546.00|559.36|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3546.00||||3546.00|920.7|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3546.00||||3546.00|639.53|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3546.00||||3546.00|1524.78|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3546.00||||3546.00|643.23|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3546.00||||3546.00|906.57|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MULTIPLAN [1680]|HMA [168003]|3546.00||||3546.00|945.92|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3546.00||||3546.00|540.25|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3546.00||||3546.00|3546|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3546.00||||3546.00|807.65|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3546.00||||3546.00|693.68|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3546.00||||3546.00|662.15|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3546.00||||3546.00|1653.46|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3546.00||||3546.00|744.66|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3546.00||||3546.00|1524.78|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3546.00||||3546.00|1510.6|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3546.00||||3546.00|693.68|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3546.00||||3546.00|1244.65|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3546.00||||3546.00|1776.55|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3546.00||||3546.00|2127.6|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3546.00||||3546.00|630.61|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3546.00||||3546.00|559.36|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3546.00||||3546.00|3191.4|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3546.00||||3546.00|1700.31|3546|514.51 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3546.00||||3546.00||| 61073722|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC Joint LOWER EXTREMITY W/ CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3546.00||||3546.00||| 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3708.00||||3708.00|2224.8|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3708.00||||3708.00|381.65|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3708.00||||3708.00|1594.44|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3708.00||||3708.00|1857.71|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3708.00||||3708.00|1301.51|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3708.00||||3708.00|1579.61|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3708.00||||3708.00|922.36|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3708.00||||3708.00|706.36|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3708.00||||3708.00|399.82|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3708.00||||3708.00|682.23|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3708.00||||3708.00|1777.99|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3708.00||||3708.00|807.65|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3708.00||||3708.00|807.59|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3708.00||||3708.00|522.53|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3708.00||||3708.00|545.22|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3708.00||||3708.00|1594.44|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3708.00||||3708.00|370.75|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3708.00||||3708.00|778.68|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3708.00||||3708.00|3708|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3708.00||||3708.00|2410.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3708.00||||3708.00|706.36|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3708.00||||3708.00|522.53|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3708.00||||3708.00|734.17|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3708.00||||3708.00|2781|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|GEHA [1415]|GEHA [141500]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3708.00||||3708.00|399.82|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|||3708.00||||3708.00|1112.4|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3708.00||||3708.00|530.68|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3708.00||||3708.00|363.48|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3708.00||||3708.00|649.73|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3708.00||||3708.00|3337.2|3708|363.48 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3708.00||||3708.00||| 61073723|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC MRI LOW JOINT W&W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3708.00||||3708.00||| 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3165.00||||3165.00|664.65|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|GEHA [1415]|GEHA [141500]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3165.00||||3165.00|424.15|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3165.00||||3165.00|318.9|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3165.00||||3165.00|2057.25|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|||3165.00||||3165.00|949.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3165.00||||3165.00|1517.62|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3165.00||||3165.00|3165|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3165.00||||3165.00|461.12|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3165.00||||3165.00|527.2|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3165.00||||3165.00|226.26|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3165.00||||3165.00|323.87|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3165.00||||3165.00|318.9|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS 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BEHAVORIAL COMMERCIAL [289500]|3165.00||||3165.00|244.01|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3165.00||||3165.00|807.65|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC 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CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3165.00||||3165.00|221.83|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3165.00||||3165.00|2848.5|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3165.00||||3165.00|1348.29|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3165.00||||3165.00|551.1|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3165.00||||3165.00|1585.67|3165|221.83 61074181|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO 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& W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3386.00||||3386.00|682.23|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3386.00||||3386.00|1696.39|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3386.00||||3386.00|399.82|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3386.00||||3386.00|1455.98|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3386.00||||3386.00|1188.49|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3386.00||||3386.00|1442.44|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3386.00||||3386.00|922.36|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3386.00||||3386.00|399.82|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3386.00||||3386.00|706.36|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3386.00||||3386.00|381.65|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3386.00||||3386.00|1455.98|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3386.00||||3386.00|807.59|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3386.00||||3386.00|807.65|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3386.00||||3386.00|370.75|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3386.00||||3386.00|522.53|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3386.00||||3386.00|363.48|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3386.00||||3386.00|3047.4|3386|363.48 61074183|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC ABDOMEN W & W/O CONTRAST|BCBS 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[1830]|PRESBYTERIAN HIX [183001]|2646.00||||2646.00|237.44|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2646.00||||2646.00|221.83|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2646.00||||2646.00|2381.4|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2646.00||||2646.00|928.75|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2646.00||||2646.00|1587.6|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2646.00||||2646.00|232.92|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2646.00||||2646.00|551.1|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2646.00||||2646.00|461.12|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2646.00||||2646.00|1268.76|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2646.00||||2646.00|221.83|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2646.00||||2646.00|2381.4|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2646.00||||2646.00|2381.4|2646|221.83 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2646.00||||2646.00||| 61170551|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2646.00||||2646.00||| 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4325.00||||4325.00|540.25|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4325.00||||4325.00|1859.75|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4325.00||||4325.00|2166.83|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4325.00||||4325.00|1518.08|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4325.00||||4325.00|1842.45|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4325.00||||4325.00|2595|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4325.00||||4325.00|381.65|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4325.00||||4325.00|2073.84|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4325.00||||4325.00|559.36|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4325.00||||4325.00|922.36|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|4325.00||||4325.00|807.65|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4325.00||||4325.00|522.53|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4325.00||||4325.00|1859.75|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4325.00||||4325.00|639.53|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|4325.00||||4325.00|545.22|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4325.00||||4325.00|370.75|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4325.00||||4325.00|530.68|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4325.00||||4325.00|908.25|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|||4325.00||||4325.00|1297.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4325.00||||4325.00|4325|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4325.00||||4325.00|2811.25|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4325.00||||4325.00|559.36|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4325.00||||4325.00|514.51|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4325.00||||4325.00|522.53|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|GEHA [1415]|GEHA [141500]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|4325.00||||4325.00|3243.75|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4325.00||||4325.00|399.82|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4325.00||||4325.00|363.48|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4325.00||||4325.00|399.82|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4325.00||||4325.00|3892.5|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4325.00||||4325.00|581.38|4325|363.48 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4325.00||||4325.00||| 61170552|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4325.00||||4325.00||| 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|||5300.00||||5300.00|1590|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5300.00||||5300.00|2541.35|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5300.00||||5300.00|5300|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5300.00||||5300.00|399.82|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5300.00||||5300.00|2279|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|5300.00||||5300.00|807.65|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5300.00||||5300.00|522.53|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5300.00||||5300.00|370.75|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5300.00||||5300.00|530.68|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5300.00||||5300.00|682.23|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5300.00||||5300.00|381.65|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5300.00||||5300.00|2279|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5300.00||||5300.00|2257.8|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|5300.00||||5300.00|545.22|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5300.00||||5300.00|399.82|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5300.00||||5300.00|1860.3|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5300.00||||5300.00|807.59|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5300.00||||5300.00|922.36|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5300.00||||5300.00|2655.3|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5300.00||||5300.00|3180|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5300.00||||5300.00|1113|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5300.00||||5300.00|706.36|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5300.00||||5300.00|3445|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5300.00||||5300.00|706.36|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5300.00||||5300.00|734.17|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5300.00||||5300.00|522.53|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|5300.00||||5300.00|3975|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5300.00||||5300.00|649.73|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5300.00||||5300.00|4770|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5300.00||||5300.00|363.48|5300|363.48 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5300.00||||5300.00||| 61170553|EAP|0611 - MAGNETIC RESONANCE TECHNOLOGY-MRI-BRAIN/BRA|HC BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5300.00||||5300.00||| 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3200.00||||3200.00|1603.2|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3200.00||||3200.00|244.01|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3200.00||||3200.00|1376|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3200.00||||3200.00|1123.2|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3200.00||||3200.00|1363.2|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3200.00||||3200.00|1920|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3200.00||||3200.00|232.92|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3200.00||||3200.00|461.12|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3200.00||||3200.00|244.01|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3200.00||||3200.00|445.37|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3200.00||||3200.00|318.9|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3200.00||||3200.00|332.74|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3200.00||||3200.00|1376|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3200.00||||3200.00|527.2|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3200.00||||3200.00|226.26|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3200.00||||3200.00|807.65|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3200.00||||3200.00|323.87|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3200.00||||3200.00|672|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3200.00||||3200.00|3200|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3200.00||||3200.00|551.1|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3200.00||||3200.00|2080|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|||3200.00||||3200.00|960|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3200.00||||3200.00|318.9|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3200.00||||3200.00|2400|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|GEHA [1415]|GEHA [141500]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3200.00||||3200.00|424.15|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3200.00||||3200.00|479.28|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3200.00||||3200.00|2880|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3200.00||||3200.00|221.83|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3200.00||||3200.00|461.12|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3200.00||||3200.00|1534.4|3200|221.83 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3200.00||||3200.00||| 61272141|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3200.00||||3200.00||| 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3358.00||||3358.00|479.28|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|GEHA [1415]|GEHA [141500]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3358.00||||3358.00|318.9|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3358.00||||3358.00|2518.5|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3358.00||||3358.00|424.15|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3358.00||||3358.00|461.12|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|||3358.00||||3358.00|1007.4|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3358.00||||3358.00|1610.16|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3358.00||||3358.00|2182.7|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3358.00||||3358.00|705.18|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3358.00||||3358.00|527.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3358.00||||3358.00|1443.94|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3358.00||||3358.00|318.9|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3358.00||||3358.00|3358|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3358.00||||3358.00|332.74|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3358.00||||3358.00|323.87|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3358.00||||3358.00|807.65|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3358.00||||3358.00|226.26|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3358.00||||3358.00|551.1|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3358.00||||3358.00|1178.66|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3358.00||||3358.00|3022.2|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3358.00||||3358.00|1430.51|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3358.00||||3358.00|1682.36|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3358.00||||3358.00|1443.94|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3358.00||||3358.00|244.01|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3358.00||||3358.00|2014.8|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3358.00||||3358.00|232.92|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3358.00||||3358.00|461.12|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3358.00||||3358.00|445.37|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3358.00||||3358.00|244.01|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3358.00||||3358.00|221.83|3358|221.83 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3358.00||||3358.00||| 61272146|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3358.00||||3358.00||| 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4514.00||||4514.00|399.82|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4514.00||||4514.00|1941.02|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4514.00||||4514.00|2261.51|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4514.00||||4514.00|1584.41|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4514.00||||4514.00|922.36|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4514.00||||4514.00|2708.4|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4514.00||||4514.00|559.36|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4514.00||||4514.00|399.82|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4514.00||||4514.00|540.25|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|4514.00||||4514.00|545.22|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4514.00||||4514.00|522.53|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4514.00||||4514.00|1941.02|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4514.00||||4514.00|639.53|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4514.00||||4514.00|370.75|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|4514.00||||4514.00|807.65|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4514.00||||4514.00|530.68|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4514.00||||4514.00|947.94|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4514.00||||4514.00|4514|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4514.00||||4514.00|2934.1|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4514.00||||4514.00|559.36|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4514.00||||4514.00|381.65|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|4514.00||||4514.00|3385.5|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4514.00||||4514.00|1922.96|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|GEHA [1415]|GEHA [141500]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4514.00||||4514.00|581.38|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4514.00||||4514.00|522.53|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4514.00||||4514.00|514.51|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4514.00||||4514.00|363.48|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|||4514.00||||4514.00|1354.2|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4514.00||||4514.00|2164.46|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4514.00||||4514.00|4062.6|4514|363.48 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4514.00||||4514.00||| 61272147|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4514.00||||4514.00||| 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|GEHA [1415]|GEHA [141500]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3481.00||||3481.00|479.28|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3481.00||||3481.00|318.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3481.00||||3481.00|2610.75|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3481.00||||3481.00|424.15|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|||3481.00||||3481.00|1044.3|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3481.00||||3481.00|1669.14|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3481.00||||3481.00|3481|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3481.00||||3481.00|731.01|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3481.00||||3481.00|323.87|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3481.00||||3481.00|226.26|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3481.00||||3481.00|1496.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3481.00||||3481.00|527.2|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3481.00||||3481.00|318.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3481.00||||3481.00|332.74|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3481.00||||3481.00|2262.65|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3481.00||||3481.00|807.65|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3481.00||||3481.00|461.12|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3481.00||||3481.00|445.37|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3481.00||||3481.00|461.12|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3481.00||||3481.00|232.92|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3481.00||||3481.00|1496.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3481.00||||3481.00|244.01|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3481.00||||3481.00|1482.91|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3481.00||||3481.00|1221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3481.00||||3481.00|1743.98|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3481.00||||3481.00|551.1|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3481.00||||3481.00|244.01|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3481.00||||3481.00|221.83|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3481.00||||3481.00|3132.9|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3481.00||||3481.00|2088.6|3481|221.83 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3481.00||||3481.00||| 61272148|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3481.00||||3481.00||| 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3933.00||||3933.00|1970.43|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3933.00||||3933.00|389.06|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3933.00||||3933.00|1691.19|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3933.00||||3933.00|1380.48|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3933.00||||3933.00|1675.46|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3933.00||||3933.00|922.36|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3933.00||||3933.00|2359.8|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3933.00||||3933.00|371.38|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3933.00||||3933.00|559.36|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3933.00||||3933.00|389.06|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3933.00||||3933.00|540.25|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3933.00||||3933.00|508.47|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|3933.00||||3933.00|530.54|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3933.00||||3933.00|1691.19|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3933.00||||3933.00|639.53|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3933.00||||3933.00|360.77|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3933.00||||3933.00|807.65|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3933.00||||3933.00|516.39|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3933.00||||3933.00|825.93|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3933.00||||3933.00|3933|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3933.00||||3933.00|2556.45|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|||3933.00||||3933.00|1179.9|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|GEHA [1415]|GEHA [141500]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3933.00||||3933.00|581.38|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3933.00||||3933.00|2949.75|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3933.00||||3933.00|514.51|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3933.00||||3933.00|508.47|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3933.00||||3933.00|3539.7|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3933.00||||3933.00|353.69|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3933.00||||3933.00|1885.87|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3933.00||||3933.00|559.36|3933|353.69 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3933.00||||3933.00||| 61272149|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3933.00||||3933.00||| 61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|5245.00||||5245.00|4720.5|5245|353.69 61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5245.00||||5245.00|734.17|5245|353.69 61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|5245.00||||5245.00|4720.5|5245|353.69 61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5245.00||||5245.00|4720.5|5245|353.69 61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5245.00||||5245.00|522.53|5245|353.69 61272156|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR C-SPINE W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA 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[115527]|5375.00||||5375.00|2311.25|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5375.00||||5375.00|2692.88|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5375.00||||5375.00|1886.63|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5375.00||||5375.00|922.36|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5375.00||||5375.00|3225|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5375.00||||5375.00|381.65|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5375.00||||5375.00|399.82|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5375.00||||5375.00|682.23|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5375.00||||5375.00|522.53|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|5375.00||||5375.00|545.22|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5375.00||||5375.00|2311.25|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5375.00||||5375.00|807.59|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5375.00||||5375.00|370.75|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|5375.00||||5375.00|807.65|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5375.00||||5375.00|530.68|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5375.00||||5375.00|1128.75|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5375.00||||5375.00|5375|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5375.00||||5375.00|3493.75|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5375.00||||5375.00|706.36|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|5375.00||||5375.00|4031.25|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5375.00||||5375.00|734.17|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5375.00||||5375.00|522.53|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5375.00||||5375.00|649.73|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5375.00||||5375.00|363.48|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5375.00||||5375.00|4837.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|||5375.00||||5375.00|1612.5|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5375.00||||5375.00|2577.31|5375|363.48 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5375.00||||5375.00||| 61272157|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR T-SPINE W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5375.00||||5375.00||| 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5290.00||||5290.00|734.17|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5290.00||||5290.00|522.53|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5290.00||||5290.00|649.73|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|||5290.00||||5290.00|1587|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5290.00||||5290.00|2536.56|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5290.00||||5290.00|5290|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5290.00||||5290.00|1110.9|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5290.00||||5290.00|2274.7|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5290.00||||5290.00|807.59|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5290.00||||5290.00|530.68|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5290.00||||5290.00|522.53|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|5290.00||||5290.00|545.22|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5290.00||||5290.00|3438.5|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|5290.00||||5290.00|807.65|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5290.00||||5290.00|682.23|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5290.00||||5290.00|706.36|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5290.00||||5290.00|371.38|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5290.00||||5290.00|2274.7|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5290.00||||5290.00|399.82|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5290.00||||5290.00|2253.54|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|5290.00||||5290.00|3967.5|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5290.00||||5290.00|363.48|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5290.00||||5290.00|922.36|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5290.00||||5290.00|3174|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5290.00||||5290.00|2650.29|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5290.00||||5290.00|706.36|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5290.00||||5290.00|399.82|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|5290.00||||5290.00|4761|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5290.00||||5290.00|370.75|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5290.00||||5290.00|1856.79|5290|363.48 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5290.00||||5290.00||| 61272158|EAP|0612 - MAGNETIC RESONANCE TECHNOLOGY-MRI-SPINAL CO|HC MR L-SPINE W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5290.00||||5290.00||| 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3140.00||||3140.00|551.1|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|BCBS MEDICARE 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61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3140.00||||3140.00|1337.64|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3140.00||||3140.00|1884|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3140.00||||3140.00|232.92|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3140.00||||3140.00|461.12|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3140.00||||3140.00|244.01|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3140.00||||3140.00|445.37|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3140.00||||3140.00|318.9|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3140.00||||3140.00|332.74|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3140.00||||3140.00|1350.2|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3140.00||||3140.00|527.2|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3140.00||||3140.00|226.26|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3140.00||||3140.00|323.87|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3140.00||||3140.00|659.4|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3140.00||||3140.00|3140|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3140.00||||3140.00|2041|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|||3140.00||||3140.00|942|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|GEHA [1415]|GEHA [141500]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3140.00||||3140.00|479.28|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3140.00||||3140.00|2355|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3140.00||||3140.00|424.15|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3140.00||||3140.00|318.9|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3140.00||||3140.00|807.65|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3140.00||||3140.00|221.83|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3140.00||||3140.00|461.12|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3140.00||||3140.00|2826|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3140.00||||3140.00|302.61|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3140.00||||3140.00|1505.63|3140|221.83 61472195|EAP|0610 - MAGNETIC RESONANCE TECHNOLOGY-GENERAL|HC PELVIS W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3140.00||||3140.00||| 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2380.00||||2380.00|479.28|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|GEHA [1415]|GEHA [141500]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2380.00||||2380.00|318.9|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2380.00||||2380.00|1785|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2380.00||||2380.00|424.15|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2380.00||||2380.00|461.12|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|||2380.00||||2380.00|714|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2380.00||||2380.00|1141.21|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2380.00||||2380.00|527.2|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2380.00||||2380.00|226.26|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2380.00||||2380.00|1023.4|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2380.00||||2380.00|318.9|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2380.00||||2380.00|332.74|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2380.00||||2380.00|323.87|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2380.00||||2380.00|1547|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2380.00||||2380.00|807.65|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2380.00||||2380.00|1428|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2380.00||||2380.00|551.1|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2380.00||||2380.00|835.38|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2380.00||||2380.00|2142|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2380.00||||2380.00|1013.88|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2380.00||||2380.00|1192.38|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2380.00||||2380.00|1023.4|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2380.00||||2380.00|244.01|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2380.00||||2380.00|232.92|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2380.00||||2380.00|445.37|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2380.00||||2380.00|244.01|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2380.00||||2380.00|221.83|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2380.00||||2380.00|499.8|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2380.00||||2380.00|2380|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2380.00||||2380.00|461.12|2380|221.83 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2380.00||||2380.00||| 61570544|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2380.00||||2380.00||| 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3276.00||||3276.00|1395.58|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3276.00||||3276.00|399.82|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3276.00||||3276.00|1408.68|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3276.00||||3276.00|1641.28|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3276.00||||3276.00|1149.88|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3276.00||||3276.00|922.36|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3276.00||||3276.00|1965.6|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3276.00||||3276.00|381.65|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3276.00||||3276.00|706.36|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3276.00||||3276.00|399.82|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3276.00||||3276.00|545.22|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3276.00||||3276.00|522.53|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3276.00||||3276.00|1408.68|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3276.00||||3276.00|807.59|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3276.00||||3276.00|370.75|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3276.00||||3276.00|807.65|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3276.00||||3276.00|530.68|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3276.00||||3276.00|687.96|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3276.00||||3276.00|682.23|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3276.00||||3276.00|3276|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3276.00||||3276.00|2129.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3276.00||||3276.00|706.36|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3276.00||||3276.00|649.73|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3276.00||||3276.00|2457|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3276.00||||3276.00|734.17|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3276.00||||3276.00|522.53|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3276.00||||3276.00|2948.4|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3276.00||||3276.00|363.48|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3276.00||||3276.00|1570.84|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|||3276.00||||3276.00|982.8|3276|363.48 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3276.00||||3276.00||| 61570546|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA BRAIN W/ & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3276.00||||3276.00||| 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|GEHA [1415]|GEHA [141500]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2343.00||||2343.00|479.28|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2343.00||||2343.00|318.9|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2343.00||||2343.00|424.15|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2343.00||||2343.00|461.12|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|||2343.00||||2343.00|702.9|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2343.00||||2343.00|1123.47|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2343.00||||2343.00|2343|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2343.00||||2343.00|1007.49|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|2343.00||||2343.00|332.74|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2343.00||||2343.00|807.65|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2343.00||||2343.00|445.37|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2343.00||||2343.00|244.01|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2343.00||||2343.00|461.12|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2343.00||||2343.00|232.92|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2343.00||||2343.00|1405.8|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2343.00||||2343.00|551.1|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2343.00||||2343.00|318.9|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2343.00||||2343.00|1007.49|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2343.00||||2343.00|1173.84|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2343.00||||2343.00|822.39|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2343.00||||2343.00|998.12|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2343.00||||2343.00|244.01|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2343.00||||2343.00|1757.25|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2343.00||||2343.00|527.2|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2343.00||||2343.00|226.26|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2343.00||||2343.00|492.03|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2343.00||||2343.00|221.83|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2343.00||||2343.00|2108.7|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2343.00||||2343.00|323.87|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2343.00||||2343.00|1522.95|2343|221.83 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2343.00||||2343.00||| 61570547|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2343.00||||2343.00||| 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2836.00||||2836.00|995.44|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2836.00||||2836.00|1420.84|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2836.00||||2836.00|389.06|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2836.00||||2836.00|1219.48|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2836.00||||2836.00|1208.14|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2836.00||||2836.00|1701.6|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2836.00||||2836.00|371.38|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2836.00||||2836.00|559.36|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2836.00||||2836.00|389.06|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2836.00||||2836.00|540.25|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2836.00||||2836.00|508.47|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2836.00||||2836.00|1219.48|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2836.00||||2836.00|639.53|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2836.00||||2836.00|360.77|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|2836.00||||2836.00|807.65|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|UMR [2035]|UMR OPTIONS [203501]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2836.00||||2836.00|516.39|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2836.00||||2836.00|595.56|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2836.00||||2836.00|2836|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2836.00||||2836.00|1843.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2836.00||||2836.00|1359.86|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|||2836.00||||2836.00|850.8|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2836.00||||2836.00|922.36|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|GEHA [1415]|GEHA [141500]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2836.00||||2836.00|581.38|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|2836.00||||2836.00|2127|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2836.00||||2836.00|514.51|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2836.00||||2836.00|508.47|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2836.00||||2836.00|2552.4|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2836.00||||2836.00|353.69|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2836.00||||2836.00|559.36|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|MULTIPLAN [1680]|HMA [168003]|2836.00||||2836.00|530.54|2836|353.69 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2836.00||||2836.00||| 61570548|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W/CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2836.00||||2836.00||| 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|CORESOURCE [1315]|CORESOURCE [131500]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3599.00||||3599.00|734.17|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|GEHA [1415]|GEHA [141500]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3599.00||||3599.00|522.53|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|CHAMPVA [1240]|CHAMP VA [124000]|3599.00||||3599.00|2699.25|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3599.00||||3599.00|649.73|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3599.00||||3599.00|706.36|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|||3599.00||||3599.00|1079.7|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3599.00||||3599.00|2339.35|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3599.00||||3599.00|755.79|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3599.00||||3599.00|807.59|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|FIRST HEALTH [1375]|QUALCHOICE [137513]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3599.00||||3599.00|370.75|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3599.00||||3599.00|1547.57|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|FMH BENEFIT SERVICES [1390]|FMH [139000]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|UMR [2035]|UMR OPTIONS [203501]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MULTIPLAN [1680]|IHC HS [168011]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3599.00||||3599.00|522.53|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MULTIPLAN [1680]|HMA [168003]|3599.00||||3599.00|545.22|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|HEALTHNET [1495]|HEALTHNET [149500]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3599.00||||3599.00|530.68|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3599.00||||3599.00|3599|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3599.00||||3599.00|1725.72|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|AETNA [1015]|AETNA ACO WILCO [101532]|3599.00||||3599.00|807.65|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|TRUSTMARK [2030]|STARMARK [203000]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3599.00||||3599.00|682.23|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3599.00||||3599.00|399.82|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3599.00||||3599.00|922.36|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3599.00||||3599.00|1263.25|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3599.00||||3599.00|1533.17|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3599.00||||3599.00|399.82|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3599.00||||3599.00|1803.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3599.00||||3599.00|1547.57|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3599.00||||3599.00|381.65|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3599.00||||3599.00|2159.4|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3599.00||||3599.00|706.36|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3599.00||||3599.00|3239.1|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3599.00||||3599.00|363.48|3599|363.48 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3599.00||||3599.00||| 61570549|EAP|0615 - MAGNETIC RESONANCE TECHNOLOGY-MRA-HEAD AND|HC MRV/MRA NECK W & W/O CONTRAST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3599.00||||3599.00||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|||0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901001|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVICORE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|||0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901002|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDCURRENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|||0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901003|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM MEDICALIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|||0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901004|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NDSC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|||0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901005|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM NIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|||0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901006|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM TEST APPROP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|||0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901007|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AIM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|||0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901008|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CRANBERRY PK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|||0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901009|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SAGE HEALTH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|||0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901010|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM STANSON|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|||0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901011|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM QUALIFIED NOS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|||0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901012|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM AGILEMD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|||0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901013|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EVIDENCECARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|||0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901014|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INVENIQA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|||0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901015|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM RELIANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|||0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901016|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM SPEED OF CARE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|||0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901017|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM HEALTHHELP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|||0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901018|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INFINX|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|||0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901019|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM LOGICNETS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|||0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901020|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM CURBSIDE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|||0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901021|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM EHEALTHLINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|||0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901022|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM INTERMOUNTAIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|HEALTHNET [1495]|HEALTHNET [149500]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MULTIPLAN [1680]|IHC HS [168011]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|TRUSTMARK [2030]|STARMARK [203000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|UMR [2035]|UMR OPTIONS [203501]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|CHAMPVA [1240]|CHAMP VA [124000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|CORESOURCE [1315]|CORESOURCE [131500]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|GEHA [1415]|GEHA [141500]|0.01||||0.01|0.01|0.01|0.01 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|AETNA [1015]|AETNA ACO WILCO [101532]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|MULTIPLAN [1680]|HMA [168003]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|||0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.01||||0.01||| 61901023|EAP|0619 - MAGNETIC RESONANCE TECHNOLOGY-OTHER MRT|HC CDSM PERSIVIA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.01||||0.01||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|||10.00||||10.00|3|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6193|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENAZOPYRIDINE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|||10.00||||10.00|3|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6217|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENOBARBITAL 32.4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|GEHA [1415]|GEHA [141500]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|CHAMPVA [1240]|CHAMP VA [124000]|13.39||||13.39|10.04|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|CORESOURCE [1315]|CORESOURCE [131500]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|||13.39||||13.39|4.02|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.39||||13.39|6.42|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.39||||13.39|2.81|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.39||||13.39|5.76|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|HEALTHNET [1495]|HEALTHNET [149500]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MULTIPLAN [1680]|IHC HS [168011]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|UMR [2035]|UMR OPTIONS [203501]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.39||||13.39|8.7|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|TRUSTMARK [2030]|STARMARK [203000]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.39||||13.39|5.76|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.39||||13.39|6.71|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.39||||13.39|4.7|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.39||||13.39|5.7|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.39||||13.39|8.03|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.39||||13.39|12.05|12.05|2.81 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MULTIPLAN [1680]|HMA [168003]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|AETNA [1015]|AETNA ACO WILCO [101532]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.39||||13.39||| 6244|ERX|0250 - PHARMACY-GENERAL|PHENYLEPHRINE 0.5 % NASAL SPRAY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.39||||13.39||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6257|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|||10.00||||10.00|3|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PIROXICAM 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|||10.00||||10.00|3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6468|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 1 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|||10.00||||10.00|3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6470|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAZOSIN 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142.93||||142.93|50.17|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142.93||||142.93|30.02|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142.93||||142.93|61.46|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|||142.93||||142.93|42.88|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|142.93||||142.93|107.2|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|GEHA [1415]|GEHA [141500]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142.93||||142.93|68.53|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142.93||||142.93|92.9|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142.93||||142.93|85.76|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142.93||||142.93|61.46|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|142.93||||142.93|71.61|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|142.93||||142.93|60.89|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142.93||||142.93|128.64|128.64|30.02 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MULTIPLAN [1680]|HMA [168003]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142.93||||142.93||| 6487|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142.93||||142.93||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|||10.00||||10.00|3|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.01|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.01|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|||10.00||||10.00|3|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.01 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6493|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|||10.00||||10.00|3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|||10.00||||10.00|3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|||10.00||||10.00|3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.11|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.11|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.11|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.11 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6494|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.21|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.21|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|||10.00||||10.00|3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|||10.00||||10.00|3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|||10.00||||10.00|3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|||10.00||||10.00|3|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.21|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.21|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.21 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6496|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|||10.00||||10.00|3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.05|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.05|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.05|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.05|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|||10.00||||10.00|3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|||10.00||||10.00|3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|||10.00||||10.00|3|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.05 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6497|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.53|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|0.53|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|||10.00||||10.00|3|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|||10.00||||10.00|3|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|0.53 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6498|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PREDNISONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|||10.00||||10.00|3|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|||10.00||||10.00|3|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6544|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRIMIDONE 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|||10.00||||10.00|3|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|||10.00||||10.00|3|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6561|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROBENECID 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|292.83||||292.83|175.7|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|292.83||||292.83|124.75|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|292.83||||292.83|190.34|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|292.83||||292.83|76.03|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|||292.83||||292.83|87.85|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|292.83||||292.83|140.41|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|292.83||||292.83|219.62|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|292.83||||292.83|61.49|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|292.83||||292.83|125.92|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|292.83||||292.83|102.49|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|292.83||||292.83|146.71|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|292.83||||292.83|102.78|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|292.83||||292.83|125.92|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|292.83||||292.83|263.55|263.55|61.49 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|292.83||||292.83||| 6562|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCAINAMIDE 100 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|292.83||||292.83||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72.00||||72.00|46.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72.00||||72.00|36.07|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72.00||||72.00|43.2|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72.00||||72.00|30.67|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72.00||||72.00|25.27|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72.00||||72.00|30.96|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|72.00||||72.00|25.2|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72.00||||72.00|30.96|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72.00||||72.00|15.12|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72.00||||72.00|5.41|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|72.00||||72.00|54|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|||72.00||||72.00|21.6|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|72.00||||72.00|64.8|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72.00||||72.00|34.52|64.8|5.41 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72.00||||72.00||| 6580|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72.00||||72.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|||10.00||||10.00|3|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|||10.00||||10.00|3|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6583|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROCHLORPERAZINE MALEATE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|||10.00||||10.00|3|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|5|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6622|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROMETHAZINE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|||10.00||||10.00|3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|||10.00||||10.00|3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|||10.00||||10.00|3|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 664|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASCORBIC ACID (VITAMIN C) 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|||10.00||||10.00|3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|||10.00||||10.00|3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|||10.00||||10.00|3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|||10.00||||10.00|3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6656|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|||10.00||||10.00|3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6658|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PROPRANOLOL 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|||10.00||||10.00|3|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6714|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PSEUDOEPHEDRINE 30 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|||10.00||||10.00|3|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|||10.00||||10.00|3|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6748|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PYRIDOXINE (VITAMIN B6) 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|||10.00||||10.00|3|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 6777|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|QUINIDINE SULFATE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 679|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|||10.00||||10.00|3|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 681|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 685|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 325 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|||10.00||||10.00|3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 70284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM, SODIUM PHOSPHATES 280 MG-160 MG-250 MG ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.04||||96.04|33.71|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.04||||96.04|57.62|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.04||||96.04|57.62|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.04||||96.04|33.71|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.04||||96.04|48.12|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.04||||96.04|57.62|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.04||||96.04|40.91|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.04||||96.04|48.12|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.04||||96.04|40.91|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.04||||96.04|48.12|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.04||||96.04|40.91|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.04||||96.04|33.71|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96.04||||96.04|33.71|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.04||||96.04|20.17|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.04||||96.04|20.17|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96.04||||96.04|48.12|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.04||||96.04|20.17|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.04||||96.04|62.43|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96.04||||96.04|20.17|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.04||||96.04|62.43|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.04||||96.04|62.43|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96.04||||96.04|62.43|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|||96.04||||96.04|28.81|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.04||||96.04|46.05|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.04||||96.04|46.05|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.04||||96.04|46.05|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|||96.04||||96.04|28.81|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96.04||||96.04|46.05|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|||96.04||||96.04|28.81|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|||96.04||||96.04|28.81|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96.04||||96.04|40.91|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96.04||||96.04|57.62|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96.04||||96.04|41.3|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|96.04||||96.04|72.03|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|96.04||||96.04|72.03|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|GEHA [1415]|GEHA [141500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|GEHA [1415]|GEHA [141500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|GEHA [1415]|GEHA [141500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|GEHA [1415]|GEHA [141500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|96.04||||96.04|72.03|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|96.04||||96.04|72.03|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96.04||||96.04|86.44|86.44|20.17 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.04||||96.04||| 70306|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ARIPIPRAZOLE 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96.04||||96.04||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|||10.00||||10.00|3|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7034|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SALSALATE 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.66||||27.66|16.6|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.66||||27.66|16.6|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.66||||27.66|9.71|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.66||||27.66|11.78|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.66||||27.66|9.71|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.66||||27.66|11.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.66||||27.66|13.86|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27.66||||27.66|9.71|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.66||||27.66|11.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27.66||||27.66|11.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TRUSTMARK [2030]|STARMARK [203000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.66||||27.66|13.86|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.66||||27.66|11.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.66||||27.66|11.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27.66||||27.66|11.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHNET [1495]|HEALTHNET [149500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|IHC HS [168011]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.66||||27.66|5.81|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MULTIPLAN [1680]|HMA [168003]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AETNA [1015]|AETNA ACO WILCO [101532]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.66||||27.66|17.98|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.66||||27.66|17.98|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27.66||||27.66|17.98|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.66||||27.66|13.26|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.66||||27.66|13.26|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27.66||||27.66|13.26|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|||27.66||||27.66|8.3|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|||27.66||||27.66|8.3|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|||27.66||||27.66|8.3|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.66||||27.66|5.81|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27.66||||27.66|5.81|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27.66||||27.66|16.6|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UMR [2035]|UMR OPTIONS [203501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.66||||27.66|11.78|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27.66||||27.66|13.86|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27.66||||27.66|11.78|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|27.66||||27.66|20.75|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|GEHA [1415]|GEHA [141500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|27.66||||27.66|20.75|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CHAMPVA [1240]|CHAMP VA [124000]|27.66||||27.66|20.75|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|CORESOURCE [1315]|CORESOURCE [131500]|27.66||||27.66|24.89|24.89|5.81 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.66||||27.66||| 70434|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27.66||||27.66||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|GEHA [1415]|GEHA [141500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|GEHA [1415]|GEHA [141500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|46.57||||46.57|34.93|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|46.57||||46.57|34.93|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|||46.57||||46.57|13.97|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.57||||46.57|22.33|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|||46.57||||46.57|13.97|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.57||||46.57|30.27|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.57||||46.57|30.27|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.57||||46.57|9.78|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.57||||46.57|9.78|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.57||||46.57|20.03|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.57||||46.57|20.03|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.57||||46.57|22.33|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.57||||46.57|20.03|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.57||||46.57|23.33|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.57||||46.57|23.33|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.57||||46.57|27.94|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.57||||46.57|27.94|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.57||||46.57|41.91|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MULTIPLAN [1680]|HMA [168003]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MULTIPLAN [1680]|HMA [168003]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.57||||46.57|19.84|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.57||||46.57|16.35|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.57||||46.57|20.03|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.57||||46.57|19.84|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.57||||46.57|16.35|41.91|9.78 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.57||||46.57||| 70536|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.57||||46.57||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|||10.00||||10.00|3|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|||10.00||||10.00|3|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 717|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|||10.00||||10.00|3|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATENOLOL 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.46||||52.46|31.48|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.46||||52.46|26.28|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.46||||52.46|18.41|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.46||||52.46|18.41|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.46||||52.46|26.28|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.46||||52.46|22.56|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.46||||52.46|22.35|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.46||||52.46|22.56|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.46||||52.46|22.56|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.46||||52.46|31.48|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.46||||52.46|22.35|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.46||||52.46|11.02|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.46||||52.46|34.1|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.46||||52.46|34.1|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.46||||52.46|25.15|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.46||||52.46|25.15|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.46||||52.46|22.56|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|||52.46||||52.46|15.74|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|||52.46||||52.46|15.74|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|52.46||||52.46|39.35|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|52.46||||52.46|39.35|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.46||||52.46|47.21|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.46||||52.46|11.02|47.21|11.02 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.46||||52.46||| 7224|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SILVER SULFADIAZINE 1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.46||||52.46||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7227|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SIMETHICONE 80 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|459.00||||459.00|197.37|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|459.00||||459.00|56.05|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|459.00||||459.00|229.96|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|459.00||||459.00|161.11|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|459.00||||459.00|133.61|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|459.00||||459.00|275.4|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|459.00||||459.00|103.48|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|459.00||||459.00|57.6|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MULTIPLAN [1680]|IHC HS [168011]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|459.00||||459.00|53.41|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|UMR [2035]|UMR OPTIONS [203501]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|459.00||||459.00|96.39|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|459.00||||459.00|298.35|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|CHAMPVA [1240]|CHAMP VA [124000]|459.00||||459.00|344.25|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|GEHA [1415]|GEHA [141500]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|459.00||||459.00|107.55|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|CORESOURCE [1315]|CORESOURCE [131500]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|459.00||||459.00|75.28|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|459.00||||459.00|95.19|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|459.00||||459.00|103.48|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|||459.00||||459.00|137.7|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|459.00||||459.00|220.09|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|459.00||||459.00|459|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|459.00||||459.00|76.45|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|459.00||||459.00|54.98|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|459.00||||459.00|195.53|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|459.00||||459.00|118.31|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|459.00||||459.00|197.37|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|459.00||||459.00|75.28|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MULTIPLAN [1680]|HMA [168003]|459.00||||459.00|78.55|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|HEALTHNET [1495]|HEALTHNET [149500]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|TRUSTMARK [2030]|STARMARK [203000]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|459.00||||459.00|413.1|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|459.00||||459.00|52.36|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|459.00||||459.00|99.95|459|52.36 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|459.00||||459.00||| 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|459.00||||459.00||| 73093005|EAP|0730 - EKG/ECG (ELECTROCARDIOGRAM)-GENERAL|HC EKG ROUTINE TRACING ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|459.00||||459.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|||10.00||||10.00|3|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|||10.00||||10.00|3|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7313|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM BICARBONATE 650 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.69|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.69 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 7318|ERX|0258 - PHARMACY-IV SOLUTIONS|SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|||10.00||||10.00|3|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7325|ERX|0250 - PHARMACY-GENERAL|SODIUM CHLORIDE 0.9 % FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|||10.00||||10.00|3|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|||10.00||||10.00|3|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7328|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SODIUM CHLORIDE 1 GRAM TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|GEHA [1415]|GEHA [141500]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|120.06||||120.06|90.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|305.54||||305.54|229.16|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|||120.06||||120.06|36.02|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|||305.54||||305.54|91.66|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|305.54||||305.54|146.51|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120.06||||120.06|78.04|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|305.54||||305.54|198.6|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120.06||||120.06|25.21|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|305.54||||305.54|64.16|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120.06||||120.06|51.63|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|305.54||||305.54|131.38|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120.06||||120.06|57.57|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120.06||||120.06|51.63|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|120.06||||120.06|60.15|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120.06||||120.06|42.14|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|120.06||||120.06|51.15|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|305.54||||305.54|131.38|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|305.54||||305.54|153.08|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|305.54||||305.54|107.24|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|305.54||||305.54|130.16|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120.06||||120.06|72.04|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|305.54||||305.54|183.32|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|GEHA [1415]|GEHA [141500]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120.06||||120.06|108.05|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|305.54||||305.54|274.99|274.99|25.21 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|305.54||||305.54||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120.06||||120.06||| 736|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ATROPINE 1 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|305.54||||305.54||| 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1770.00||||1770.00|265.01|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1770.00||||1770.00|761.1|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1770.00||||1770.00|886.77|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1770.00||||1770.00|621.27|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1770.00||||1770.00|754.02|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1770.00||||1770.00|603.08|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1770.00||||1770.00|1062|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1770.00||||1770.00|252.97|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1770.00||||1770.00|213.8|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1770.00||||1770.00|206.49|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|TRUSTMARK [2030]|STARMARK [203000]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MULTIPLAN [1680]|IHC HS [168011]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1770.00||||1770.00|346.35|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MULTIPLAN [1680]|HMA [168003]|1770.00||||1770.00|361.38|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|HEALTHNET [1495]|HEALTHNET [149500]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|FMH BENEFIT SERVICES [1390]|FMH [139000]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|FIRST HEALTH [1375]|QUALCHOICE [137513]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1770.00||||1770.00|761.1|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1770.00||||1770.00|244.44|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1770.00||||1770.00|245.74|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|UMR [2035]|UMR OPTIONS [203501]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1770.00||||1770.00|351.74|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1770.00||||1770.00|265.01|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1770.00||||1770.00|371.7|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1770.00||||1770.00|1770|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1770.00||||1770.00|1150.5|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1770.00||||1770.00|848.72|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|||1770.00||||1770.00|531|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1770.00||||1770.00|213.8|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1770.00||||1770.00|240.92|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1770.00||||1770.00|196.65|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|CHAMPVA [1240]|CHAMP VA [124000]|1770.00||||1770.00|1327.5|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1770.00||||1770.00|346.35|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|CORESOURCE [1315]|CORESOURCE [131500]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|GEHA [1415]|GEHA [141500]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1770.00||||1770.00|1593|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1770.00||||1770.00|222.22|1770|196.65 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|AETNA [1015]|AETNA ACO WILCO [101532]|1770.00||||1770.00||| 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1770.00||||1770.00||| 74095812|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG MONITOR 41-60 MINUTES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1770.00||||1770.00||| 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|GEHA [1415]|GEHA [141500]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|CORESOURCE [1315]|CORESOURCE [131500]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|CHAMPVA [1240]|CHAMP VA [124000]|1949.00||||1949.00|1461.75|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1949.00||||1949.00|196.65|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1949.00||||1949.00|213.8|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|||1949.00||||1949.00|584.7|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1949.00||||1949.00|1266.85|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1949.00||||1949.00|409.29|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|UMR [2035]|UMR OPTIONS [203501]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1949.00||||1949.00|245.74|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1949.00||||1949.00|244.44|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1949.00||||1949.00|838.07|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|FIRST HEALTH [1375]|QUALCHOICE [137513]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|FMH BENEFIT SERVICES [1390]|FMH [139000]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1949.00||||1949.00|351.74|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|HEALTHNET [1495]|HEALTHNET [149500]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MULTIPLAN [1680]|IHC HS [168011]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1949.00||||1949.00|1949|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1949.00||||1949.00|346.35|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MULTIPLAN [1680]|HMA [168003]|1949.00||||1949.00|361.38|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1949.00||||1949.00|934.55|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|TRUSTMARK [2030]|STARMARK [203000]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1949.00||||1949.00|346.35|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1949.00||||1949.00|206.49|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1949.00||||1949.00|265.01|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1949.00||||1949.00|213.8|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1949.00||||1949.00|222.22|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1949.00||||1949.00|252.97|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1949.00||||1949.00|1169.4|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1949.00||||1949.00|603.08|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1949.00||||1949.00|838.07|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1949.00||||1949.00|976.45|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1949.00||||1949.00|684.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1949.00||||1949.00|830.27|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1949.00||||1949.00|265.01|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1949.00||||1949.00|240.92|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1949.00||||1949.00|1754.1|1949|196.65 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1949.00||||1949.00||| 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|AETNA [1015]|AETNA ACO WILCO [101532]|1949.00||||1949.00||| 74095813|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG > 1 HOUR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1949.00||||1949.00||| 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2313.00||||2313.00|265.01|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2313.00||||2313.00|1158.81|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2313.00||||2313.00|811.86|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2313.00||||2313.00|985.34|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2313.00||||2313.00|603.08|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2313.00||||2313.00|1387.8|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2313.00||||2313.00|252.97|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2313.00||||2313.00|265.01|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2313.00||||2313.00|206.49|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|TRUSTMARK [2030]|STARMARK [203000]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MULTIPLAN [1680]|IHC HS [168011]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2313.00||||2313.00|346.35|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|HEALTHNET [1495]|HEALTHNET [149500]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|FMH BENEFIT SERVICES [1390]|FMH [139000]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|FIRST HEALTH [1375]|QUALCHOICE [137513]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MULTIPLAN [1680]|HMA [168003]|2313.00||||2313.00|361.38|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2313.00||||2313.00|994.59|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2313.00||||2313.00|244.44|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2313.00||||2313.00|245.74|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|UMR [2035]|UMR OPTIONS [203501]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2313.00||||2313.00|351.74|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2313.00||||2313.00|485.73|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2313.00||||2313.00|2313|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2313.00||||2313.00|1503.45|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2313.00||||2313.00|1109.08|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2313.00||||2313.00|213.8|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|||2313.00||||2313.00|693.9|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2313.00||||2313.00|994.59|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2313.00||||2313.00|213.8|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2313.00||||2313.00|240.92|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2313.00||||2313.00|196.65|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|CHAMPVA [1240]|CHAMP VA [124000]|2313.00||||2313.00|1734.75|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2313.00||||2313.00|346.35|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|CORESOURCE [1315]|CORESOURCE [131500]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|GEHA [1415]|GEHA [141500]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2313.00||||2313.00|2081.7|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2313.00||||2313.00|222.22|2313|196.65 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2313.00||||2313.00||| 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|AETNA [1015]|AETNA ACO WILCO [101532]|2313.00||||2313.00||| 74095816|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/DROWSY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2313.00||||2313.00||| 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2655.00||||2655.00|222.22|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|GEHA [1415]|GEHA [141500]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|CORESOURCE [1315]|CORESOURCE [131500]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2655.00||||2655.00|346.35|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|CHAMPVA [1240]|CHAMP VA [124000]|2655.00||||2655.00|1991.25|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2655.00||||2655.00|196.65|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2655.00||||2655.00|213.8|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|||2655.00||||2655.00|796.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2655.00||||2655.00|1273.07|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2655.00||||2655.00|1725.75|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2655.00||||2655.00|2655|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2655.00||||2655.00|557.55|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2655.00||||2655.00|351.74|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|UMR [2035]|UMR OPTIONS [203501]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2655.00||||2655.00|245.74|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2655.00||||2655.00|244.44|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2655.00||||2655.00|1141.65|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|FIRST HEALTH [1375]|QUALCHOICE [137513]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|FMH BENEFIT SERVICES [1390]|FMH [139000]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|HEALTHNET [1495]|HEALTHNET [149500]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MULTIPLAN [1680]|IHC HS [168011]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2655.00||||2655.00|346.35|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MULTIPLAN [1680]|HMA [168003]|2655.00||||2655.00|361.38|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|TRUSTMARK [2030]|STARMARK [203000]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2655.00||||2655.00|206.49|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2655.00||||2655.00|265.01|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2655.00||||2655.00|213.8|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2655.00||||2655.00|252.97|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2655.00||||2655.00|1593|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2655.00||||2655.00|603.08|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2655.00||||2655.00|1141.65|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2655.00||||2655.00|1330.16|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2655.00||||2655.00|931.91|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2655.00||||2655.00|1131.03|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2655.00||||2655.00|265.01|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2655.00||||2655.00|240.92|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2655.00||||2655.00|2389.5|2655|196.65 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|AETNA [1015]|AETNA ACO WILCO [101532]|2655.00||||2655.00||| 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2655.00||||2655.00||| 74095819|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG AWAKE/ASLEEP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2655.00||||2655.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2157.00||||2157.00|927.51|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2157.00||||2157.00|1080.66|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2157.00||||2157.00|757.11|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2157.00||||2157.00|918.88|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2157.00||||2157.00|603.08|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2157.00||||2157.00|213.8|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2157.00||||2157.00|206.49|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|TRUSTMARK [2030]|STARMARK [203000]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|HEALTHNET [1495]|HEALTHNET [149500]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|FMH BENEFIT SERVICES [1390]|FMH [139000]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MULTIPLAN [1680]|IHC HS [168011]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|FIRST HEALTH [1375]|QUALCHOICE [137513]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2157.00||||2157.00|927.51|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2157.00||||2157.00|244.44|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|UMR [2035]|UMR OPTIONS [203501]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2157.00||||2157.00|452.97|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2157.00||||2157.00|2157|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2157.00||||2157.00|1294.2|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2157.00||||2157.00|1402.05|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2157.00||||2157.00|1034.28|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|||2157.00||||2157.00|647.1|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2157.00||||2157.00|213.8|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2157.00||||2157.00|196.65|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|CHAMPVA [1240]|CHAMP VA [124000]|2157.00||||2157.00|1617.75|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|CORESOURCE [1315]|CORESOURCE [131500]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|GEHA [1415]|GEHA [141500]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2157.00||||2157.00|1941.3|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2157.00||||2157.00|222.22|2157|196.65 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|AETNA [1015]|AETNA ACO WILCO [101532]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MULTIPLAN [1680]|HMA [168003]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2157.00||||2157.00||| 74095822|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG SLEEP ONLY|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2157.00||||2157.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|GEHA [1415]|GEHA [141500]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|CORESOURCE [1315]|CORESOURCE [131500]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|CHAMPVA [1240]|CHAMP VA [124000]|1331.00||||1331.00|998.25|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1331.00||||1331.00|219.47|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|||1331.00||||1331.00|399.3|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1331.00||||1331.00|865.15|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1331.00||||1331.00|279.51|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|UMR [2035]|UMR OPTIONS [203501]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1331.00||||1331.00|272.79|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1331.00||||1331.00|572.33|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|HEALTHNET [1495]|HEALTHNET [149500]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MULTIPLAN [1680]|IHC HS [168011]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1331.00||||1331.00|1331|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1331.00||||1331.00|638.21|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1331.00||||1331.00|238.6|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|TRUSTMARK [2030]|STARMARK [203000]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1331.00||||1331.00|230.45|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1331.00||||1331.00|238.6|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1331.00||||1331.00|798.6|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1331.00||||1331.00|1088.21|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1331.00||||1331.00|247.99|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1331.00||||1331.00|572.33|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1331.00||||1331.00|666.83|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1331.00||||1331.00|467.18|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1331.00||||1331.00|567.01|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1331.00||||1331.00|1197.9|1331|219.47 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MULTIPLAN [1680]|HMA [168003]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|AETNA [1015]|AETNA ACO WILCO [101532]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1331.00||||1331.00||| 74095824|EAP|0740 - EEG (ELECTROENCEPHALOGRAM)-GENERAL|HC EEG DEATH DETERMINATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1331.00||||1331.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|||10.00||||10.00|3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|||10.00||||10.00|3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|||10.00||||10.00|3|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7437|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SPIRONOLACTONE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|25.00||||25.00|18.75|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|||25.00||||25.00|7.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|||25.00||||25.00|7.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.00||||25.00|16.25|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.00||||25.00|5.25|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UMR [2035]|UMR OPTIONS [203501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|10.75|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.00||||25.00|10.75|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.00||||25.00|11.99|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.00||||25.00|15|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|10.75|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.00||||25.00|10.75|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.00||||25.00|12.53|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.00||||25.00|8.78|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.00||||25.00|10.65|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|GEHA [1415]|GEHA [141500]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MULTIPLAN [1680]|HMA [168003]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.00||||25.00|22.5|22.5|5.25 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 7485|ERX|0250 - PHARMACY-GENERAL|WATER FOR IRRIGATION, STERILE SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.00||||25.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|||10.00||||10.00|3|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7562|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SULFASALAZINE 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|58.03||||58.03|43.52|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|||58.03||||58.03|17.41|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.03||||58.03|27.83|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.03||||58.03|37.72|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.03||||58.03|12.19|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|UMR [2035]|UMR OPTIONS [203501]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.03||||58.03|24.95|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.03||||58.03|34.82|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|GEHA [1415]|GEHA [141500]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.03||||58.03|24.95|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.03||||58.03|29.07|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.03||||58.03|20.37|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.03||||58.03|24.72|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.03||||58.03|52.23|52.23|12.19 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MULTIPLAN [1680]|HMA [168003]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.03||||58.03||| 76720|ERX|0250 - PHARMACY-GENERAL|SODIUM HYPOCHLORITE 0.125 % SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.03||||58.03||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|||10.00||||10.00|3|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76824|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|||10.00||||10.00|3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|||10.00||||10.00|3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|||10.00||||10.00|3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76950|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|||10.00||||10.00|3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|||10.00||||10.00|3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|||10.00||||10.00|3|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 76978|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 600 MG (1,500 MG)-VITAMIN D3 400 UNIT TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|CORESOURCE [1315]|CORESOURCE [131500]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|47.00||||47.00|35.19|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|CHAMPVA [1240]|CHAMP VA [124000]|47.00||||47.00|35.25|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47.00||||47.00|31.15|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47.00||||47.00|33.86|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|||47.00||||47.00|14.1|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47.00||||47.00|30.55|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47.00||||47.00|22.54|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47.00||||47.00|9.87|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47.00||||47.00|47|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|UMR [2035]|UMR OPTIONS [203501]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47.00||||47.00|37|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|47.00||||47.00|38.72|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47.00||||47.00|20.21|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MULTIPLAN [1680]|IHC HS [168011]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|47.00||||47.00|47|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MULTIPLAN [1680]|HMA [168003]|47.00||||47.00|86.33|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|HEALTHNET [1495]|HEALTHNET [149500]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|TRUSTMARK [2030]|STARMARK [203000]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47.00||||47.00|47|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47.00||||47.00|57.56|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47.00||||47.00|32.71|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|47.00||||47.00|47|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47.00||||47.00|39.9|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47.00||||47.00|33.86|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|GEHA [1415]|GEHA [141500]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47.00||||47.00|28.2|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47.00||||47.00|38.09|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47.00||||47.00|20.21|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|47.00||||47.00|23.55|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|47.00||||47.00|20.02|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47.00||||47.00|16.5|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47.00||||47.00|47|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47.00||||47.00|36.28|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47.00||||47.00|42.3|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47.00||||47.00|39.9|86.33|9.87 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|47.00||||47.00||| 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|AETNA [1015]|AETNA ACO WILCO [101532]|47.00||||47.00||| 77100008|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ INFLUENZA VACCINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|47.00||||47.00||| 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|158.00||||158.00|67.31|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158.00||||158.00|38.09|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158.00||||158.00|94.8|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158.00||||158.00|33.86|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158.00||||158.00|39.9|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158.00||||158.00|32.71|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158.00||||158.00|57.56|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|HEALTHNET [1495]|HEALTHNET [149500]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MULTIPLAN [1680]|IHC HS [168011]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|158.00||||158.00|52.15|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MULTIPLAN [1680]|HMA [168003]|158.00||||158.00|86.33|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|FIRST HEALTH [1375]|QUALCHOICE [137513]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|FMH BENEFIT SERVICES [1390]|FMH [139000]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158.00||||158.00|67.94|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|158.00||||158.00|38.72|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158.00||||158.00|37|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|UMR [2035]|UMR OPTIONS [203501]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158.00||||158.00|52.96|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158.00||||158.00|33.18|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158.00||||158.00|158|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|TRUSTMARK [2030]|STARMARK [203000]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.00||||158.00|75.76|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158.00||||158.00|102.7|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|||158.00||||158.00|47.4|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158.00||||158.00|33.86|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158.00||||158.00|55.46|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158.00||||158.00|31.15|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|CHAMPVA [1240]|CHAMP VA [124000]|158.00||||158.00|118.5|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|158.00||||158.00|52.15|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|158.00||||158.00|35.19|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|CORESOURCE [1315]|CORESOURCE [131500]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|GEHA [1415]|GEHA [141500]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158.00||||158.00|39.9|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158.00||||158.00|67.94|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158.00||||158.00|36.28|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|158.00||||158.00|79.16|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158.00||||158.00|142.2|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158.00||||158.00|142.82|158|31.15 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158.00||||158.00||| 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|AETNA [1015]|AETNA ACO WILCO [101532]|158.00||||158.00||| 77100009|EAP|0771 - PREVENTIVE CARE SERVICES-VACCINE ADMINISTRA|HC INJ PNEUMOCOCCAL VACCINE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|158.00||||158.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|||10.00||||10.00|3|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7711|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMOXIFEN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|||10.00||||10.00|3|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7753|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TEMAZEPAM 15 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|519.86||||519.86|389.9|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|||519.86||||519.86|155.96|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|519.86||||519.86|125.08|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|519.86||||519.86|148.63|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|519.86||||519.86|337.91|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|519.86||||519.86|130.96|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|519.86||||519.86|143|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|519.86||||519.86|109.17|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|519.86||||519.86|137.52|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|519.86||||519.86|223.54|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|519.86||||519.86|181.95|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|519.86||||519.86|182.47|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|519.86||||519.86|163.18|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|519.86||||519.86|223.54|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|519.86||||519.86|260.45|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|519.86||||519.86|143|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|519.86||||519.86|311.92|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|519.86||||519.86|221.46|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|519.86||||519.86|249.27|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|519.86||||519.86|467.87|467.87|109.17 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|519.86||||519.86||| 77685|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MICAFUNGIN 100 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|519.86||||519.86||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.85||||22.85|14.85|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.85||||22.85|4.8|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.85||||22.85|10.96|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.85||||22.85|14.85|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.85||||22.85|8.02|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|||22.85||||22.85|6.85|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|GEHA [1415]|GEHA [141500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|22.85||||22.85|17.14|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|||22.85||||22.85|6.85|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.85||||22.85|10.96|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|22.85||||22.85|17.14|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22.85||||22.85|11.45|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22.85||||22.85|11.45|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.85||||22.85|13.71|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22.85||||22.85|8.02|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.85||||22.85|9.83|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22.85||||22.85|9.73|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22.85||||22.85|9.73|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22.85||||22.85|4.8|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22.85||||22.85|9.83|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22.85||||22.85|13.71|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.85||||22.85|9.83|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.85||||22.85|9.83|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|22.85||||22.85|20.57|20.57|4.8 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.85||||22.85||| 77725|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.85||||22.85||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7796|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRACYCLINE 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|||10.00||||10.00|3|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 7800|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TETRAHYDROZOLINE 0.05 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|||10.00||||10.00|3|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 78003|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CODEINE 10 MG-GUAIFENESIN 100 MG/5 ML ORAL LIQUID|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95.00||||95.00|29.32|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95.00||||95.00|37.46|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|CORESOURCE [1315]|CORESOURCE [131500]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95.00||||95.00|40.85|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95.00||||95.00|32.76|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95.00||||95.00|27.98|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95.00||||95.00|38.31|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|CHAMPVA [1240]|CHAMP VA [124000]|95.00||||95.00|71.25|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|FIRST HEALTH [1375]|QUALCHOICE [137513]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95.00||||95.00|19.95|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.00||||95.00|57|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|||95.00||||95.00|28.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95.00||||95.00|33.35|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95.00||||95.00|32.76|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95.00||||95.00|30.13|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95.00||||95.00|34.05|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95.00||||95.00|45.55|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95.00||||95.00|38.31|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|FMH BENEFIT SERVICES [1390]|FMH [139000]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|TRUSTMARK [2030]|STARMARK [203000]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|GEHA [1415]|GEHA [141500]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95.00||||95.00|61.75|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95.00||||95.00|47.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95.00||||95.00|40.47|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95.00||||95.00|27.18|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95.00||||95.00|40.85|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95.00||||95.00|31.64|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95.00||||95.00|95|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|HEALTHNET [1495]|HEALTHNET [149500]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95.00||||95.00|47.6|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95.00||||95.00|38.91|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95.00||||95.00|26.65|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95.00||||95.00|29.32|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MULTIPLAN [1680]|IHC HS [168011]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|UMR [2035]|UMR OPTIONS [203501]|95.00||||95.00|85.5|95|19.95 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95.00||||95.00||| 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|AETNA [1015]|AETNA ACO WILCO [101532]|95.00||||95.00||| 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95.00||||95.00||| 78003014|EAP|0780 - TELEMEDICINE-GENERAL|HC TELEHEALTH FACILITY FEE|MULTIPLAN [1680]|HMA [168003]|95.00||||95.00||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.24||||52.24|22.46|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.24||||52.24|33.96|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.24||||52.24|10.97|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|52.24||||52.24|39.18|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.24||||52.24|22.46|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|||52.24||||52.24|15.67|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.24||||52.24|25.05|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.24||||52.24|18.34|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.24||||52.24|31.34|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.24||||52.24|5.36|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|52.24||||52.24|18.28|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.24||||52.24|22.25|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|52.24||||52.24|47.02|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.24||||52.24|26.17|47.02|5.36 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.24||||52.24||| 7876|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.24||||52.24||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|FIRST HEALTH [1375]|QUALCHOICE [137513]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6252.00||||6252.00|2663.35|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|TRUSTMARK [2030]|STARMARK [203000]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6252.00||||6252.00|2688.36|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6252.00||||6252.00|3132.25|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6252.00||||6252.00|3751.2|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|HEALTHNET [1495]|HEALTHNET [149500]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MULTIPLAN [1680]|IHC HS [168011]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|UMR [2035]|UMR OPTIONS [203501]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6252.00||||6252.00|4063.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6252.00||||6252.00|1312.92|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6252.00||||6252.00|6252|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|CORESOURCE [1315]|CORESOURCE [131500]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|GEHA [1415]|GEHA [141500]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|||6252.00||||6252.00|1875.6|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6252.00||||6252.00|2997.83|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|CHAMPVA [1240]|CHAMP VA [124000]|6252.00||||6252.00|4689|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6252.00||||6252.00|5626.8|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6252.00||||6252.00|2194.45|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6252.00||||6252.00|2688.36|6252|1312.92 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|AETNA [1015]|AETNA ACO WILCO [101532]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MULTIPLAN [1680]|HMA [168003]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6252.00||||6252.00||| 80100006|EAP|0801 - INPATIENT RENAL DIALYSIS-INPATIENT HEMODIAL|HC HEMODIALYSIS ACUTE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6252.00||||6252.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|CORESOURCE [1315]|CORESOURCE [131500]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|GEHA [1415]|GEHA [141500]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2048.00||||2048.00|1331.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2048.00||||2048.00|982.02|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|UMR [2035]|UMR OPTIONS [203501]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2048.00||||2048.00|880.64|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2048.00||||2048.00|430.08|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|||2048.00||||2048.00|614.4|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|HEALTHNET [1495]|HEALTHNET [149500]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|TRUSTMARK [2030]|STARMARK [203000]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MULTIPLAN [1680]|IHC HS [168011]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2048.00||||2048.00|2048|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2048.00||||2048.00|1026.05|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2048.00||||2048.00|872.45|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|CHAMPVA [1240]|CHAMP VA [124000]|2048.00||||2048.00|1536|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2048.00||||2048.00|718.85|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2048.00||||2048.00|880.64|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2048.00||||2048.00|1843.2|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2048.00||||2048.00|1228.8|2048|430.08 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|AETNA [1015]|AETNA ACO WILCO [101532]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MULTIPLAN [1680]|HMA [168003]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2048.00||||2048.00||| 80400002|EAP|0804 - INPATIENT RENAL DIALYSIS-INPATIENT CONTINUO|HC CCPD TREATMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2048.00||||2048.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|||10.00||||10.00|3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8085|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRAZODONE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|19.67||||19.67|14.75|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.67||||19.67|12.79|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19.67||||19.67|12.79|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|||19.67||||19.67|5.9|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.67||||19.67|4.13|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19.67||||19.67|4.13|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|||19.67||||19.67|5.9|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.67||||19.67|9.43|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.67||||19.67|8.46|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19.67||||19.67|8.46|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|19.67||||19.67|14.75|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.67||||19.67|11.8|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.67||||19.67|8.38|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19.67||||19.67|8.38|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19.67||||19.67|9.43|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.67||||19.67|6.9|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.67||||19.67|8.46|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.67||||19.67|9.85|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19.67||||19.67|6.9|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19.67||||19.67|8.46|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19.67||||19.67|11.8|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19.67||||19.67|9.85|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19.67||||19.67|17.7|17.7|4.13 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19.67||||19.67||| 8113|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19.67||||19.67||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|||10.00||||10.00|3|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8132|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.52||||10.52|7.89|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|||10.52||||10.52|3.16|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.52||||10.52|5.04|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.52||||10.52|6.84|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.52||||10.52|6.84|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.52||||10.52|7.89|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.52||||10.52|2.21|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.52||||10.52|4.52|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.52||||10.52|4.52|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.52||||10.52|2.21|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.52||||10.52|5.04|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|||10.52||||10.52|3.16|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.52||||10.52|6.31|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.52||||10.52|6.31|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.52||||10.52|4.52|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.52||||10.52|5.27|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.52||||10.52|3.69|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.52||||10.52|4.48|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.52||||10.52|4.52|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.52||||10.52|5.27|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.52||||10.52|3.69|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.52||||10.52|4.48|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.52||||10.52|9.47|9.47|2.21 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.52||||10.52||| 81426|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.52||||10.52||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|||10.00||||10.00|3|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|||10.00||||10.00|3|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8166|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TRIHEXYPHENIDYL 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|44.87||||44.87|33.65|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|||44.87||||44.87|13.46|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44.87||||44.87|21.52|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44.87||||44.87|19.29|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44.87||||44.87|26.92|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44.87||||44.87|19.29|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44.87||||44.87|22.48|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44.87||||44.87|15.75|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44.87||||44.87|19.11|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44.87||||44.87|9.42|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44.87||||44.87|29.17|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44.87||||44.87|40.38|40.38|9.42 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44.87||||44.87||| 8259|ERX|0250 - PHARMACY-GENERAL|TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44.87||||44.87||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8429|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VALPROIC ACID 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|63.60||||63.60|47.7|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.87|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.87|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|GEHA [1415]|GEHA [141500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|||63.60||||63.60|19.08|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|||63.60||||63.60|19.08|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|||63.60||||63.60|19.08|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR [2035]|UMR OPTIONS [203501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63.60||||63.60|13.36|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|||63.60||||63.60|19.08|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63.60||||63.60|30.5|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63.60||||63.60|41.34|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63.60||||63.60|38.16|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUSTMARK [2030]|STARMARK [203000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63.60||||63.60|27.35|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63.60||||63.60|31.86|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63.60||||63.60|22.32|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63.60||||63.60|27.09|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.87|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63.60||||63.60|5.87|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|HMA [168003]|63.60||||63.60|22.26|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|IHC HS [168011]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|63.60||||63.60|57.24|57.24|5.87 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 8442|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63.60||||63.60||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21|2.94|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21|2.94|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21|2.94|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42.21||||42.21|2.94|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|42.21||||42.21|31.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42.21||||42.21|21.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42.21||||42.21|17.98|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42.21||||42.21|25.33|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21|14.77|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21|14.77|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21|14.77|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|42.21||||42.21|14.77|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42.21||||42.21|18.15|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42.21||||42.21|8.86|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42.21||||42.21|27.44|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42.21||||42.21|14.82|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42.21||||42.21|20.24|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|||42.21||||42.21|12.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|||42.21||||42.21|12.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|||42.21||||42.21|12.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|||42.21||||42.21|12.66|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42.21||||42.21|37.99|37.99|2.94 8443|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42.21||||42.21||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|269.51||||269.51|202.13|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|269.51||||269.51|29.36|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|||269.51||||269.51|80.85|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|||269.51||||269.51|80.85|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|269.51||||269.51|129.23|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|269.51||||269.51|129.23|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|269.51||||269.51|175.18|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|269.51||||269.51|175.18|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|269.51||||269.51|56.6|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|269.51||||269.51|115.89|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|269.51||||269.51|115.89|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|269.51||||269.51|94.33|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|269.51||||269.51|94.33|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|269.51||||269.51|56.6|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|269.51||||269.51|161.71|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|269.51||||269.51|161.71|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|269.51||||269.51|115.89|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|269.51||||269.51|135.02|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|269.51||||269.51|29.36|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|269.51||||269.51|94.6|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|269.51||||269.51|114.81|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|269.51||||269.51|115.89|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|269.51||||269.51|135.02|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|269.51||||269.51|202.13|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|269.51||||269.51|94.6|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|269.51||||269.51|114.81|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|269.51||||269.51|242.56|242.56|29.36 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|269.51||||269.51||| 8444|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|269.51||||269.51||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|270.44||||270.44|116.29|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|270.44||||270.44|94.92|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|270.44||||270.44|115.21|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|270.44||||270.44|162.26|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|270.44||||270.44|116.29|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|UMR [2035]|UMR OPTIONS [203501]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|270.44||||270.44|56.79|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|270.44||||270.44|175.79|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|270.44||||270.44|129.68|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|||270.44||||270.44|81.13|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|270.44||||270.44|135.49|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|270.44||||270.44|202.83|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|GEHA [1415]|GEHA [141500]|270.44||||270.44|243.4|243.4|56.79 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MULTIPLAN [1680]|HMA [168003]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|270.44||||270.44||| 852|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACITRACIN 500 UNIT/GRAM EYE OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|270.44||||270.44||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|||10.00||||10.00|3|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8530|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL 80 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|||10.00||||10.00|3|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|||10.00||||10.00|3|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 860|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|||10.00||||10.00|3|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 861|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BACLOFEN 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|11.28||||11.28|5.65|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|11.28||||11.28|3.96|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|11.28||||11.28|4.81|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|11.28||||11.28|4.85|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|11.28||||11.28|2.37|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|11.28||||11.28|6.77|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|11.28||||11.28|4.85|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|11.28||||11.28|7.33|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|11.28||||11.28|5.41|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|||11.28||||11.28|3.38|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|11.28||||11.28|8.46|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|11.28||||11.28|10.15|10.15|2.37 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|11.28||||11.28||| 8723|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VITAMINS A AND D-WHITE PETROLATUM-LANOLIN TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|11.28||||11.28||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|||10.00||||10.00|3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|||10.00||||10.00|3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|||10.00||||10.00|3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8749|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|||10.00||||10.00|3|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8750|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|||10.00||||10.00|3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|||10.00||||10.00|3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|||10.00||||10.00|3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8751|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|||10.00||||10.00|3|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8752|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|WARFARIN 7.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|||10.00||||10.00|3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|||10.00||||10.00|3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|||10.00||||10.00|3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|||10.00||||10.00|3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 87911|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|POTASSIUM BICARBONATE-CITRIC ACID 10 MEQ EFFERVESCENT TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20.63||||20.63|8.87|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20.63||||20.63|7.24|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|20.63||||20.63|8.79|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20.63||||20.63|12.38|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|TRUSTMARK [2030]|STARMARK [203000]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MULTIPLAN [1680]|IHC HS [168011]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20.63||||20.63|8.87|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|UMR [2035]|UMR OPTIONS [203501]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20.63||||20.63|4.33|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20.63||||20.63|13.41|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|20.63||||20.63|10.34|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20.63||||20.63|9.89|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|||20.63||||20.63|6.19|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|20.63||||20.63|15.47|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|GEHA [1415]|GEHA [141500]|20.63||||20.63|18.57|18.57|4.33 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MULTIPLAN [1680]|HMA [168003]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20.63||||20.63||| 88029|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|VERAPAMIL ER (PM) 100 MG CAPSULE 24HR PELLET CT,EXT.RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|20.63||||20.63||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|57.18||||57.18|42.89|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CHAMPVA [1240]|CHAMP VA [124000]|57.18||||57.18|42.89|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CORESOURCE [1315]|CORESOURCE [131500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|||57.18||||57.18|17.15|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|||57.18||||57.18|17.15|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.18||||57.18|27.42|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.18||||57.18|27.42|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.18||||57.18|37.17|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.18||||57.18|12.01|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UMR [2035]|UMR OPTIONS [203501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.18||||57.18|24.59|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.18||||57.18|24.59|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HEALTHNET [1495]|HEALTHNET [149500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|IHC HS [168011]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.18||||57.18|12.01|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|TRUSTMARK [2030]|STARMARK [203000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.18||||57.18|37.17|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.18||||57.18|34.31|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.18||||57.18|34.31|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.18||||57.18|24.59|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.18||||57.18|28.65|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.18||||57.18|20.07|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.18||||57.18|24.36|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.18||||57.18|24.59|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.18||||57.18|28.65|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.18||||57.18|20.07|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|GEHA [1415]|GEHA [141500]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.18||||57.18|24.36|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MULTIPLAN [1680]|HMA [168003]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA [1015]|AETNA ACO WILCO [101532]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.18||||57.18|51.46|51.46|12.01 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.18||||57.18||| 88225|ERX|0250 - PHARMACY-GENERAL|FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.18||||57.18||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.70||||29.70|12.77|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.70||||29.70|12.77|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.70||||29.70|6.24|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.70||||29.70|6.24|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.70||||29.70|19.31|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.70||||29.70|19.31|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.70||||29.70|14.24|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.70||||29.70|14.24|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|||29.70||||29.70|8.91|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|||29.70||||29.70|8.91|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|29.70||||29.70|22.28|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|29.70||||29.70|22.28|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|GEHA [1415]|GEHA [141500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|GEHA [1415]|GEHA [141500]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.70||||29.70|17.82|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.70||||29.70|12.77|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.70||||29.70|14.88|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.70||||29.70|10.42|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.70||||29.70|12.65|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.70||||29.70|12.77|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.70||||29.70|12.65|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.70||||29.70|17.82|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.70||||29.70|14.88|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.70||||29.70|26.73|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.70||||29.70|10.42|26.73|6.24 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.70||||29.70||| 88567|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRAMIPEXOLE 0.75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.70||||29.70||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.95||||58.95|12.38|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|||58.95||||58.95|17.68|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.95||||58.95|12.38|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.95||||58.95|25.35|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|GEHA [1415]|GEHA [141500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.95||||58.95|25.35|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.95||||58.95|28.27|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|58.95||||58.95|44.21|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|GEHA [1415]|GEHA [141500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.95||||58.95|25.35|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.95||||58.95|35.37|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.95||||58.95|25.35|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.95||||58.95|29.53|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.95||||58.95|20.69|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.95||||58.95|35.37|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.95||||58.95|25.11|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.95||||58.95|20.69|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.95||||58.95|38.32|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.95||||58.95|29.53|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58.95||||58.95|25.35|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58.95||||58.95|29.53|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.95||||58.95|28.27|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.95||||58.95|38.32|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|GEHA [1415]|GEHA [141500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58.95||||58.95|25.35|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|||58.95||||58.95|17.68|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|||58.95||||58.95|17.68|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|58.95||||58.95|44.21|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58.95||||58.95|28.27|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58.95||||58.95|20.69|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58.95||||58.95|38.32|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.95||||58.95|25.11|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58.95||||58.95|35.37|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|58.95||||58.95|44.21|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58.95||||58.95|25.11|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58.95||||58.95|12.38|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58.95||||58.95|53.06|53.06|12.38 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58.95||||58.95||| 88704|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|OSELTAMIVIR 30 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58.95||||58.95||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.59||||16.59|7.13|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113.96||||113.96|68.38|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113.96||||113.96|48.55|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.59||||16.59|5.82|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113.96||||113.96|49|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|||16.59||||16.59|4.98|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113.96||||113.96|49|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.59||||16.59|7.13|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113.96||||113.96|23.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.59||||16.59|3.48|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113.96||||113.96|74.07|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.59||||16.59|10.78|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|16.59||||16.59|12.44|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113.96||||113.96|57.09|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113.96||||113.96|40|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.59||||16.59|7.95|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.59||||16.59|9.95|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113.96||||113.96|54.64|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|113.96||||113.96|85.47|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113.96||||113.96||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.59||||16.59|7.07|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|||113.96||||113.96|34.19|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113.96||||113.96|102.56|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.59||||16.59|8.31|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.59||||16.59|14.93|102.56|3.48 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.59||||16.59||| 8874|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC OXIDE 20 % TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113.96||||113.96||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|||10.00||||10.00|3|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|||10.00||||10.00|3|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8880|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ZINC SULFATE 220 MG (50 MG) CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.17||||25.17|8.83|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.17||||25.17|8.83|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.17||||25.17|12.61|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.17||||25.17|10.72|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.17||||25.17|8.83|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.17||||25.17|15.1|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.17||||25.17|10.72|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.17||||25.17|15.1|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.17||||25.17|15.1|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.17||||25.17|10.72|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.17||||25.17|10.72|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.17||||25.17|8.83|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.17||||25.17|12.61|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.17||||25.17|15.1|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.17||||25.17|12.61|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|HMA [168003]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|HMA [168003]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|HMA [168003]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|HMA [168003]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.17||||25.17|5.29|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.17||||25.17|5.29|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.17||||25.17|5.29|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.17||||25.17|12.07|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.17||||25.17|5.29|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25.17||||25.17|5.29|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.17||||25.17|16.36|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.17||||25.17|16.36|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.17||||25.17|16.36|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.17||||25.17|12.07|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.17||||25.17|12.07|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.17||||25.17|12.07|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.17||||25.17|12.07|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.17||||25.17|12.61|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25.17||||25.17|10.72|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|||25.17||||25.17|7.55|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.17||||25.17|18.88|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|||25.17||||25.17|7.55|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25.17||||25.17|12.61|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MULTIPLAN [1680]|HMA [168003]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25.17||||25.17|8.83|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|||25.17||||25.17|7.55|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.17||||25.17|15.1|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|||25.17||||25.17|7.55|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.17||||25.17|16.36|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|GEHA [1415]|GEHA [141500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.17||||25.17|18.88|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|GEHA [1415]|GEHA [141500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.17||||25.17|18.88|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|GEHA [1415]|GEHA [141500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.17||||25.17|18.88|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|GEHA [1415]|GEHA [141500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25.17||||25.17|16.36|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|GEHA [1415]|GEHA [141500]|25.17||||25.17|22.65|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.17||||25.17|10.82|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|||25.17||||25.17|7.55|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|25.17||||25.17|18.88|22.65|5.29 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25.17||||25.17||| 89201|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 800 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25.17||||25.17||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|21.62||||21.62|16.22|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.62||||21.62|10.37|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.62||||21.62|4.54|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|||21.62||||21.62|6.49|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.62||||21.62|9.3|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|GEHA [1415]|GEHA [141500]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.62||||21.62|7.59|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.62||||21.62|9.3|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.62||||21.62|14.05|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.62||||21.62|9.21|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.62||||21.62|10.83|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.62||||21.62|12.97|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.62||||21.62|19.46|19.46|4.54 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|21.62||||21.62||| 89284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|NEBIVOLOL 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.62||||21.62||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|||10.00||||10.00|3|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8958|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.57||||16.57|9.94|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.57||||16.57|7.13|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.57||||16.57|8.3|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.57||||16.57|7.06|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.57||||16.57|5.82|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|GEHA [1415]|GEHA [141500]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|16.57||||16.57|12.43|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|||16.57||||16.57|4.97|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.57||||16.57|7.95|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.57||||16.57|10.77|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.57||||16.57|3.48|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|UMR [2035]|UMR OPTIONS [203501]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.57||||16.57|7.13|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.57||||16.57|14.91|14.91|3.48 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|HMA [168003]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.57||||16.57||| 8962|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.57||||16.57||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|||10.00||||10.00|3|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|||10.00||||10.00|3|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 200 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|||10.00||||10.00|3|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|||10.00||||10.00|3|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8971|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 400 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|||10.00||||10.00|3|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 8972|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACYCLOVIR 800 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|GEHA [1415]|GEHA [141500]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|CHAMPVA [1240]|CHAMP VA [124000]|55.46||||55.46|41.6|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|CORESOURCE [1315]|CORESOURCE [131500]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|||55.46||||55.46|16.64|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55.46||||55.46|36.05|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55.46||||55.46|11.65|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|UMR [2035]|UMR OPTIONS [203501]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55.46||||55.46|23.85|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MULTIPLAN [1680]|IHC HS [168011]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|TRUSTMARK [2030]|STARMARK [203000]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|HEALTHNET [1495]|HEALTHNET [149500]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55.46||||55.46|26.59|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55.46||||55.46|33.28|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55.46||||55.46|23.85|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55.46||||55.46|27.79|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55.46||||55.46|19.47|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55.46||||55.46|23.63|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|55.46||||55.46|49.91|49.91|11.65 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MULTIPLAN [1680]|HMA [168003]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55.46||||55.46||| 89791|ERX|0250 - PHARMACY-GENERAL|PANTOPRAZOLE DR 40 MG GRANULES DELAYED-RELEASE FOR SUSP IN PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55.46||||55.46||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|645.03||||645.03|57.7|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1290.06||||1290.06|645.03|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1290.06||||1290.06|645.03|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1290.06||||1290.06|645.03|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|645.03||||645.03|322.52|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1290.06||||1290.06|452.81|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1290.06||||1290.06|549.57|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1290.06||||1290.06|452.81|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1290.06||||1290.06|549.57|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1290.06||||1290.06|549.57|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|645.03||||645.03|226.41|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|645.03||||645.03|274.78|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1290.06||||1290.06|452.81|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1290.06||||1290.06|774.04|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1290.06||||1290.06|774.04|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1290.06||||1290.06|110.15|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1290.06||||1290.06|110.15|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|645.03||||645.03|70.5|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1290.06||||1290.06|774.04|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1290.06||||1290.06|110.15|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1290.06||||1290.06|774.04|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1290.06||||1290.06|136.18|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|645.03||||645.03|323.16|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1290.06||||1290.06|136.18|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1290.06||||1290.06|136.18|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|645.03||||645.03|68.09|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|645.03||||645.03|277.36|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1290.06||||1290.06|549.57|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1290.06||||1290.06|646.32|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1290.06||||1290.06|110.15|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1290.06||||1290.06|451.52|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1290.06||||1290.06|451.52|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1290.06||||1290.06|451.52|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|645.03||||645.03|75.4|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|645.03||||645.03|225.76|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|645.03||||645.03||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|645.03||||645.03||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|645.03||||645.03|277.36|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1290.06||||1290.06|161.21|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1290.06||||1290.06|161.21|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|645.03||||645.03|80.6|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1290.06||||1290.06|107|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1290.06||||1290.06|161.21|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1290.06||||1290.06|107|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|645.03||||645.03|53.5|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1290.06||||1290.06|270.91|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|645.03||||645.03|135.46|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1290.06||||1290.06|270.91|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1290.06||||1290.06|838.54|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1290.06||||1290.06|838.54|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1290.06||||1290.06|838.54|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1290.06||||1290.06|451.52|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|645.03||||645.03|419.27|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1290.06||||1290.06|618.58|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1290.06||||1290.06|618.58|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1290.06||||1290.06|618.58|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1290.06||||1290.06|618.58|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|645.03||||645.03|309.29|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1290.06||||1290.06|838.54|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|||1290.06||||1290.06|387.02|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|||1290.06||||1290.06|387.02|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|||1290.06||||1290.06|387.02|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|||645.03||||645.03|193.51|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|||1290.06||||1290.06|387.02|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|645.03||||645.03|70.5|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1290.06||||1290.06|270.91|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|645.03||||645.03|387.02|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1290.06||||1290.06|646.32|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1290.06||||1290.06|136.18|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1290.06||||1290.06|452.81|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1290.06||||1290.06|646.32|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|645.03||||645.03|57.7|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1290.06||||1290.06|270.91|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|645.03||||645.03||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|645.03||||645.03||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1290.06||||1290.06|115.39|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|645.03||||645.03|55.07|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1290.06||||1290.06|141|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|645.03||||645.03|52.45|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1290.06||||1290.06|111.19|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1290.06||||1290.06|107|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1290.06||||1290.06|111.19|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1290.06||||1290.06|111.19|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1290.06||||1290.06|111.19|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|645.03||||645.03|55.6|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1290.06||||1290.06|107|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1290.06||||1290.06|161.21|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1290.06||||1290.06|150.8|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1290.06||||1290.06|554.73|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|645.03||||645.03|75.4|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1290.06||||1290.06|646.32|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1290.06||||1290.06|129.7|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1290.06||||1290.06|129.7|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1290.06||||1290.06|129.7|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1290.06||||1290.06|129.7|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1290.06||||1290.06|645.03|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|645.03||||645.03|64.85|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1290.06||||1290.06|967.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1290.06||||1290.06|967.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1290.06||||1290.06|967.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1290.06||||1290.06|967.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|645.03||||645.03|483.77|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1290.06||||1290.06|146.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1290.06||||1290.06|104.9|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1290.06||||1290.06|146.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1290.06||||1290.06|146.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|645.03||||645.03|73.28|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1290.06||||1290.06|146.55|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|645.03||||645.03|580.53|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1290.06||||1290.06|1161.05|1161.05|52.45 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1290.06||||1290.06||| 8981|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1290.06||||1290.06||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|||10.00||||10.00|3|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9014|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|||10.00||||10.00|3|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|||10.00||||10.00|3|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9066|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMIODARONE 200 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|||10.00||||10.00|3|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9071|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|AMLODIPINE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.8|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.8|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.8|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.8|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.8 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9083|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.32||||75.32|32.09|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.32||||75.32|37.74|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.32||||75.32|26.44|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.32||||75.32|32.09|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.32||||75.32|37.74|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.32||||75.32|26.44|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.32||||75.32|32.09|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.32||||75.32|37.74|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.32||||75.32|26.44|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.32||||75.32|32.09|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.32||||75.32|37.74|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.32||||75.32|26.44|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75.32||||75.32|32.09|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75.32||||75.32|37.74|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75.32||||75.32|26.44|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.32||||75.32|45.19|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.32||||75.32|45.19|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.32||||75.32|45.19|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.32||||75.32|45.19|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|75.32||||75.32|26.36|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|75.32||||75.32|26.36|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|75.32||||75.32|26.36|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|75.32||||75.32|26.36|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|75.32||||75.32|26.36|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.32||||75.32|15.82|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.32||||75.32|15.82|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.32||||75.32|15.82|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.32||||75.32|15.82|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75.32||||75.32|15.82|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.32||||75.32|48.96|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.32||||75.32|48.96|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.32||||75.32|48.96|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.32||||75.32|48.96|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75.32||||75.32|48.96|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.32||||75.32|36.12|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.32||||75.32|36.12|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.32||||75.32|36.12|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.32||||75.32|36.12|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.32||||75.32|36.12|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|||75.32||||75.32|22.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|||75.32||||75.32|22.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|||75.32||||75.32|22.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|||75.32||||75.32|22.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|||75.32||||75.32|22.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75.32||||75.32|45.19|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75.32||||75.32|32.39|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.32||||75.32|5.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.32||||75.32|5.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.32||||75.32|5.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.32||||75.32|5.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75.32||||75.32|5.6|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|75.32||||75.32|56.49|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|75.32||||75.32|56.49|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|75.32||||75.32|56.49|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|75.32||||75.32|56.49|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|75.32||||75.32|56.49|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|75.32||||75.32|67.79|67.79|5.6 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.32||||75.32||| 9084|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75.32||||75.32||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|||90.00||||90.00|27|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 90999|ERX|0250 - PHARMACY-GENERAL|SODIUM CITRATE 4 GRAM/100 ML (4 %) SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39.14||||39.14|16.83|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39.14||||39.14|19.61|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39.14||||39.14|13.74|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39.14||||39.14|23.48|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|39.14||||39.14|13.7|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.14||||39.14|16.83|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39.14||||39.14|8.22|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39.14||||39.14|16.67|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.14||||39.14|25.44|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.14||||39.14|18.77|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|||39.14||||39.14|11.74|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39.14||||39.14|3.02|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|39.14||||39.14|29.36|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|39.14||||39.14|35.23|35.23|3.02 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39.14||||39.14||| 91279|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|OCTREOTIDE ACETATE 100 MCG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.14||||39.14||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|||10.00||||10.00|3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9151|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ASPIRIN 81 MG TABLET,DELAYED RELEASE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16.31||||16.31|7.01|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16.31||||16.31|8.17|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16.31||||16.31|6.95|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.81||||49.81|21.42|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.81||||49.81|24.95|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.81||||49.81|21.22|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.31||||16.31|9.79|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.81||||49.81|29.89|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16.31||||16.31|7.01|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.81||||49.81|21.42|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UMR [2035]|UMR OPTIONS [203501]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16.31||||16.31|3.43|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.81||||49.81|10.46|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16.31||||16.31|10.6|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.81||||49.81|32.38|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.31||||16.31|7.82|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.81||||49.81|23.88|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|||16.31||||16.31|4.89|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|||49.81||||49.81|14.94|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.81||||49.81|17.48|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16.31||||16.31|5.72|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MULTIPLAN [1680]|HMA [168003]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.81||||49.81||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|16.31||||16.31|12.23|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|49.81||||49.81|37.36|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|16.31||||16.31|14.68|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|GEHA [1415]|GEHA [141500]|49.81||||49.81|44.83|44.83|3.43 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16.31||||16.31||| 9175|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BETAMETHASONE, AUGMENTED 0.05 % TOPICAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.81||||49.81||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|1.23|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|||10.00||||10.00|3|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|||10.00||||10.00|3|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|3.5|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|1.23|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|1.23 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9183|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|AZATHIOPRINE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116.00||||116.00|49.88|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|116.00||||116.00|58.12|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|116.00||||116.00|49.42|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116.00||||116.00|49.88|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|116.00||||116.00|58.12|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|116.00||||116.00|49.42|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116.00||||116.00|69.6|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116.00||||116.00|69.6|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116.00||||116.00|49.88|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116.00||||116.00|49.88|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116.00||||116.00|24.36|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116.00||||116.00|24.36|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116.00||||116.00|75.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116.00||||116.00|75.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116.00||||116.00|55.62|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116.00||||116.00|55.62|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|||116.00||||116.00|34.8|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|||116.00||||116.00|34.8|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116.00||||116.00|40.72|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116.00||||116.00|40.72|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|116.00||||116.00|87|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|116.00||||116.00|87|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|116.00||||116.00|104.4|104.4|24.36 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|116.00||||116.00||| 9185|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|116.00||||116.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|232.00||||232.00|174|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|||232.00||||232.00|69.6|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|||232.00||||232.00|69.6|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232.00||||232.00|111.24|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|232.00||||232.00|111.24|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232.00||||232.00|150.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232.00||||232.00|48.72|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|232.00||||232.00|48.72|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232.00||||232.00|99.76|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|232.00||||232.00|99.76|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|232.00||||232.00|150.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232.00||||232.00|139.2|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|232.00||||232.00|139.2|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|232.00||||232.00|98.83|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232.00||||232.00|99.76|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|232.00||||232.00|116.23|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232.00||||232.00|81.43|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|232.00||||232.00|98.83|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|232.00||||232.00|99.76|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|232.00||||232.00|174|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|232.00||||232.00|116.23|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|232.00||||232.00|81.43|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|232.00||||232.00|208.8|208.8|48.72 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232.00||||232.00||| 9186|ERX|0250 - PHARMACY-GENERAL|AZTREONAM 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|232.00||||232.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1461.00||||1461.00|628.23|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1461.00||||1461.00|731.96|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1461.00||||1461.00|622.39|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1461.00||||1461.00|876.6|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1461.00||||1461.00|179.82|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|TRUSTMARK [2030]|STARMARK [203000]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MULTIPLAN [1680]|IHC HS [168011]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|HEALTHNET [1495]|HEALTHNET [149500]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|FMH BENEFIT SERVICES [1390]|FMH [139000]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|FIRST HEALTH [1375]|QUALCHOICE [137513]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1461.00||||1461.00|628.23|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1461.00||||1461.00|212.86|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|UMR [2035]|UMR OPTIONS [203501]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1461.00||||1461.00|306.81|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1461.00||||1461.00|186.18|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1461.00||||1461.00|1461|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1461.00||||1461.00|949.65|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1461.00||||1461.00|700.55|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1461.00||||1461.00|512.81|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|||1461.00||||1461.00|438.3|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1461.00||||1461.00|324.96|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1461.00||||1461.00|186.18|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1461.00||||1461.00|171.25|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|CHAMPVA [1240]|CHAMP VA [124000]|1461.00||||1461.00|1095.75|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|CORESOURCE [1315]|CORESOURCE [131500]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1461.00||||1461.00|193.51|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|GEHA [1415]|GEHA [141500]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1461.00||||1461.00|1314.9|1461|171.25 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|MULTIPLAN [1680]|HMA [168003]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|AETNA [1015]|AETNA ACO WILCO [101532]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1461.00||||1461.00||| 92091065|EAP|0920 - OTHER DIAGNOSTIC SERVICES-GENERAL|HC LAB LACTOSE INTOLER BREATH TEST|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1461.00||||1461.00||| 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|GEHA [1415]|GEHA [141500]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1227.00||||1227.00|212.62|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|CORESOURCE [1315]|CORESOURCE [131500]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1227.00||||1227.00|318.9|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|CHAMPVA [1240]|CHAMP VA [124000]|1227.00||||1227.00|920.25|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1227.00||||1227.00|188.17|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1227.00||||1227.00|204.57|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1227.00||||1227.00|588.35|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1227.00||||1227.00|797.55|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1227.00||||1227.00|1227|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1227.00||||1227.00|257.67|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1227.00||||1227.00|323.87|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1227.00||||1227.00|226.26|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1227.00||||1227.00|233.89|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1227.00||||1227.00|527.61|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|UMR [2035]|UMR OPTIONS [203501]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|HEALTHNET [1495]|HEALTHNET [149500]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MULTIPLAN [1680]|IHC HS [168011]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1227.00||||1227.00|318.9|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MULTIPLAN [1680]|HMA [168003]|1227.00||||1227.00|332.74|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|1227.00||||1227.00|598.78|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|||1227.00||||1227.00|368.1|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|TRUSTMARK [2030]|STARMARK [203000]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1227.00||||1227.00|197.59|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1227.00||||1227.00|244.01|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1227.00||||1227.00|204.57|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1227.00||||1227.00|232.92|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1227.00||||1227.00|736.2|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1227.00||||1227.00|527.61|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1227.00||||1227.00|614.73|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1227.00||||1227.00|430.68|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1227.00||||1227.00|522.7|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1227.00||||1227.00|551.1|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1227.00||||1227.00|244.01|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1227.00||||1227.00|221.83|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1227.00||||1227.00|1104.3|1227|188.17 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1227.00||||1227.00||| 92193880|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC US DUPLEX EXTRACRAN/CAROTID BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1227.00||||1227.00||| 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1742.00||||1742.00|114.16|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1742.00||||1742.00|254.52|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1742.00||||1742.00|749.06|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1742.00||||1742.00|872.74|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1742.00||||1742.00|611.44|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1742.00||||1742.00|742.09|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1742.00||||1742.00|108.97|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1742.00||||1742.00|87.57|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1742.00||||1742.00|84.58|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|TRUSTMARK [2030]|STARMARK [203000]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|1742.00||||1742.00|850.1|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1742.00||||1742.00|149.2|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MULTIPLAN [1680]|HMA [168003]|1742.00||||1742.00|155.68|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|HEALTHNET [1495]|HEALTHNET [149500]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1742.00||||1742.00|749.06|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1742.00||||1742.00|100.12|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1742.00||||1742.00|105.86|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|UMR [2035]|UMR OPTIONS [203501]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MULTIPLAN [1680]|IHC HS [168011]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1742.00||||1742.00|151.52|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1742.00||||1742.00|114.16|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1742.00||||1742.00|365.82|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1742.00||||1742.00|1742|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1742.00||||1742.00|1045.2|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1742.00||||1742.00|1132.3|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1742.00||||1742.00|835.29|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|||1742.00||||1742.00|522.6|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1742.00||||1742.00|87.57|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1742.00||||1742.00|103.78|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1742.00||||1742.00|80.55|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|CHAMPVA [1240]|CHAMP VA [124000]|1742.00||||1742.00|1306.5|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1742.00||||1742.00|149.2|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|CORESOURCE [1315]|CORESOURCE [131500]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1742.00||||1742.00|91.02|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|GEHA [1415]|GEHA [141500]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1742.00||||1742.00|1567.8|1742|80.55 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1742.00||||1742.00||| 92193922|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DOPPLER ART 1-2 LEVEL BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1742.00||||1742.00||| 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|HEALTHNET [1495]|HEALTHNET [149500]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MULTIPLAN [1680]|IHC HS [168011]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1442.00||||1442.00|318.9|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MULTIPLAN [1680]|HMA [168003]|1442.00||||1442.00|332.74|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|1442.00||||1442.00|703.7|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|TRUSTMARK [2030]|STARMARK [203000]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1442.00||||1442.00|215.86|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1442.00||||1442.00|197.59|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1442.00||||1442.00|244.01|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1442.00||||1442.00|204.57|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1442.00||||1442.00|226.65|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1442.00||||1442.00|865.2|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1442.00||||1442.00|620.06|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1442.00||||1442.00|722.44|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1442.00||||1442.00|506.14|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1442.00||||1442.00|614.29|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1442.00||||1442.00|551.1|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1442.00||||1442.00|244.01|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1442.00||||1442.00|620.06|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1442.00||||1442.00|302.82|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|||1442.00||||1442.00|432.6|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|CORESOURCE [1315]|CORESOURCE [131500]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1442.00||||1442.00|188.17|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1442.00||||1442.00|226.26|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1442.00||||1442.00|204.57|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|GEHA [1415]|GEHA [141500]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1442.00||||1442.00|233.89|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1442.00||||1442.00|691.44|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|UMR [2035]|UMR OPTIONS [203501]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|CHAMPVA [1240]|CHAMP VA [124000]|1442.00||||1442.00|1081.5|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1442.00||||1442.00|212.62|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1442.00||||1442.00|1442|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1442.00||||1442.00|323.87|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1442.00||||1442.00|1297.8|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1442.00||||1442.00|937.3|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1442.00||||1442.00|221.83|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1442.00||||1442.00|318.9|1442|188.17 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1442.00||||1442.00||| 92193925|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1442.00||||1442.00||| 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1274.00||||1274.00|108.82|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|UMR [2035]|UMR OPTIONS [203501]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1274.00||||1274.00|123.97|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1274.00||||1274.00|153.38|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1274.00||||1274.00|764.4|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1274.00||||1274.00|542.72|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1274.00||||1274.00|547.82|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1274.00||||1274.00|547.82|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1274.00||||1274.00|118.07|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1274.00||||1274.00|1274|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MULTIPLAN [1680]|HMA [168003]|1274.00||||1274.00|160.04|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|GEHA [1415]|GEHA [141500]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1274.00||||1274.00|128.35|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1274.00||||1274.00|146.75|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|CORESOURCE [1315]|CORESOURCE [131500]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1274.00||||1274.00|128.35|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1274.00||||1274.00|610.88|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MULTIPLAN [1680]|IHC HS [168011]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1274.00||||1274.00|133.4|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1274.00||||1274.00|828.1|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1274.00||||1274.00|268.93|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|HEALTHNET [1495]|HEALTHNET [149500]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1274.00||||1274.00|112.03|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1274.00||||1274.00|153.38|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|TRUSTMARK [2030]|STARMARK [203000]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1274.00||||1274.00|447.17|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1274.00||||1274.00|638.27|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|AETNA [1015]|AETNA ACO WILCO [101532]|1274.00||||1274.00|621.71|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1274.00||||1274.00|155.77|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1274.00||||1274.00|117.36|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1274.00||||1274.00|106.69|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1274.00||||1274.00|117.36|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|||1274.00||||1274.00|382.2|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|CHAMPVA [1240]|CHAMP VA [124000]|1274.00||||1274.00|955.5|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1274.00||||1274.00|267.54|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1274.00||||1274.00|1146.6|1274|106.69 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1274.00||||1274.00||| 92193926|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL LOW EXTREM UNILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1274.00||||1274.00||| 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1533.00||||1533.00|653.06|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1533.00||||1533.00|244.01|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1533.00||||1533.00|197.59|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1533.00||||1533.00|244.01|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1533.00||||1533.00|188.17|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1533.00||||1533.00|919.8|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|CORESOURCE [1315]|CORESOURCE [131500]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1533.00||||1533.00|996.45|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1533.00||||1533.00|321.93|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1533.00||||1533.00|318.9|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|GEHA [1415]|GEHA [141500]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1533.00||||1533.00|204.57|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1533.00||||1533.00|226.26|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1533.00||||1533.00|768.03|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1533.00||||1533.00|233.89|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1533.00||||1533.00|318.9|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1533.00||||1533.00|735.07|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MULTIPLAN [1680]|IHC HS [168011]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|HEALTHNET [1495]|HEALTHNET [149500]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1533.00||||1533.00|323.87|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1533.00||||1533.00|212.62|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1533.00||||1533.00|204.57|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|UMR [2035]|UMR OPTIONS [203501]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1533.00||||1533.00|221.83|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MULTIPLAN [1680]|HMA [168003]|1533.00||||1533.00|332.74|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|CHAMPVA [1240]|CHAMP VA [124000]|1533.00||||1533.00|1149.75|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1533.00||||1533.00|1533|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1533.00||||1533.00|232.92|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1533.00||||1533.00|538.08|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1533.00||||1533.00|659.19|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|||1533.00||||1533.00|459.9|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1533.00||||1533.00|659.19|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|TRUSTMARK [2030]|STARMARK [203000]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|1533.00||||1533.00|748.1|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1533.00||||1533.00|1379.7|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1533.00||||1533.00|551.1|1533|188.17 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1533.00||||1533.00||| 92193930|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ARTERIAL UPPER EXT BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1533.00||||1533.00||| 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1507.00||||1507.00|112.03|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1507.00||||1507.00|268.93|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1507.00||||1507.00|123.97|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1507.00||||1507.00|528.96|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1507.00||||1507.00|641.98|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1507.00||||1507.00|648.01|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1507.00||||1507.00|153.38|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|HEALTHNET [1495]|HEALTHNET [149500]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1507.00||||1507.00|146.75|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MULTIPLAN [1680]|HMA [168003]|1507.00||||1507.00|160.04|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1507.00||||1507.00|117.36|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1507.00||||1507.00|648.01|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1507.00||||1507.00|128.35|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1507.00||||1507.00|1507|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1507.00||||1507.00|155.77|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1507.00||||1507.00|316.47|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1507.00||||1507.00|153.38|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1507.00||||1507.00|755.01|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|||1507.00||||1507.00|452.1|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|MULTIPLAN [1680]|IHC HS [168011]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1507.00||||1507.00|128.35|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|UMR [2035]|UMR OPTIONS [203501]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|AETNA [1015]|AETNA ACO WILCO [101532]|1507.00||||1507.00|735.42|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|TRUSTMARK [2030]|STARMARK [203000]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1507.00||||1507.00|904.2|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|GEHA [1415]|GEHA [141500]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1507.00||||1507.00|117.36|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1507.00||||1507.00|106.69|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1507.00||||1507.00|133.4|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|CORESOURCE [1315]|CORESOURCE [131500]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1507.00||||1507.00|722.61|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1507.00||||1507.00|1356.3|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|CHAMPVA [1240]|CHAMP VA [124000]|1507.00||||1507.00|1130.25|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1507.00||||1507.00|118.07|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1507.00||||1507.00|108.82|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1507.00||||1507.00|979.55|1507|106.69 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1507.00||||1507.00||| 92193931|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX UPPR EXTREM ARTERIAL UNILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1507.00||||1507.00||| 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1410.00||||1410.00|197.59|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1410.00||||1410.00|244.01|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1410.00||||1410.00|551.1|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1410.00||||1410.00|494.91|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1410.00||||1410.00|600.66|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1410.00||||1410.00|606.3|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1410.00||||1410.00|204.57|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1410.00||||1410.00|846|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1410.00||||1410.00|244.01|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1410.00||||1410.00|706.41|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|CHAMPVA [1240]|CHAMP VA [124000]|1410.00||||1410.00|1057.5|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|GEHA [1415]|GEHA [141500]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1410.00||||1410.00|212.62|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|CORESOURCE [1315]|CORESOURCE [131500]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1410.00||||1410.00|323.87|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1410.00||||1410.00|232.92|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|||1410.00||||1410.00|423|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|HEALTHNET [1495]|HEALTHNET [149500]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1410.00||||1410.00|188.17|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1410.00||||1410.00|204.57|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|TRUSTMARK [2030]|STARMARK [203000]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MULTIPLAN [1680]|HMA [168003]|1410.00||||1410.00|332.74|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1410.00||||1410.00|233.89|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|AETNA [1015]|AETNA ACO WILCO [101532]|1410.00||||1410.00|688.08|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1410.00||||1410.00|606.3|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1410.00||||1410.00|296.1|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1410.00||||1410.00|226.26|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1410.00||||1410.00|916.5|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MULTIPLAN [1680]|IHC HS [168011]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1410.00||||1410.00|318.9|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1410.00||||1410.00|1410|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1410.00||||1410.00|318.9|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1410.00||||1410.00|676.1|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1410.00||||1410.00|221.83|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|UMR [2035]|UMR OPTIONS [203501]|1410.00||||1410.00|1269|1410|188.17 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1410.00||||1410.00||| 92193970|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY BILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1410.00||||1410.00||| 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|913.00||||913.00|547.8|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|913.00||||913.00|112.03|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|913.00||||913.00|191.73|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|913.00||||913.00|913|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|TRUSTMARK [2030]|STARMARK [203000]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|913.00||||913.00|268.93|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|913.00||||913.00|117.36|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|913.00||||913.00|123.97|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|913.00||||913.00|128.35|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|913.00||||913.00|117.36|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|913.00||||913.00|392.59|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|913.00||||913.00|457.41|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|913.00||||913.00|320.46|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|AETNA [1015]|AETNA ACO WILCO [101532]|913.00||||913.00|445.54|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|913.00||||913.00|146.75|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|FIRST HEALTH [1375]|QUALCHOICE [137513]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|913.00||||913.00|108.82|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|||913.00||||913.00|273.9|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|913.00||||913.00|593.45|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|GEHA [1415]|GEHA [141500]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|913.00||||913.00|388.94|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|913.00||||913.00|153.38|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|913.00||||913.00|437.78|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|913.00||||913.00|128.35|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|FMH BENEFIT SERVICES [1390]|FMH [139000]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|HEALTHNET [1495]|HEALTHNET [149500]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|913.00||||913.00|155.77|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MULTIPLAN [1680]|IHC HS [168011]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|913.00||||913.00|106.69|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|MULTIPLAN [1680]|HMA [168003]|913.00||||913.00|160.04|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|UMR [2035]|UMR OPTIONS [203501]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|913.00||||913.00|118.07|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|CORESOURCE [1315]|CORESOURCE [131500]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|913.00||||913.00|392.59|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|913.00||||913.00|153.38|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|CHAMPVA [1240]|CHAMP VA [124000]|913.00||||913.00|684.75|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|913.00||||913.00|821.7|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|913.00||||913.00|133.4|913|106.69 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|913.00||||913.00||| 92193971|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX VENOUS EXTREMITY UNILAT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|913.00||||913.00||| 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1011.00||||1011.00|226.26|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1011.00||||1011.00|484.77|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1011.00||||1011.00|212.62|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1011.00||||1011.00|188.17|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|1011.00||||1011.00|493.37|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MULTIPLAN [1680]|HMA [168003]|1011.00||||1011.00|332.74|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1011.00||||1011.00|1011|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|1011.00||||1011.00|758.25|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1011.00||||1011.00|318.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1011.00||||1011.00|323.87|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1011.00||||1011.00|318.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1011.00||||1011.00|204.57|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|||1011.00||||1011.00|303.3|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|GEHA [1415]|GEHA [141500]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1011.00||||1011.00|197.59|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1011.00||||1011.00|430.69|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1011.00||||1011.00|434.73|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1011.00||||1011.00|354.86|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1011.00||||1011.00|244.01|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1011.00||||1011.00|606.6|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1011.00||||1011.00|551.1|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|UMR [2035]|UMR OPTIONS [203501]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1011.00||||1011.00|657.15|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1011.00||||1011.00|506.51|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1011.00||||1011.00|233.89|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1011.00||||1011.00|232.92|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1011.00||||1011.00|204.57|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1011.00||||1011.00|244.01|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1011.00||||1011.00|212.31|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1011.00||||1011.00|221.83|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1011.00||||1011.00|434.73|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1011.00||||1011.00|909.9|1011|188.17 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1011.00||||1011.00||| 92193975|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1011.00||||1011.00||| 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|790.00||||790.00|395.79|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|790.00||||790.00|197.59|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|790.00||||790.00|336.54|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|790.00||||790.00|268.93|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|790.00||||790.00|106.69|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|790.00||||790.00|103.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|790.00||||790.00|114.2|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|CORESOURCE [1315]|CORESOURCE [131500]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|790.00||||790.00|103.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|FMH BENEFIT SERVICES [1390]|FMH [139000]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|790.00||||790.00|153.38|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|GEHA [1415]|GEHA [141500]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|790.00||||790.00|106.69|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|790.00||||790.00|513.5|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|790.00||||790.00|378.81|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|790.00||||790.00|103.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|790.00||||790.00|149.25|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|790.00||||790.00|233.89|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|790.00||||790.00|108.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|HEALTHNET [1495]|HEALTHNET [149500]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|FIRST HEALTH [1375]|QUALCHOICE [137513]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|790.00||||790.00|790|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|790.00||||790.00|103.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|UMR [2035]|UMR OPTIONS [203501]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|790.00||||790.00|103.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|790.00||||790.00|165.9|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|790.00||||790.00|155.77|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|790.00||||790.00|106.69|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|790.00||||790.00|339.7|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MULTIPLAN [1680]|HMA [168003]|790.00||||790.00|160.04|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|790.00||||790.00|103.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MULTIPLAN [1680]|IHC HS [168011]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|AETNA [1015]|COVENTRY HEALTHCARE [101502]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|790.00||||790.00|204.57|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|790.00||||790.00|277.29|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|AETNA [1015]|AETNA ACO WILCO [101532]|790.00||||790.00|385.52|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|790.00||||790.00|112.03|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|790.00||||790.00|204.57|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|790.00||||790.00|106.69|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|790.00||||790.00|188.17|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|790.00||||790.00|339.7|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|790.00||||790.00|117.36|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|||790.00||||790.00|237|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|TRUSTMARK [2030]|STARMARK [203000]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|790.00||||790.00|212.62|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|790.00||||790.00|711|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|790.00||||790.00|474|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|790.00||||790.00|103.82|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|CHAMPVA [1240]|CHAMP VA [124000]|790.00||||790.00|592.5|790|103.82 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|790.00||||790.00||| 92193976|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX ABD/PEL/RETRO LIMITED|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|790.00||||790.00||| 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|806.00||||806.00|244.01|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|806.00||||806.00|551.1|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|806.00||||806.00|343.36|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|806.00||||806.00|215.86|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|806.00||||806.00|346.58|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|GEHA [1415]|GEHA [141500]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|806.00||||806.00|523.9|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|806.00||||806.00|212.62|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|806.00||||806.00|188.17|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|AETNA [1015]|AETNA ACO WILCO [101532]|806.00||||806.00|393.33|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|806.00||||806.00|204.57|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MULTIPLAN [1680]|HMA [168003]|806.00||||806.00|332.74|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|806.00||||806.00|386.48|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|UMR [2035]|UMR OPTIONS [203501]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|FIRST HEALTH [1375]|QUALCHOICE [137513]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|806.00||||806.00|346.58|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|FMH BENEFIT SERVICES [1390]|FMH [139000]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|806.00||||806.00|233.89|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|806.00||||806.00|806|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|HEALTHNET [1495]|HEALTHNET [149500]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|806.00||||806.00|323.87|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|806.00||||806.00|226.26|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|806.00||||806.00|318.9|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|||806.00||||806.00|241.8|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|806.00||||806.00|169.26|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|806.00||||806.00|204.57|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|806.00||||806.00|221.83|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|806.00||||806.00|318.9|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|CHAMPVA [1240]|CHAMP VA [124000]|806.00||||806.00|604.5|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|TRUSTMARK [2030]|STARMARK [203000]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|CORESOURCE [1315]|CORESOURCE [131500]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MULTIPLAN [1680]|IHC HS [168011]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|806.00||||806.00|244.01|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|806.00||||806.00|197.59|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|806.00||||806.00|232.92|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|806.00||||806.00|483.6|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|806.00||||806.00|725.4|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|806.00||||806.00|403.81|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|806.00||||806.00|282.91|806|169.26 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|806.00||||806.00||| 92193978|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/GRAFT COMPLETE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|806.00||||806.00||| 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|556.00||||556.00|278.56|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|556.00||||556.00|117.36|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|UMR [2035]|UMR OPTIONS [203501]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|556.00||||556.00|268.93|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|FIRST HEALTH [1375]|QUALCHOICE [137513]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|FMH BENEFIT SERVICES [1390]|FMH [139000]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|556.00||||556.00|239.08|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|556.00||||556.00|333.6|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|556.00||||556.00|112.03|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MULTIPLAN [1680]|IHC HS [168011]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|556.00||||556.00|123.97|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|AETNA [1015]|AETNA ACO WILCO [101532]|556.00||||556.00|271.33|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|AETNA [1015]|COVENTRY HEALTHCARE [101502]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|556.00||||556.00|239.08|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|556.00||||556.00|108.82|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MULTIPLAN [1680]|HMA [168003]|556.00||||556.00|160.04|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|556.00||||556.00|155.77|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|556.00||||556.00|116.76|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|556.00||||556.00|556|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|TRUSTMARK [2030]|STARMARK [203000]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|556.00||||556.00|361.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|556.00||||556.00|117.36|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|556.00||||556.00|153.38|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|556.00||||556.00|266.6|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|556.00||||556.00|128.35|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|556.00||||556.00|118.07|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|556.00||||556.00|195.16|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|HEALTHNET [1495]|HEALTHNET [149500]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|556.00||||556.00|128.35|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|556.00||||556.00|236.86|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|556.00||||556.00|133.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|CORESOURCE [1315]|CORESOURCE [131500]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|556.00||||556.00|153.38|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|GEHA [1415]|GEHA [141500]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|556.00||||556.00|146.75|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|||556.00||||556.00|166.8|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|556.00||||556.00|106.69|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|CHAMPVA [1240]|CHAMP VA [124000]|556.00||||556.00|417|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|556.00||||556.00|500.4|556|106.69 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|556.00||||556.00||| 92193979|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX AORTA/IVC/ILIAC/GRAFT LTD|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|556.00||||556.00||| 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|311.00||||311.00|128.35|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|||311.00||||311.00|93.3|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|311.00||||311.00|118.07|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|CHAMPVA [1240]|CHAMP VA [124000]|311.00||||311.00|233.25|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|311.00||||311.00|132.49|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|311.00||||311.00|153.38|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|CORESOURCE [1315]|CORESOURCE [131500]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|GEHA [1415]|GEHA [141500]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|311.00||||311.00|128.35|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|311.00||||311.00|155.81|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|311.00||||311.00|133.73|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|311.00||||311.00|65.31|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|311.00||||311.00|117.36|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|311.00||||311.00|155.77|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|311.00||||311.00|146.75|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|FIRST HEALTH [1375]|QUALCHOICE [137513]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|FMH BENEFIT SERVICES [1390]|FMH [139000]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|HEALTHNET [1495]|HEALTHNET [149500]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|311.00||||311.00|202.15|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|311.00||||311.00|123.97|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|311.00||||311.00|133.73|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|311.00||||311.00|109.16|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|311.00||||311.00|133.4|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|UMR [2035]|UMR OPTIONS [203501]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|311.00||||311.00|112.03|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|TRUSTMARK [2030]|STARMARK [203000]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|311.00||||311.00|186.6|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|311.00||||311.00|268.93|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|311.00||||311.00|149.12|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MULTIPLAN [1680]|HMA [168003]|311.00||||311.00|160.04|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|311.00||||311.00|108.82|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|311.00||||311.00|311|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|AETNA [1015]|AETNA ACO WILCO [101532]|311.00||||311.00|151.77|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|311.00||||311.00|117.36|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MULTIPLAN [1680]|IHC HS [168011]|311.00||||311.00|279.9|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|311.00||||311.00|153.38|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|311.00||||311.00|106.69|311|65.31 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|311.00||||311.00||| 92193990|EAP|0921 - OTHER DIAGNOSTIC SERVICES-PERIPHERAL VASCUL|HC DUPLEX OF HEMODIALYSIS ACCESS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|311.00||||311.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|||10.00||||10.00|3|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|||10.00||||10.00|3|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9220|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENAZEPRIL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1915.00||||1915.00|918.24|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|CHAMPVA [1240]|CHAMP VA [124000]|1915.00||||1915.00|1436.25|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1915.00||||1915.00|247.99|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|CORESOURCE [1315]|CORESOURCE [131500]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1915.00||||1915.00|219.47|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|GEHA [1415]|GEHA [141500]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1915.00||||1915.00|238.6|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|||1915.00||||1915.00|574.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1915.00||||1915.00|1244.75|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1915.00||||1915.00|1915|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|FIRST HEALTH [1375]|QUALCHOICE [137513]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1915.00||||1915.00|272.79|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1915.00||||1915.00|823.45|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|TRUSTMARK [2030]|STARMARK [203000]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1915.00||||1915.00|823.45|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1915.00||||1915.00|1149|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1915.00||||1915.00|959.42|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|HEALTHNET [1495]|HEALTHNET [149500]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1915.00||||1915.00|603.08|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1915.00||||1915.00|815.79|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1915.00||||1915.00|230.45|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MULTIPLAN [1680]|IHC HS [168011]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1915.00||||1915.00|238.6|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1915.00||||1915.00|672.17|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|UMR [2035]|UMR OPTIONS [203501]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|FMH BENEFIT SERVICES [1390]|FMH [139000]|1915.00||||1915.00|1723.5|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1915.00||||1915.00|402.15|1915|219.47 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MULTIPLAN [1680]|HMA [168003]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|AETNA [1015]|AETNA ACO WILCO [101532]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1915.00||||1915.00||| 92295925|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP UPPER LIMBS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1915.00||||1915.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2123.00||||2123.00|1063.62|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2123.00||||2123.00|1273.8|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2123.00||||2123.00|230.45|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2123.00||||2123.00|272.79|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2123.00||||2123.00|912.89|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|FMH BENEFIT SERVICES [1390]|FMH [139000]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2123.00||||2123.00|2123|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2123.00||||2123.00|912.89|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MULTIPLAN [1680]|IHC HS [168011]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|FIRST HEALTH [1375]|QUALCHOICE [137513]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|UMR [2035]|UMR OPTIONS [203501]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2123.00||||2123.00|238.6|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|HEALTHNET [1495]|HEALTHNET [149500]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|TRUSTMARK [2030]|STARMARK [203000]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2123.00||||2123.00|445.83|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2123.00||||2123.00|1379.95|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2123.00||||2123.00|238.6|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|||2123.00||||2123.00|636.9|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2123.00||||2123.00|1017.98|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2123.00||||2123.00|219.47|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|CHAMPVA [1240]|CHAMP VA [124000]|2123.00||||2123.00|1592.25|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2123.00||||2123.00|904.4|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|CORESOURCE [1315]|CORESOURCE [131500]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|GEHA [1415]|GEHA [141500]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2123.00||||2123.00|247.99|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2123.00||||2123.00|1910.7|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2123.00||||2123.00|745.17|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2123.00||||2123.00|603.08|2123|219.47 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|AETNA [1015]|AETNA ACO WILCO [101532]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MULTIPLAN [1680]|HMA [168003]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2123.00||||2123.00||| 92295926|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC SSEP LOW LIMBS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2123.00||||2123.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1770.00||||1770.00|371.7|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|UMR [2035]|UMR OPTIONS [203501]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1770.00||||1770.00|761.1|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|FMH BENEFIT SERVICES [1390]|FMH [139000]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|HEALTHNET [1495]|HEALTHNET [149500]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MULTIPLAN [1680]|IHC HS [168011]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1770.00||||1770.00|272.79|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|FIRST HEALTH [1375]|QUALCHOICE [137513]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1770.00||||1770.00|761.1|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|TRUSTMARK [2030]|STARMARK [203000]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1770.00||||1770.00|1770|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1770.00||||1770.00|1062|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1770.00||||1770.00|754.02|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1770.00||||1770.00|324.96|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1770.00||||1770.00|621.27|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1770.00||||1770.00|886.77|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1770.00||||1770.00|238.6|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1770.00||||1770.00|230.45|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1770.00||||1770.00|247.99|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|GEHA [1415]|GEHA [141500]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|CORESOURCE [1315]|CORESOURCE [131500]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|CHAMPVA [1240]|CHAMP VA [124000]|1770.00||||1770.00|1327.5|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1770.00||||1770.00|219.47|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1770.00||||1770.00|1593|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1770.00||||1770.00|238.6|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|||1770.00||||1770.00|531|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1770.00||||1770.00|848.72|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1770.00||||1770.00|1150.5|1770|219.47 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|AETNA [1015]|AETNA ACO WILCO [101532]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MULTIPLAN [1680]|HMA [168003]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1770.00||||1770.00||| 92295930|EAP|0922 - OTHER DIAGNOSTIC SERVICES-ELECTROMYOGRAM|HC EVOKED POTENTIAL VISUAL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1770.00||||1770.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9285|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|150.53||||150.53|112.9|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131500]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.53||||150.53|2.94|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|||150.53||||150.53|45.16|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.53||||150.53|72.18|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.53||||150.53|97.84|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.53||||150.53|31.61|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.53||||150.53|52.84|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.53||||150.53|64.13|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.53||||150.53|75.42|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.53||||150.53|64.73|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.53||||150.53|90.32|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|150.53||||150.53|52.69|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.53||||150.53|64.73|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|UMR [2035]|UMR OPTIONS [203501]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.53||||150.53|135.48|135.48|2.94 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.53||||150.53||| 92895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 1 GRAM/200 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.53||||150.53||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31.51||||31.51|13.55|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31.51||||31.51|11.06|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31.51||||31.51|13.42|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31.51||||31.51|18.91|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31.51||||31.51|13.55|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31.51||||31.51|6.62|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31.51||||31.51|20.48|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.51||||31.51|15.11|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31.51||||31.51|15.79|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|31.51||||31.51|23.63|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.51||||31.51|28.36|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|||31.51||||31.51|9.45|28.36|6.62 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31.51||||31.51||| 9296|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31.51||||31.51||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|29.18||||29.18|21.89|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|29.18||||29.18|21.89|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.18||||29.18|13.99|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.18||||29.18|13.99|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.18||||29.18|18.97|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.18||||29.18|18.97|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.18||||29.18|6.13|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|||29.18||||29.18|8.75|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.18||||29.18|12.55|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|GEHA [1415]|GEHA [141500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.18||||29.18|12.55|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|||29.18||||29.18|8.75|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.18||||29.18|6.13|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.18||||29.18|17.51|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.18||||29.18|10.24|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.18||||29.18|10.24|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.18||||29.18|12.43|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.18||||29.18|12.55|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.18||||29.18|12.43|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.18||||29.18|14.62|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.18||||29.18|14.62|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.18||||29.18|12.55|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.18||||29.18|17.51|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.18||||29.18|26.26|26.26|6.13 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|29.18||||29.18||| 9297|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BROMOCRIPTINE 2.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.18||||29.18||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|||10.00||||10.00|3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|||10.00||||10.00|3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|||10.00||||10.00|3|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9310|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUMETANIDE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|||29.00||||29.00|8.7|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9317|ERX|0250 - PHARMACY-GENERAL|BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|||10.00||||10.00|3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|||10.00||||10.00|3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|||10.00||||10.00|3|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9321|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|||10.00||||10.00|3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|||10.00||||10.00|3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|||10.00||||10.00|3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|||10.00||||10.00|3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|||10.00||||10.00|3|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9322|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUPROPION HCL 75 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|||10.00||||10.00|3|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9323|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|||10.00||||10.00|3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9324|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BUSPIRONE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|||10.00||||10.00|3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|||10.00||||10.00|3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|||10.00||||10.00|3|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9350|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCITRIOL 0.25 MCG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|481.25||||481.25|360.94|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|481.25||||481.25|156.46|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|||481.25||||481.25|144.37|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|481.25||||481.25|230.76|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|481.25||||481.25|312.81|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|481.25||||481.25|101.06|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|481.25||||481.25|206.94|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|481.25||||481.25|288.75|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|481.25||||481.25|206.94|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|481.25||||481.25|241.11|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|481.25||||481.25|168.92|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|481.25||||481.25|205.01|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|481.25||||481.25|240.63|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|481.25||||481.25|433.13|433.13|101.06 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|481.25||||481.25||| 93574|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|481.25||||481.25||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|||10.00||||10.00|3|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9385|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CALCIUM CARBONATE 200 MG CALCIUM (500 MG) CHEWABLE TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|||10.00||||10.00|3|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|||10.00||||10.00|3|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 93931|ERX|0250 - PHARMACY-GENERAL|IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|150.00||||150.00|64.5|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|150.00||||150.00|75.15|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|150.00||||150.00|52.65|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|150.00||||150.00|90|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|TRUSTMARK [2030]|STARMARK [203000]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|HEALTHNET [1495]|HEALTHNET [149500]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|FMH BENEFIT SERVICES [1390]|FMH [139000]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MULTIPLAN [1680]|IHC HS [168011]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|FIRST HEALTH [1375]|QUALCHOICE [137513]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|150.00||||150.00|64.5|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|UMR [2035]|UMR OPTIONS [203501]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|150.00||||150.00|31.5|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|150.00||||150.00|150|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|150.00||||150.00|71.93|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|150.00||||150.00|63.9|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|150.00||||150.00|97.5|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|||150.00||||150.00|45|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|CHAMPVA [1240]|CHAMP VA [124000]|150.00||||150.00|112.5|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|CORESOURCE [1315]|CORESOURCE [131500]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|GEHA [1415]|GEHA [141500]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|150.00||||150.00|135|150|31.5 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MULTIPLAN [1680]|HMA [168003]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|AETNA [1015]|AETNA ACO WILCO [101532]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|150.00||||150.00||| 94000010|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT MASSAGE THERAPY BENEFIT NON-MC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|150.00||||150.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|GEHA [1415]|GEHA [141500]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|CORESOURCE [1315]|CORESOURCE [131500]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|||185.00||||185.00|55.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|185.00||||185.00|120.25|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|185.00||||185.00|88.71|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|185.00||||185.00|185|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|UMR [2035]|UMR OPTIONS [203501]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|185.00||||185.00|79.55|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|FIRST HEALTH [1375]|QUALCHOICE [137513]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|FMH BENEFIT SERVICES [1390]|FMH [139000]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|185.00||||185.00|38.85|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MULTIPLAN [1680]|IHC HS [168011]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|HEALTHNET [1495]|HEALTHNET [149500]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|TRUSTMARK [2030]|STARMARK [203000]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|CHAMPVA [1240]|CHAMP VA [124000]|185.00||||185.00|138.75|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|185.00||||185.00|111|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|185.00||||185.00|79.55|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|185.00||||185.00|92.69|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|185.00||||185.00|64.94|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|185.00||||185.00|78.81|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|185.00||||185.00|166.5|185|38.85 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MULTIPLAN [1680]|HMA [168003]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|AETNA [1015]|AETNA ACO WILCO [101532]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|185.00||||185.00||| 94000011|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC PT PRE EMPLOYMENT SCREEN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|185.00||||185.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|||10.00||||10.00|3|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9406|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 10 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|||10.00||||10.00|3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|||10.00||||10.00|3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|||10.00||||10.00|3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9407|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|||10.00||||10.00|3|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9408|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CARBIDOPA 25 MG-LEVODOPA 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|GEHA [1415]|GEHA [141500]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|914.00||||914.00|173.84|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|CORESOURCE [1315]|CORESOURCE [131500]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|CHAMPVA [1240]|CHAMP VA [124000]|914.00||||914.00|685.5|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|914.00||||914.00|167.25|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|||914.00||||914.00|274.2|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|914.00||||914.00|438.26|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|914.00||||914.00|594.1|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|914.00||||914.00|914|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|914.00||||914.00|191.94|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|UMR [2035]|UMR OPTIONS [203501]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|914.00||||914.00|191.22|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|914.00||||914.00|393.02|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|FIRST HEALTH [1375]|QUALCHOICE [137513]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|FMH BENEFIT SERVICES [1390]|FMH [139000]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|HEALTHNET [1495]|HEALTHNET [149500]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MULTIPLAN [1680]|IHC HS [168011]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|TRUSTMARK [2030]|STARMARK [203000]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|914.00||||914.00|153.84|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|914.00||||914.00|161.54|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|914.00||||914.00|167.25|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|914.00||||914.00|393.02|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|914.00||||914.00|457.91|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|914.00||||914.00|320.81|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|914.00||||914.00|389.36|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|914.00||||914.00|548.4|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|914.00||||914.00|591.53|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|914.00||||914.00|822.6|914|153.84 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MULTIPLAN [1680]|HMA [168003]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|AETNA [1015]|AETNA ACO WILCO [101532]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|914.00||||914.00||| 94095991|EAP|0940 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC REFILL/MAINT SPINAL/BRAIN PUMP/RESERVOIR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|914.00||||914.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|||10.00||||10.00|3|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 94141|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZOCAINE 15 MG-MENTHOL 3.6 MG LOZENGES|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|||10.00||||10.00|3|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|||10.00||||10.00|3|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 94284|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLECALCIFEROL (VITAMIN D3) 50 MCG (2,000 UNIT) TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132.00||||132.00|36.77|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132.00||||132.00|66.13|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132.00||||132.00|46.33|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132.00||||132.00|56.23|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132.00||||132.00|79.2|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.00||||132.00|35.1|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132.00||||132.00|21.69|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132.00||||132.00|36.77|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132.00||||132.00|20.95|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|TRUSTMARK [2030]|STARMARK [203000]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MULTIPLAN [1680]|IHC HS [168011]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132.00||||132.00|46.47|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|HEALTHNET [1495]|HEALTHNET [149500]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MULTIPLAN [1680]|HMA [168003]|132.00||||132.00|50.15|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132.00||||132.00|24.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132.00||||132.00|56.76|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132.00||||132.00|34.1|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|UMR [2035]|UMR OPTIONS [203501]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132.00||||132.00|46.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132.00||||132.00|27.72|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132.00||||132.00|132|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132.00||||132.00|85.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.00||||132.00|63.29|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.00||||132.00|66|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|||132.00||||132.00|39.6|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132.00||||132.00|56.76|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132.00||||132.00|21.69|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132.00||||132.00|33.43|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132.00||||132.00|19.96|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|CHAMPVA [1240]|CHAMP VA [124000]|132.00||||132.00|99|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132.00||||132.00|46.47|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|CORESOURCE [1315]|CORESOURCE [131500]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132.00||||132.00|22.54|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|GEHA [1415]|GEHA [141500]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132.00||||132.00|118.8|132|19.96 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132.00||||132.00||| 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|AETNA [1015]|AETNA ACO WILCO [101532]|132.00||||132.00||| 94297802|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT INITIAL IND EA 15MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132.00||||132.00||| 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|GEHA [1415]|GEHA [141500]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|100.00||||100.00|22.54|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|CORESOURCE [1315]|CORESOURCE [131500]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|100.00||||100.00|39.27|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|CHAMPVA [1240]|CHAMP VA [124000]|100.00||||100.00|75|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100.00||||100.00|19.96|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100.00||||100.00|21.69|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100.00||||100.00|47.95|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100.00||||100.00|65|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100.00||||100.00|100|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100.00||||100.00|21|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100.00||||100.00|39.55|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100.00||||100.00|28.82|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100.00||||100.00|43|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|100.00||||100.00|24.8|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|UMR [2035]|UMR OPTIONS [203501]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|HEALTHNET [1495]|HEALTHNET [149500]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MULTIPLAN [1680]|IHC HS [168011]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|100.00||||100.00|39.27|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MULTIPLAN [1680]|HMA [168003]|100.00||||100.00|42.38|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|||100.00||||100.00|30|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|TRUSTMARK [2030]|STARMARK [203000]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100.00||||100.00|20.95|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100.00||||100.00|31.08|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100.00||||100.00|21.69|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100.00||||100.00|29.66|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100.00||||100.00|60|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100.00||||100.00|50|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100.00||||100.00|43|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|100.00||||100.00|50.1|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100.00||||100.00|35.1|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|100.00||||100.00|42.6|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100.00||||100.00|31.08|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100.00||||100.00|28.25|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100.00||||100.00|90|100|19.96 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|100.00||||100.00||| 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|AETNA [1015]|AETNA ACO WILCO [101532]|100.00||||100.00||| 94297803|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT REASSESS IND EA 15MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|100.00||||100.00||| 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|TRUSTMARK [2030]|STARMARK [203000]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44.00||||44.00|21.8|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MULTIPLAN [1680]|HMA [168003]|44.00||||44.00|23.52|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|HEALTHNET [1495]|HEALTHNET [149500]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|FMH BENEFIT SERVICES [1390]|FMH [139000]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|FIRST HEALTH [1375]|QUALCHOICE [137513]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44.00||||44.00|19.78|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44.00||||44.00|18.92|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44.00||||44.00|15.99|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|UMR [2035]|UMR OPTIONS [203501]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44.00||||44.00|21.95|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44.00||||44.00|9.24|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44.00||||44.00|44|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MULTIPLAN [1680]|IHC HS [168011]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44.00||||44.00|28.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44.00||||44.00|21.1|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|||44.00||||44.00|13.2|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44.00||||44.00|17.3|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44.00||||44.00|15.91|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|CHAMPVA [1240]|CHAMP VA [124000]|44.00||||44.00|33|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44.00||||44.00|21.8|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|CORESOURCE [1315]|CORESOURCE [131500]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44.00||||44.00|17.98|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|GEHA [1415]|GEHA [141500]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44.00||||44.00|26.4|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44.00||||44.00|18.92|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44.00||||44.00|17.3|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44.00||||44.00|17.25|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44.00||||44.00|22|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44.00||||44.00|39.6|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44.00||||44.00|18.74|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44.00||||44.00|15.68|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44.00||||44.00|15.44|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44.00||||44.00|16.71|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44.00||||44.00|17.25|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44.00||||44.00|16.46|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44.00||||44.00|22.04|44|9.24 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|AETNA [1015]|AETNA ACO WILCO [101532]|44.00||||44.00||| 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44.00||||44.00||| 94297804|EAP|0942 - OTHER THERAPEUTIC SERVICES (SEE ALSO 095X,|HC MNT GRP EA 30MIN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44.00||||44.00||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|49.41||||49.41|37.06|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|49.41||||49.41|17.29|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.41||||49.41|21.05|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.41||||49.41|8.27|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|||49.41||||49.41|14.82|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.41||||49.41|24.75|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.41||||49.41|23.69|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.41||||49.41|29.65|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.41||||49.41|17.34|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.41||||49.41|21.25|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.41||||49.41|10.38|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.41||||49.41|21.25|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|49.41||||49.41|44.47|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.41||||49.41|32.12|44.47|8.27 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.41||||49.41||| 9476|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTAZIDIME 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.41||||49.41||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.67|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.67|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|2.67|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|2.67 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9487|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 1 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|5.34|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|10.15|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|17.4|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|5.34|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|5.34|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|5.34|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|12.35|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|10.18|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|14.53|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|||29.00||||29.00|8.7|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|13.91|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|21.75|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|5.34|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|5.34 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00||| 9488|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CEFTRIAXONE 2 GRAM SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|||10.00||||10.00|3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|||10.00||||10.00|3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|||10.00||||10.00|3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9495|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 250 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|GEHA [1415]|GEHA [141500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|GEHA [1415]|GEHA [141500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.79||||13.79|10.34|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|||13.79||||13.79|4.14|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.79||||13.79|6.61|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.79||||13.79|6.61|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.79||||13.79|8.96|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.79||||13.79|2.9|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.79||||13.79|8.96|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.79||||13.79|2.9|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.79||||13.79|5.93|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|||13.79||||13.79|4.14|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.79||||13.79|6.61|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.79||||13.79|8.96|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.79||||13.79|5.93|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.79||||13.79|5.93|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.79||||13.79|10.34|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.79||||13.79|2.9|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.79||||13.79|4.84|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.79||||13.79|8.27|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.79||||13.79|5.93|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.79||||13.79|8.27|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.79||||13.79|5.93|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.79||||13.79|6.91|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.79||||13.79|4.84|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.79||||13.79|5.93|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.79||||13.79|5.87|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.79||||13.79|6.91|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.79||||13.79|5.87|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|||13.79||||13.79|4.14|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.79||||13.79|6.91|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.79||||13.79|4.84|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.79||||13.79|5.87|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.79||||13.79|8.27|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|GEHA [1415]|GEHA [141500]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.79||||13.79|12.41|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.79||||13.79|10.34|12.41|2.9 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.79||||13.79||| 9496|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEFUROXIME AXETIL 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.79||||13.79||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|||10.00||||10.00|3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9499|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|||10.00||||10.00|3|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9500|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 500 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74.29||||74.29|37.22|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74.29||||74.29|31.94|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74.29||||74.29|31.65|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74.29||||74.29|37.22|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74.29||||74.29|31.65|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74.29||||74.29|44.57|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74.29||||74.29|31.94|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74.29||||74.29|31.94|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|FIRST HEALTH [1375]|QUALCHOICE [137513]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74.29||||74.29|31.94|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74.29||||74.29|26.08|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74.29||||74.29|44.57|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74.29||||74.29|35.62|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|||74.29||||74.29|22.29|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|74.29||||74.29|55.72|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA [141500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|74.29||||74.29|55.72|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74.29||||74.29|35.62|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74.29||||74.29|48.29|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74.29||||74.29|48.29|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|||74.29||||74.29|22.29|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74.29||||74.29|15.6|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74.29||||74.29|15.6|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MULTIPLAN [1680]|HMA [168003]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74.29||||74.29|26.08|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74.29||||74.29|66.86|66.86|15.6 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74.29||||74.29||| 9502|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CEPHALEXIN 250 MG/5 ML ORAL SUSPENSION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74.29||||74.29||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|||10.00||||10.00|3|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9506|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CETIRIZINE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|||10.00||||10.00|3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|||10.00||||10.00|3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|||10.00||||10.00|3|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9516|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHLORHEXIDINE GLUCONATE 0.12 % MOUTHWASH|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|||10.00||||10.00|3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|||10.00||||10.00|3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|||10.00||||10.00|3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9588|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|32.36||||32.36|24.27|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|32.36||||32.36|24.27|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|32.36||||32.36|24.27|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|32.36||||32.36|24.27|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CORESOURCE [1315]|CORESOURCE [131500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|GEHA [1415]|GEHA [141500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32.36||||32.36|16.21|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.36||||32.36|11.36|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32.36||||32.36|13.79|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32.36||||32.36|16.21|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.36||||32.36|11.36|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32.36||||32.36|13.79|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32.36||||32.36|16.21|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.36||||32.36|11.36|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32.36||||32.36|13.79|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32.36||||32.36|16.21|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32.36||||32.36|11.36|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32.36||||32.36|13.79|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.36||||32.36|19.42|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.36||||32.36|19.42|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.36||||32.36|19.42|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUSTMARK [2030]|STARMARK [203000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHNET [1495]|HEALTHNET [149500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FMH BENEFIT SERVICES [1390]|FMH [139000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|FIRST HEALTH [1375]|QUALCHOICE [137513]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|IHC HS [168011]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR [2035]|UMR OPTIONS [203501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.36||||32.36|6.8|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.36||||32.36|6.8|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.36||||32.36|6.8|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32.36||||32.36|6.8|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.36||||32.36|21.03|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.36||||32.36|21.03|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.36||||32.36|21.03|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32.36||||32.36|21.03|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32.36||||32.36|19.42|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.36||||32.36|15.52|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.36||||32.36|15.52|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.36||||32.36|15.52|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.36||||32.36|15.52|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|||32.36||||32.36|9.71|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|||32.36||||32.36|9.71|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|||32.36||||32.36|9.71|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|||32.36||||32.36|9.71|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32.36||||32.36|13.91|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32.36||||32.36|29.12|29.12|6.8 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32.36||||32.36||| 9610|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CIPROFLOXACIN 0.3 % EYE DROPS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32.36||||32.36||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|GEHA [1415]|GEHA [141500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|21.07||||21.07|15.8|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|21.07||||21.07|15.8|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|21.07||||21.07|15.8|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|||21.07||||21.07|6.32|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|||21.07||||21.07|6.32|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|||21.07||||21.07|6.32|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.07||||21.07|10.1|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.07||||21.07|10.1|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.07||||21.07|10.1|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.07||||21.07|13.7|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.07||||21.07|13.7|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.07||||21.07|13.7|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.07||||21.07|13.7|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.07||||21.07|4.42|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.07||||21.07|4.42|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.07||||21.07|4.42|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.07||||21.07|4.42|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.07||||21.07|10.1|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|||21.07||||21.07|6.32|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.07||||21.07|12.64|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.07||||21.07|12.64|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.07||||21.07|12.64|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.07||||21.07|12.64|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.07||||21.07|10.56|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.07||||21.07|7.4|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.07||||21.07|8.98|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.07||||21.07|10.56|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.07||||21.07|7.4|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.07||||21.07|8.98|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.07||||21.07|10.56|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.07||||21.07|7.4|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.07||||21.07|8.98|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.07||||21.07|9.06|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.07||||21.07|10.56|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.07||||21.07|7.4|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.07||||21.07|8.98|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|21.07||||21.07|15.8|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MULTIPLAN [1680]|HMA [168003]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.07||||21.07|18.96|18.96|4.42 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.07||||21.07||| 9617|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLARITHROMYCIN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.07||||21.07||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|||10.00||||10.00|3|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9621|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLINDAMYCIN HCL 300 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9637|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|||10.00||||10.00|3|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|||10.00||||10.00|3|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9638|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLONAZEPAM 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|||10.00||||10.00|3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|||10.00||||10.00|3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|||10.00||||10.00|3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9644|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CLOTRIMAZOLE 10 MG TROCHE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112.41||||112.41|48.34|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112.41||||112.41|39.46|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|112.41||||112.41|47.89|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|224.81||||224.81|96.67|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|224.81||||224.81|112.63|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|224.81||||224.81|78.91|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|224.81||||224.81|95.77|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112.41||||112.41|67.45|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|TRUSTMARK [2030]|STARMARK [203000]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA [1015]|COVENTRY HEALTHCARE [101502]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MULTIPLAN [1680]|IHC HS [168011]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHNET [1495]|HEALTHNET [149500]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|FMH BENEFIT SERVICES [1390]|FMH [139000]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112.41||||112.41|48.34|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|224.81||||224.81|96.67|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|FIRST HEALTH [1375]|QUALCHOICE [137513]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UMR [2035]|UMR OPTIONS [203501]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112.41||||112.41|23.61|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|224.81||||224.81|47.21|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112.41||||112.41|73.07|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|224.81||||224.81|146.13|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112.41||||112.41|53.9|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|224.81||||224.81|107.8|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|224.81||||224.81|134.89|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|||112.41||||112.41|33.72|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|||224.81||||224.81|67.44|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|112.41||||112.41|56.32|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA [1015]|AETNA ACO WILCO [101532]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MULTIPLAN [1680]|HMA [168003]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|224.81||||224.81||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|112.41||||112.41|84.31|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CHAMPVA [1240]|CHAMP VA [124000]|224.81||||224.81|168.61|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|CORESOURCE [1315]|CORESOURCE [131500]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|112.41||||112.41|101.17|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|GEHA [1415]|GEHA [141500]|224.81||||224.81|202.33|202.33|23.61 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|112.41||||112.41||| 9682|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|224.81||||224.81||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|44.17||||44.17|33.13|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|||44.17||||44.17|13.25|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44.17||||44.17|21.18|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44.17||||44.17|9.28|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44.17||||44.17|18.99|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44.17||||44.17|28.71|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|GEHA [1415]|GEHA [141500]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44.17||||44.17|26.5|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44.17||||44.17|18.99|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44.17||||44.17|22.13|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44.17||||44.17|15.5|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44.17||||44.17|18.82|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44.17||||44.17|39.75|39.75|9.28 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MULTIPLAN [1680]|HMA [168003]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44.17||||44.17||| 96968|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44.17||||44.17||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52.73||||52.73|22.67|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52.73||||52.73|26.42|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52.73||||52.73|18.51|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52.73||||52.73|22.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52.73||||52.73|31.64|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.73||||52.73|22.67|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52.73||||52.73|11.07|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52.73||||52.73|34.27|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.73||||52.73|25.28|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|||52.73||||52.73|15.82|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|52.73||||52.73|39.55|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|GEHA [1415]|GEHA [141500]|52.73||||52.73|47.46|47.46|11.07 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52.73||||52.73||| 96969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 100 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52.73||||52.73||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|GEHA [1415]|GEHA [141500]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|50.76||||50.76|38.07|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|||50.76||||50.76|15.23|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50.76||||50.76|24.34|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50.76||||50.76|32.99|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50.76||||50.76|21.83|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50.76||||50.76|10.66|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50.76||||50.76|30.46|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50.76||||50.76|21.83|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50.76||||50.76|25.43|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50.76||||50.76|17.82|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50.76||||50.76|21.62|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50.76||||50.76|45.68|45.68|10.66 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MULTIPLAN [1680]|HMA [168003]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50.76||||50.76||| 96970|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|LACOSAMIDE 150 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50.76||||50.76||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48.65||||48.65|20.92|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48.65||||48.65|24.37|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48.65||||48.65|17.08|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48.65||||48.65|29.19|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48.65||||48.65|20.92|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48.65||||48.65|10.22|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48.65||||48.65|20.72|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48.65||||48.65|31.62|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48.65||||48.65|23.33|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|||48.65||||48.65|14.59|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|48.65||||48.65|36.49|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|48.65||||48.65|43.79|43.79|10.22 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48.65||||48.65||| 9706|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CYCLOSPORINE 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48.65||||48.65||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|GEHA [1415]|GEHA [141500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|GEHA [1415]|GEHA [141500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|46.54||||46.54|34.91|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|||46.54||||46.54|13.96|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.54||||46.54|22.32|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.54||||46.54|30.25|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.54||||46.54|30.25|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.54||||46.54|9.77|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.54||||46.54|9.77|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.54||||46.54|20.01|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.54||||46.54|20.01|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.54||||46.54|22.32|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|||46.54||||46.54|13.96|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.54||||46.54|27.92|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.54||||46.54|27.92|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.54||||46.54|19.83|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.54||||46.54|20.01|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.54||||46.54|23.32|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.54||||46.54|16.34|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.54||||46.54|19.83|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|46.54||||46.54|34.91|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.54||||46.54|20.01|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.54||||46.54|23.32|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.54||||46.54|16.34|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MULTIPLAN [1680]|HMA [168003]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.54||||46.54|41.89|41.89|9.77 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.54||||46.54||| 97133|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FEBUXOSTAT 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.54||||46.54||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|||10.00||||10.00|3|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9718|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DANTROLENE 25 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|49.88||||49.88|37.41|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.88||||49.88|5.87|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49.88||||49.88|5.87|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|||49.88||||49.88|14.96|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.88||||49.88|23.92|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.88||||49.88|32.42|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49.88||||49.88|32.42|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.88||||49.88|10.47|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49.88||||49.88|10.47|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.88||||49.88|21.45|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.88||||49.88|21.45|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|49.88||||49.88|17.46|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|49.88||||49.88|17.46|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.88||||49.88|23.92|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|||49.88||||49.88|14.96|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.88||||49.88|29.93|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49.88||||49.88|29.93|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.88||||49.88|21.45|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.88||||49.88|24.99|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.88||||49.88|17.51|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.88||||49.88|21.25|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|49.88||||49.88|37.41|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49.88||||49.88|21.45|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49.88||||49.88|24.99|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49.88||||49.88|17.51|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49.88||||49.88|21.25|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49.88||||49.88|44.89|44.89|5.87 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.88||||49.88||| 97371|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|VANCOMYCIN 750 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.88||||49.88||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|||90.00||||90.00|27|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|18.9 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 9801|ERX|0250 - PHARMACY-GENERAL|POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 %-0.45 % SODIUM CHLORIDE IV|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.29|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.29 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 9814|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90.00||||90.00|45.09|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90.00||||90.00|38.7|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90.00||||90.00|2.29|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|||90.00||||90.00|27|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90.00||||90.00|43.16|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|90.00||||90.00|67.5|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90.00||||90.00|38.7|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90.00||||90.00|54|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90.00||||90.00|58.5|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90.00||||90.00|18.9|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90.00||||90.00|38.34|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|90.00||||90.00|81|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90.00||||90.00|31.59|81|2.29 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90.00||||90.00||| 9815|ERX|0258 - PHARMACY-IV SOLUTIONS|DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90.00||||90.00||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53.30||||53.30|22.92|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53.30||||53.30|11.19|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|UMR [2035]|UMR OPTIONS [203501]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53.30||||53.30|25.56|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53.30||||53.30|34.65|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53.30||||53.30|22.92|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53.30||||53.30|26.65|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53.30||||53.30|31.98|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53.30||||53.30|18.71|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53.30||||53.30|22.71|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53.30||||53.30|26.7|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|||53.30||||53.30|15.99|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53.30||||53.30|5.72|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|53.30||||53.30|39.98|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|GEHA [1415]|GEHA [141500]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53.30||||53.30|47.97|47.97|5.72 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MULTIPLAN [1680]|HMA [168003]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53.30||||53.30||| 9828|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53.30||||53.30||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.42||||46.42|27.85|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46.42||||46.42|19.77|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46.42||||46.42|23.26|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46.42||||46.42|19.96|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46.42||||46.42|16.29|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.42||||46.42|19.96|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|46.42||||46.42|34.82|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46.42||||46.42|9.75|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46.42||||46.42|30.17|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.42||||46.42|22.26|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|GEHA [1415]|GEHA [141500]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|||46.42||||46.42|13.93|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46.42||||46.42|41.78|41.78|9.75 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MULTIPLAN [1680]|HMA [168003]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46.42||||46.42||| 98329|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONEDARONE 400 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46.42||||46.42||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|||10.00||||10.00|3|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 98373|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PRASUGREL 10 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10788.00||||10788.00|3786.59|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10788.00||||10788.00|4638.84|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10788.00||||10788.00|5404.79|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10788.00||||10788.00|6472.8|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10788.00||||10788.00|4595.69|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|TRUSTMARK [2030]|STARMARK [203000]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MULTIPLAN [1680]|IHC HS [168011]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|HEALTHNET [1495]|HEALTHNET [149500]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10788.00||||10788.00|4638.84|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|CORESOURCE [1315]|CORESOURCE [131500]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10788.00||||10788.00|5172.85|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10788.00||||10788.00|7012.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10788.00||||10788.00|2265.48|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|||10788.00||||10788.00|3236.4|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|CHAMPVA [1240]|CHAMP VA [124000]|10788.00||||10788.00|8091|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|UMR [2035]|UMR OPTIONS [203501]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MULTIPLAN [1680]|HMA [168003]|10788.00||||10788.00|3775.8|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10788.00||||10788.00|5394|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|GEHA [1415]|GEHA [141500]|10788.00||||10788.00|9709.2|9709.2|2265.48 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|AETNA [1015]|AETNA ACO WILCO [101532]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10788.00||||10788.00||| 98451|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO I-123 IOBENGUANE (MIBG) PER DOSE UP TO 15MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10788.00||||10788.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2940.00||||2940.00|1264.2|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MULTIPLAN [1680]|IHC HS [168011]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|HEALTHNET [1495]|HEALTHNET [149500]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2940.00||||2940.00|1764|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2940.00||||2940.00|1031.94|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2940.00||||2940.00|1472.94|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2940.00||||2940.00|1264.2|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2940.00||||2940.00|1470|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|UMR [2035]|UMR OPTIONS [203501]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|TRUSTMARK [2030]|STARMARK [203000]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2940.00||||2940.00|1252.44|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2940.00||||2940.00|1911|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|CORESOURCE [1315]|CORESOURCE [131500]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|GEHA [1415]|GEHA [141500]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|CHAMPVA [1240]|CHAMP VA [124000]|2940.00||||2940.00|2205|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|||2940.00||||2940.00|882|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2940.00||||2940.00|1409.73|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2940.00||||2940.00|2646|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2940.00||||2940.00|617.4|2646|617.4 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MULTIPLAN [1680]|HMA [168003]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|AETNA [1015]|AETNA ACO WILCO [101532]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2940.00||||2940.00||| 98452|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO IN-111 OXYQUINOLINE (OXINE) PER 0.5MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2940.00||||2940.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2352.00||||2352.00|825.55|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2352.00||||2352.00|1176|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2352.00||||2352.00|1001.95|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2352.00||||2352.00|1011.36|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2352.00||||2352.00|1411.2|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|TRUSTMARK [2030]|STARMARK [203000]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MULTIPLAN [1680]|IHC HS [168011]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|HEALTHNET [1495]|HEALTHNET [149500]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|UMR [2035]|UMR OPTIONS [203501]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MULTIPLAN [1680]|HMA [168003]|2352.00||||2352.00|823.2|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|CHAMPVA [1240]|CHAMP VA [124000]|2352.00||||2352.00|1764|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2352.00||||2352.00|1178.35|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|GEHA [1415]|GEHA [141500]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|||2352.00||||2352.00|705.6|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2352.00||||2352.00|1528.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2352.00||||2352.00|1127.78|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|CORESOURCE [1315]|CORESOURCE [131500]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2352.00||||2352.00|1011.36|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2352.00||||2352.00|493.92|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2352.00||||2352.00|2116.8|2116.8|493.92 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|AETNA [1015]|AETNA ACO WILCO [101532]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2352.00||||2352.00||| 98453|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M EXAMETAZIME (CERETEC) PER DOSE UP TO 25MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2352.00||||2352.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|561.00||||561.00|117.81|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|CHAMPVA [1240]|CHAMP VA [124000]|561.00||||561.00|420.75|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|||561.00||||561.00|168.3|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|CORESOURCE [1315]|CORESOURCE [131500]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|561.00||||561.00|269|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|UMR [2035]|UMR OPTIONS [203501]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|GEHA [1415]|GEHA [141500]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|561.00||||561.00|364.65|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|561.00||||561.00|241.23|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|TRUSTMARK [2030]|STARMARK [203000]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|561.00||||561.00|281.06|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|561.00||||561.00|238.99|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|561.00||||561.00|280.5|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|561.00||||561.00|241.23|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|561.00||||561.00|196.91|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|561.00||||561.00|336.6|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MULTIPLAN [1680]|IHC HS [168011]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|HEALTHNET [1495]|HEALTHNET [149500]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|561.00||||561.00|504.9|504.9|117.81 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MULTIPLAN [1680]|HMA [168003]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|AETNA [1015]|AETNA ACO WILCO [101532]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|561.00||||561.00||| 98464|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TC99M SUCCIMER (DMSA) PER DOSE UP TO 10MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|561.00||||561.00||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|163.42||||163.42|98.05|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|163.42||||163.42|81.71|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|163.42||||163.42|81.87|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|TRUSTMARK [2030]|STARMARK [203000]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MULTIPLAN [1680]|HMA [168003]|163.42||||163.42|57.2|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|AETNA [1015]|COVENTRY HEALTHCARE [101502]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|HEALTHNET [1495]|HEALTHNET [149500]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|163.42||||163.42|69.62|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|163.42||||163.42|34.32|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|163.42||||163.42|78.36|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|||163.42||||163.42|49.03|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|163.42||||163.42|70.27|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|163.42||||163.42|57.36|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|CHAMPVA [1240]|CHAMP VA [124000]|163.42||||163.42|122.57|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MULTIPLAN [1680]|IHC HS [168011]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|GEHA [1415]|GEHA [141500]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|CORESOURCE [1315]|CORESOURCE [131500]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|163.42||||163.42|106.22|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|163.42||||163.42|70.27|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|UMR [2035]|UMR OPTIONS [203501]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|FIRST HEALTH [1375]|QUALCHOICE [137513]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|FMH BENEFIT SERVICES [1390]|FMH [139000]|163.42||||163.42|147.08|147.08|34.32 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|AETNA [1015]|AETNA ACO WILCO [101532]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|163.42||||163.42||| 98468|ERX|0343 - NUCLEAR MEDICINE-DIAGNOSTIC RADIOPHARMACEUT|NM ISO TL-201 THALLOUS CHLORIDE PER MCI|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|163.42||||163.42||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|||10.00||||10.00|3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 988|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZONATATE 100 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.27||||13.27|6.36|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.27||||13.27|2.79|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.27||||13.27|8.63|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.27||||13.27|2.79|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.27||||13.27|8.63|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|||13.27||||13.27|3.98|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.27||||13.27|6.36|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|||13.27||||13.27|3.98|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|||13.27||||13.27|3.98|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.27||||13.27|8.63|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.27||||13.27|2.79|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.27||||13.27|6.36|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.27||||13.27|9.95|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|GEHA [1415]|GEHA [141500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.27||||13.27|9.95|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.27||||13.27|9.95|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|GEHA [1415]|GEHA [141500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|GEHA [1415]|GEHA [141500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.27||||13.27|6.65|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.27||||13.27|4.66|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.27||||13.27|5.65|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.27||||13.27|6.65|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.27||||13.27|5.65|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.27||||13.27|6.65|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.27||||13.27|4.66|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.27||||13.27|5.65|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.27||||13.27|7.96|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.27||||13.27|7.96|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.27||||13.27|7.96|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.27||||13.27|5.71|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.27||||13.27|4.66|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.27||||13.27|5.71|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.27||||13.27|5.71|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.27||||13.27|5.71|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.27||||13.27|5.71|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.27||||13.27|5.71|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.27||||13.27|11.94|11.94|2.79 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.27||||13.27||| 9894|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.27||||13.27||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|GEHA [1415]|GEHA [141500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.25||||13.25|9.94|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.25||||13.25|9.94|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|||13.25||||13.25|3.97|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.25||||13.25|6.35|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|GEHA [1415]|GEHA [141500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.25||||13.25|6.35|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.25||||13.25|8.61|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.25||||13.25|5.7|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.25||||13.25|5.7|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.25||||13.25|2.78|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.25||||13.25|8.61|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|||13.25||||13.25|3.97|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.25||||13.25|6.64|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.25||||13.25|4.65|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.25||||13.25|5.64|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.25||||13.25|5.7|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.25||||13.25|2.78|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.25||||13.25|6.64|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.25||||13.25|4.65|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.25||||13.25|5.64|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.25||||13.25|11.93|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.25||||13.25|7.95|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.25||||13.25|5.7|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.25||||13.25|7.95|11.93|2.78 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.25||||13.25||| 9895|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 2 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.25||||13.25||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.91||||13.91|5.98|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.91||||13.91|6.97|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.91||||13.91|5.93|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.91||||13.91|4.88|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13.91||||13.91|6.97|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13.91||||13.91|5.93|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.91||||13.91|8.35|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13.91||||13.91|8.35|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.91||||13.91|5.98|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.91||||13.91|2.92|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13.91||||13.91|2.92|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.91||||13.91|5.98|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.91||||13.91|9.04|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.91||||13.91|6.67|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13.91||||13.91|4.88|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13.91||||13.91|5.98|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.91||||13.91|10.43|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|13.91||||13.91|10.43|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.91||||13.91|6.67|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13.91||||13.91|9.04|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MULTIPLAN [1680]|HMA [168003]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|GEHA [1415]|GEHA [141500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|GEHA [1415]|GEHA [141500]|13.91||||13.91|12.52|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|||13.91||||13.91|4.17|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|||13.91||||13.91|4.17|12.52|2.92 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13.91||||13.91||| 9896|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DOXAZOSIN 4 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13.91||||13.91||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|GEHA [1415]|GEHA [141500]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|||21.80||||21.80|6.54|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21.80||||21.80|10.45|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21.80||||21.80|14.17|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21.80||||21.80|4.58|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21.80||||21.80|9.37|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21.80||||21.80|0.72|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21.80||||21.80|13.08|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|21.80||||21.80|16.35|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21.80||||21.80|9.37|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21.80||||21.80|10.92|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21.80||||21.80|7.65|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21.80||||21.80|9.29|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21.80||||21.80|10.9|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21.80||||21.80|19.62|19.62|0.72 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21.80||||21.80||| 9904|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 2.5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21.80||||21.80||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.49||||41.49|20.75|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.49||||41.49|14.56|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.49||||41.49|17.84|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.49||||41.49|20.79|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41.49||||41.49|14.56|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.49||||41.49|24.89|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41.49||||41.49|24.89|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.49||||41.49|17.84|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.49||||41.49|8.71|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41.49||||41.49|8.71|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|FIRST HEALTH [1375]|QUALCHOICE [137513]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41.49||||41.49|17.84|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.49||||41.49|26.97|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.49||||41.49|19.89|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|||41.49||||41.49|12.45|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41.49||||41.49|20.75|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.49||||41.49|17.67|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41.49||||41.49|26.97|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41.49||||41.49|17.84|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41.49||||41.49|20.79|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41.49||||41.49|17.67|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.49||||41.49|1.44|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41.49||||41.49|1.44|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|||41.49||||41.49|12.45|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41.49||||41.49|19.89|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|41.49||||41.49|31.12|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|41.49||||41.49|31.12|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|GEHA [1415]|GEHA [141500]|41.49||||41.49|37.34|37.34|1.44 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.49||||41.49||| 9905|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|DRONABINOL 5 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41.49||||41.49||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|742.96||||742.96|136.16|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|742.96||||742.96|557.22|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|742.96||||742.96|557.22|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|742.96||||742.96|120.57|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|742.96||||742.96|131|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|||742.96||||742.96|222.89|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|742.96||||742.96|120.57|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|742.96||||742.96|136.16|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|||742.96||||742.96|222.89|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|742.96||||742.96|356.25|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|742.96||||742.96|356.25|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|742.96||||742.96|482.92|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|742.96||||742.96|482.92|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|742.96||||742.96|156.02|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|742.96||||742.96|156.02|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|742.96||||742.96|149.67|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|742.96||||742.96|319.47|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|742.96||||742.96|319.47|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|742.96||||742.96|149.67|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|742.96||||742.96|126.6|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA [141500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|742.96||||742.96|131|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|742.96||||742.96|131|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|742.96||||742.96|445.78|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|742.96||||742.96|445.78|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|742.96||||742.96|260.78|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|742.96||||742.96|316.5|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|742.96||||742.96|319.47|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|742.96||||742.96|319.47|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|742.96||||742.96|131|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|742.96||||742.96|372.22|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|742.96||||742.96|260.78|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|742.96||||742.96|316.5|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|742.96||||742.96|372.22|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|742.96||||742.96|371.48|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|742.96||||742.96|371.48|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|742.96||||742.96|126.6|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|HMA [168003]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|742.96||||742.96|668.66|668.66|120.57 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|742.96||||742.96||| 9938|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|EPOETIN ALFA 10,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|742.96||||742.96||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|||10.00||||10.00|3|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 9967|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|GEHA [1415]|GEHA [141500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|772.27||||772.27|579.2|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|||772.27||||772.27|231.68|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|772.27||||772.27|370.3|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|772.27||||772.27|501.98|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|772.27||||772.27|501.98|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|772.27||||772.27|162.18|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UMR [2035]|UMR OPTIONS [203501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UMR [2035]|UMR OPTIONS [203501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|772.27||||772.27|332.08|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|772.27||||772.27|162.18|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|772.27||||772.27|332.08|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|772.27||||772.27|370.3|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|GEHA [1415]|GEHA [141500]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|||772.27||||772.27|231.68|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|772.27||||772.27|579.2|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|772.27||||772.27|463.36|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|772.27||||772.27|463.36|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|772.27||||772.27|271.07|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|772.27||||772.27|328.99|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|772.27||||772.27|332.08|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|772.27||||772.27|386.91|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|772.27||||772.27|271.07|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|772.27||||772.27|328.99|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|772.27||||772.27|332.08|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MULTIPLAN [1680]|HMA [168003]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MULTIPLAN [1680]|HMA [168003]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|772.27||||772.27|695.04|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|772.27||||772.27|386.91|695.04|162.18 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|772.27||||772.27||| 9969|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ESTRADIOL 0.01% (0.1 MG/GRAM) VAGINAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|772.27||||772.27||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|TRUSTMARK [2030]|STARMARK [203000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHNET [1495]|HEALTHNET [149500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.65||||57.65|24.79|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UMR [2035]|UMR OPTIONS [203501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.65||||57.65|12.11|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.65||||57.65|12.11|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.65||||57.65|24.79|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.65||||57.65|37.47|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.65||||57.65|27.64|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|||57.65||||57.65|17.29|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|||57.65||||57.65|17.29|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|IHC HS [168011]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.65||||57.65|27.64|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|57.65||||57.65|43.24|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CHAMPVA [1240]|CHAMP VA [124000]|57.65||||57.65|43.24|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CORESOURCE [1315]|CORESOURCE [131500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.65||||57.65|37.47|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|GEHA [1415]|GEHA [141500]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.65||||57.65|51.89|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.65||||57.65|24.79|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.65||||57.65|28.88|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.65||||57.65|20.24|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.65||||57.65|24.56|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.65||||57.65|24.79|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.65||||57.65|28.88|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.65||||57.65|20.24|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.65||||57.65|24.56|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA ACO WILCO [101532]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|HMA [168003]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.65||||57.65|34.59|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.65||||57.65|34.59|51.89|12.11 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.65||||57.65||| 99694|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|SEVELAMER CARBONATE 0.8 GRAM ORAL POWDER PACKET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.65||||57.65||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|GEHA [1415]|GEHA [141500]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|||24.98||||24.98|7.49|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24.98||||24.98|16.24|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24.98||||24.98|5.25|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.98||||24.98|10.74|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.98||||24.98|11.98|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|24.98||||24.98|18.74|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24.98||||24.98|14.99|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24.98||||24.98|10.74|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24.98||||24.98|12.51|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24.98||||24.98|8.77|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24.98||||24.98|10.64|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24.98||||24.98|22.48|22.48|5.25 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MULTIPLAN [1680]|HMA [168003]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.98||||24.98||| 9974|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.98||||24.98||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|878.64||||878.64|440.2|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|878.64||||878.64|308.4|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|878.64||||878.64|374.3|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|TRUSTMARK [2030]|STARMARK [203000]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|HEALTHNET [1495]|HEALTHNET [149500]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|FMH BENEFIT SERVICES [1390]|FMH [139000]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MULTIPLAN [1680]|IHC HS [168011]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|878.64||||878.64|377.82|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|FIRST HEALTH [1375]|QUALCHOICE [137513]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|UMR [2035]|UMR OPTIONS [203501]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|878.64||||878.64|184.51|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|878.64||||878.64|527.18|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|878.64||||878.64|377.82|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|878.64||||878.64|571.12|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|878.64||||878.64|421.31|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|||878.64||||878.64|263.59|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|CHAMPVA [1240]|CHAMP VA [124000]|878.64||||878.64|658.98|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|CORESOURCE [1315]|CORESOURCE [131500]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|GEHA [1415]|GEHA [141500]|878.64||||878.64|790.78|790.78|184.51 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|AETNA [1015]|AETNA ACO WILCO [101532]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MULTIPLAN [1680]|HMA [168003]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|878.64||||878.64||| 9977|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|878.64||||878.64||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|||10.00||||10.00|3|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 998|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 0.5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|||10.00||||10.00|3|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 99835|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GUANFACINE ER 1 MG TABLET,EXTENDED RELEASE 24 HR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|GEHA [1415]|GEHA [141500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|||10.00||||10.00|3|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|||10.00||||10.00|3|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|4.8|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|6|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|7.5|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.01|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|3.51|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.26|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 999|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|BENZTROPINE 1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|||0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900006|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC AIRWAY MAINT/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|||0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900017|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC EQUIP REPLACE STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|||0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900053|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT EVAL/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|||0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900054|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TRAVEL/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|||0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900055|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC OT TREATMENT/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|||0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900064|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT EVAL/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|||0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900065|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT INSTRUCT PROGRAM STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|||0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900068|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TRAVEL/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|||0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900069|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PT TREATMENT/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|||0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900070|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULM REHAB/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|||0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900073|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC PULSE OXIMETRY STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|||0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900085|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RESP CARE ASSESS 15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|||0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900090|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC RT ASSIST/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|||0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900104|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST EVAL/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|||0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900106|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC ST TREATMENT/15 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|GEHA [1415]|GEHA [141500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|FIRST HEALTH [1375]|QUALCHOICE [137513]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MULTIPLAN [1680]|IHC HS [168011]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MULTIPLAN [1680]|HMA [168003]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|AETNA [1015]|AETNA ACO WILCO [101532]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|||0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 99900109|EAP|0999 - PATIENT CONVENIENCE ITEMS-OTHER CONVENIENCE|HC TRACH CARE 30 MIN STATISTIC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|0.00||||0.00||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|CHAMPVA [1240]|CHAMP VA [124000]|867536.26||||||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|867536.26|299257.84|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|867536.26|715128.4|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|867536.26|6525|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|AETNA [1015]|AETNA ACO WILCO [101532]|867536.26|397401.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|TRUSTMARK [2030]|STARMARK [203000]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|HEALTHNET [1495]|HEALTHNET [149500]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MULTIPLAN [1680]|IHC HS [168011]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MULTIPLAN [1680]|HMA [168003]|867536.26|45607.35|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|867536.26|191788.8|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|867536.26|345809.06|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|UMR [2035]|UMR OPTIONS [203501]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|867536.26|21250|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|867536.26|332508.72|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|867536.26|665017.43|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|867536.26|299257.84|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|867536.26|321382.26|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|867536.26|432261.32|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|867536.26|345809.06|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|||867536.26|260260.88|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|867536.26|386308.63|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|867536.26|180219.39|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|867536.26|191788.8|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|867536.26|368653.12|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|CORESOURCE [1315]|CORESOURCE [131500]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|867536.26|715128.4|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|GEHA [1415]|GEHA [141500]|867536.26|598515.68|715128.4|6525|||| MS001|DRG||Heart Transplant Or Implant Of Heart Assist System With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|867536.26|598515.68|715128.4|6525|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|GEHA [1415]|GEHA [141500]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|912661.71|517336.93|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|CORESOURCE [1315]|CORESOURCE [131500]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|CHAMPVA [1240]|CHAMP VA [124000]|912661.71|683532.24|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|912661.71|165925.13|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|912661.71|367307.19|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|||912661.71|273798.51|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|912661.71|410999.6|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|912661.71|220433.86|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|912661.71|316153.54|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|UMR [2035]|UMR OPTIONS [203501]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|912661.71|328799.68|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|912661.71|165925.13|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MULTIPLAN [1680]|IHC HS [168011]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MULTIPLAN [1680]|HMA [168003]|912661.71|8186.47|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|912661.71|632307.07|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|HEALTHNET [1495]|HEALTHNET [149500]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|TRUSTMARK [2030]|STARMARK [203000]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|912661.71|14500|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|912661.71|31450|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|912661.71|517336.93|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|912661.71|569076.37|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|912661.71|284538.18|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|912661.71|284538.18|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|912661.71|328799.68|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|912661.71|156132.7|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|912661.71|241377.92|683532.24|8186.47|||| MS003|DRG||Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major O.R. Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|912661.71|569076.37|683532.24|8186.47|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|CHAMPVA [1240]|CHAMP VA [124000]|559531.80||||||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|559531.80|177607.09|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|559531.80|153698.44|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|559531.80|153698.44|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|559531.80|261823.96|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|559531.80|17850|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|559531.80|9425|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|TRUSTMARK [2030]|STARMARK [203000]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|HEALTHNET [1495]|HEALTHNET [149500]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MULTIPLAN [1680]|IHC HS [168011]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MULTIPLAN [1680]|HMA [168003]|559531.80|5537.96|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|559531.80|98444.36|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|559531.80|177607.09|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|UMR [2035]|UMR OPTIONS [203501]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|559531.80|170776.05|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|559531.80|341552.09|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|559531.80|134254.39|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|559531.80|222008.86|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|||559531.80|167859.54|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|559531.80|198407.61|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|559531.80|74825.38|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|559531.80|98444.36|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|559531.80|171421.85|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|CORESOURCE [1315]|CORESOURCE [131500]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|559531.80|261823.96|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|GEHA [1415]|GEHA [141500]|559531.80|307396.89|341552.09|5537.96|||| MS004|DRG||Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R. Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|559531.80|307396.89|341552.09|5537.96|||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|GEHA [1415]|GEHA [141500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|CHAMPVA [1240]|CHAMP VA [124000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|UMR [2035]|UMR OPTIONS [203501]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MULTIPLAN [1680]|IHC HS [168011]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MULTIPLAN [1680]|HMA [168003]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|HEALTHNET [1495]|HEALTHNET [149500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|TRUSTMARK [2030]|STARMARK [203000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|CORESOURCE [1315]|CORESOURCE [131500]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72688.03||||||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72688.03|42224.48|42224.48|2550|||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72688.03|40360.07|42224.48|2550|||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|||72688.03|21806.41|42224.48|2550|||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72688.03|40360.07|42224.48|2550|||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72688.03|2550|42224.48|2550|||| MS011|DRG||Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72688.03|42224.48|42224.48|2550|||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|AETNA [1015]|AETNA ACO WILCO [101532]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|TRUSTMARK [2030]|STARMARK [203000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|HEALTHNET [1495]|HEALTHNET [149500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MULTIPLAN [1680]|IHC HS [168011]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MULTIPLAN [1680]|HMA [168003]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|UMR [2035]|UMR OPTIONS [203501]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|CHAMPVA [1240]|CHAMP VA [124000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|CORESOURCE [1315]|CORESOURCE [131500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|GEHA [1415]|GEHA [141500]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|255758.12||||||| MS020|DRG||Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With McC|||255758.12|76727.44|76727.44|76727.44|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|GEHA [1415]|GEHA [141500]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|168348.65|97793.75|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|CORESOURCE [1315]|CORESOURCE [131500]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|CHAMPVA [1240]|CHAMP VA [124000]|168348.65|154721.72|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|168348.65|43539.8|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|168348.65|47966.4|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|||168348.65|50504.59|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|168348.65|53672.15|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|168348.65|65326.87|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|168348.65|74291.05|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|UMR [2035]|UMR OPTIONS [203501]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|168348.65|42748.24|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|168348.65|43539.8|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|FIRST HEALTH [1375]|QUALCHOICE [137513]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|FMH BENEFIT SERVICES [1390]|FMH [139000]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MULTIPLAN [1680]|IHC HS [168011]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MULTIPLAN [1680]|HMA [168003]|168348.65|93.45|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|168348.65|82572.54|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|HEALTHNET [1495]|HEALTHNET [149500]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|TRUSTMARK [2030]|STARMARK [203000]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|AETNA [1015]|COVENTRY HEALTHCARE [101502]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|AETNA [1015]|AETNA ACO WILCO [101532]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|168348.65|725|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|168348.65|8500|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|168348.65|97793.75|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|168348.65|74315.28|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|168348.65|8377.89|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|168348.65|80183.83|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|168348.65|42748.24|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|168348.65|35401.49|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|168348.65|8357.47|154721.72|93.45|||| MS023|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With McC Or Chemotherapy Implant Or Epilepsy With Neurostimulator|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|168348.65|74315.28|154721.72|93.45|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151683.10|57021.25|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|151683.10|1450|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|TRUSTMARK [2030]|STARMARK [203000]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|HEALTHNET [1495]|HEALTHNET [149500]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MULTIPLAN [1680]|IHC HS [168011]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151683.10|55688.13|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MULTIPLAN [1680]|HMA [168003]|151683.10|198.56|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151683.10|56755.47|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151683.10|56755.47|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|UMR [2035]|UMR OPTIONS [203501]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151683.10|51800.53|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151683.10|109145.13|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151683.10|46711.9|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151683.10||||||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151683.10|70944.34|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|||151683.10|45504.93|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151683.10|63402.41|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|CHAMPVA [1240]|CHAMP VA [124000]|151683.10|202765.2|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|151683.10|50231.59|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|CORESOURCE [1315]|CORESOURCE [131500]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|GEHA [1415]|GEHA [141500]|151683.10|98230.62|202765.2|198.56|||| MS024|DRG||Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151683.10|98230.62|202765.2|198.56|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|195024.65|5075|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|195024.65|5950|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|195024.65|153096|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|195024.65|58812.55|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|195024.65|65129.65|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|195024.65|63606.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|195024.65|104204.4|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|195024.65|58222.53|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|||195024.65|58507.39|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|195024.65|104204.4|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|GEHA [1415]|GEHA [141500]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|195024.65|51108.04|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MULTIPLAN [1680]|HMA [168003]|195024.65|4194.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|195024.65|42622.39|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|195024.65|130255.5|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|195024.65|116408.33|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|195024.65|42622.39|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|195024.65|153096|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|195024.65|28126.7|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|195024.65|57943|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|195024.65|180353.77|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|195024.65|65256.96|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|195024.65|200393.07|200393.07|4194.96|||| MS025|DRG||Craniotomy And Endovascular Intracranial Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|195024.65|180353.77|200393.07|4194.96|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120140.48|49931.58|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120140.48|26753.71|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120140.48|55871.13|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120140.48|35422.65|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|120140.48|174915.21|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|||120140.48|36042.14|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|120140.48|1450|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|120140.48|46995.67|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|120140.48|26753.71|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120140.48|43304.34|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120140.48|85955.58|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120140.48|46995.67|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120140.48|44341|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120140.48|40520.79|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120140.48|850|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|120140.48|251.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120140.48|24233.88|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120140.48|19216.87|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|GEHA [1415]|GEHA [141500]|120140.48|77360.02|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|120140.48|39204.1|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|120140.48|31369.64|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120140.48|24233.88|174915.21|251.64|||| MS026|DRG||Craniotomy And Endovascular Intracranial Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120140.48|77360.02|174915.21|251.64|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128149.79|36421.1|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128149.79|35569.6|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128149.79|67995.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128149.79|81023.98|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128149.79|130760.09|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|128149.79|151360.66|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|||128149.79|38444.94|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128149.79|20296.69|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128149.79|84994.06|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128149.79|75958.54|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128149.79|27873.62|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128149.79|81023.98|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|128149.79|8987.83|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|128149.79|39903.21|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128149.79|31995.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128149.79|35590.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128149.79|67995.25|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128149.79|725|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128149.79|15822.44|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128149.79|20296.69|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128149.79|1700|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128149.79|117684.08|151360.66|725|||| MS027|DRG||Craniotomy And Endovascular Intracranial Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128149.79|117684.08|151360.66|725|||| MS028|DRG||Spinal Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|MULTIPLAN [1680]|HMA [168003]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|GEHA [1415]|GEHA [141500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158665.82|126228.52|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158665.82|15300|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|158665.82|22744.9|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|||158665.82|47599.75|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|158665.82|126228.52|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158665.82||||||| MS028|DRG||Spinal Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158665.82|22744.9|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|158665.82|35799.22|126228.52|15300|||| MS028|DRG||Spinal Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158665.82|35799.22|126228.52|15300|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79929.55|25495.2|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79929.55|47777.5|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79929.55|46660.5|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79929.55|22321.8|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|CHAMPVA [1240]|CHAMP VA [124000]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|GEHA [1415]|GEHA [141500]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79929.55|59539.64|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|||79929.55|23978.86|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79929.55|38700.76|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79929.55|34586.58|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79929.55|44260.42|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|FIRST HEALTH [1375]|QUALCHOICE [137513]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|FMH BENEFIT SERVICES [1390]|FMH [139000]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|HEALTHNET [1495]|HEALTHNET [149500]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79929.55|87652.17|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MULTIPLAN [1680]|IHC HS [168011]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MULTIPLAN [1680]|HMA [168003]|79929.55|721.19|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|TRUSTMARK [2030]|STARMARK [203000]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|UMR [2035]|UMR OPTIONS [203501]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79929.55|37297.41|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79929.55|22321.8|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|CORESOURCE [1315]|CORESOURCE [131500]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79929.55||||||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79929.55|6800|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79929.55|87652.17|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79929.55|725|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79929.55|25495.2|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|AETNA [1015]|AETNA ACO WILCO [101532]|79929.55|40107.74|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79929.55|53585.68|87652.17|721.19|||| MS029|DRG||Spinal Procedures With Cc Or Spinal Neurostimulators|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79929.55|40107.74|87652.17|721.19|||| MS030|DRG||Spinal Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|188923.59|98240.27|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|188923.59|1299.55|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|188923.59|33378.89|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|188923.59|725|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|188923.59|98240.27|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|188923.59|34177.95|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|188923.59|122800.34|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|188923.59|26424.52|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|188923.59|188923.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|188923.59|109745.72|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|188923.59|28415.59|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|188923.59||||||| MS030|DRG||Spinal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|||188923.59|56677.08|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|188923.59|170031.24|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|188923.59|28842.22|188923.59|725|||| MS030|DRG||Spinal Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|188923.59|170031.24|188923.59|725|||| MS031|DRG||Ventricular Shunt Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|GEHA [1415]|GEHA [141500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MULTIPLAN [1680]|HMA [168003]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|||146325.62|43897.69|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146325.62|25677.36|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146325.62|178679.75|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146325.62|11900|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146325.62|25677.36|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146325.62||||||| MS031|DRG||Ventricular Shunt Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146325.62|25785.45|178679.75|11900|||| MS031|DRG||Ventricular Shunt Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146325.62|178679.75|178679.75|11900|||| MS032|DRG||Ventricular Shunt Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|GEHA [1415]|GEHA [141500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|||103424.91|31027.47|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103424.91|9378.38|31027.47|9378.38|||| MS032|DRG||Ventricular Shunt Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103424.91||||||| MS032|DRG||Ventricular Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103424.91||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90192.39||||||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|||90192.39|27057.72|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90192.39|10906.1|27057.72|10906.1|||| MS033|DRG||Ventricular Shunt Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90192.39|10906.1|27057.72|10906.1|||| MS034|DRG||Carotid Artery Stent Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|GEHA [1415]|GEHA [141500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92902.86|44738.62|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|92902.86|44738.62|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92902.86|1700|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|||92902.86|27870.86|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|MULTIPLAN [1680]|HMA [168003]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92902.86|43945.41|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92902.86||||||| MS034|DRG||Carotid Artery Stent Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|92902.86|43945.41|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|92902.86|24904.85|44738.62|1700|||| MS034|DRG||Carotid Artery Stent Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92902.86|24904.85|44738.62|1700|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|GEHA [1415]|GEHA [141500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93622.49||||||| MS035|DRG||Carotid Artery Stent Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93622.49|14736.76|28086.75|14736.76|||| MS035|DRG||Carotid Artery Stent Procedures With Cc|||93622.49|28086.75|28086.75|14736.76|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80192.88|51837.99|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80192.88|12593.77|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80192.88|850|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|||80192.88|24057.86|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|80192.88|51837.99|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80192.88|11713.05|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80192.88||||||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|80192.88|12593.77|51837.99|850|||| MS036|DRG||Carotid Artery Stent Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80192.88|11713.05|51837.99|850|||| MS037|DRG||Extracranial Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|121701.06|98532.97|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|GEHA [1415]|GEHA [141500]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|121701.06|110253.8|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|||121701.06|36510.32|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|121701.06|37719.58|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|121701.06|163199.02|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|121701.06|20369.85|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|121701.06|169621.22|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MULTIPLAN [1680]|HMA [168003]|121701.06|927.96|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|121701.06|42843.53|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|121701.06|7975|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|121701.06|88203.03|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|121701.06|6800|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|121701.06||||||| MS037|DRG||Extracranial Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|121701.06|20369.85|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|121701.06|46373.03|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|121701.06|47483.15|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|121701.06|152659.1|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|121701.06|27760.81|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|121701.06|88203.03|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|121701.06|20563.56|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|121701.06|163199.02|169621.22|927.96|||| MS037|DRG||Extracranial Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|121701.06|152659.1|169621.22|927.96|||| MS038|DRG||Extracranial Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65787.36|23469.03|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65787.36|24030.85|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65787.36|59833.06|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65787.36|98982.12|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65787.36|5950|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65787.36|3625|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|65787.36||||||| MS038|DRG||Extracranial Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|65787.36|330.77|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65787.36|59833.06|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65787.36|21195.3|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65787.36|115063.57|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65787.36|19482.58|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65787.36|98982.12|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65787.36|74791.33|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|||65787.36|19736.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65787.36|66840.44|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65787.36|15326.91|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|GEHA [1415]|GEHA [141500]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65787.36|15326.91|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|65787.36|24875.08|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65787.36|10512.09|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65787.36|103557.21|115063.57|330.77|||| MS038|DRG||Extracranial Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65787.36|10512.09|115063.57|330.77|||| MS039|DRG||Extracranial Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63944.69|8544.97|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63944.69|13157.02|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|||63944.69|19183.41|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63944.69|44305.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|63944.69|84967.98|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63944.69|12126.45|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63944.69|15057.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|63944.69|229.97|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63944.69|725|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63944.69|76270.24|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63944.69|850|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63944.69|49575.65|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63944.69|36189.57|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63944.69|12126.45|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63944.69|8544.97|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63944.69|68643.22|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63944.69|7291.06|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63944.69|16515.5|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63944.69|14148.39|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63944.69|36189.57|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63944.69|16129.38|84967.98|229.97|||| MS039|DRG||Extracranial Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63944.69|14148.39|84967.98|229.97|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138428.38|30652.7|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138428.38|51481.46|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138428.38|96335.01|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MULTIPLAN [1680]|HMA [168003]|138428.38|7320.88|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138428.38|45826.85|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138428.38|55961|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|GEHA [1415]|GEHA [141500]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138428.38|62617.76|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|||138428.38|41528.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|138428.38|34174.24|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138428.38|56046.41|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138428.38||||||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138428.38||||||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138428.38||||||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138428.38||||||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138428.38|30652.7|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138428.38|57388.1|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138428.38|24808.74|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138428.38|1450|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|138428.38|58513.72|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138428.38||||||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|138428.38|86701.51|96335.01|1450|||| MS040|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138428.38|24808.74|96335.01|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94473.26|65583.61|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|94473.26|76673.33|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|CORESOURCE [1315]|CORESOURCE [131500]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|CHAMPVA [1240]|CHAMP VA [124000]|94473.26|79121.09|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94473.26|58611.57|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|||94473.26|28341.98|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94473.26|27580.55|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94473.26|100897.85|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94473.26|31516.47|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94473.26|14490|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94473.26|52466.88|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MULTIPLAN [1680]|HMA [168003]|94473.26|6952.69|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MULTIPLAN [1680]|IHC HS [168011]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|HEALTHNET [1495]|HEALTHNET [149500]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|TRUSTMARK [2030]|STARMARK [203000]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|FIRST HEALTH [1375]|QUALCHOICE [137513]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|FMH BENEFIT SERVICES [1390]|FMH [139000]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|AETNA [1015]|AETNA ACO WILCO [101532]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|94473.26|1450|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|UMR [2035]|UMR OPTIONS [203501]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94473.26|3400|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|GEHA [1415]|GEHA [141500]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94473.26|13981.49|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94473.26|76673.33|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94473.26|11085.22|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94473.26|33289.68|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94473.26|90808.07|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94473.26|10557.35|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|94473.26|13981.49|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|94473.26|30201.05|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94473.26|52466.88|100897.85|1450|||| MS041|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94473.26|34086.6|100897.85|1450|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81125.98||||||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81125.98||||||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|81125.98||||||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81125.98||||||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81125.98||||||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81125.98|26692.07|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81125.98|27331.05|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81125.98|2900|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|81125.98|577.22|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81125.98|15008.2|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81125.98|25829.96|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81125.98|89904.35|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81125.98|15008.2|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81125.98|21495.73|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81125.98||||||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81125.98|27446.68|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81125.98|58437.82|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|||81125.98|24337.79|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81125.98|52225.46|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81125.98|11926.52|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81125.98|80913.91|89904.35|577.22|||| MS042|DRG||Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81125.98|27446.68|89904.35|577.22|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103664.18|18903.69|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|GEHA [1415]|GEHA [141500]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|103664.18||||||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103664.18|60218.53|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103664.18|21632|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|||103664.18|31099.25|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103664.18|18944.11|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103664.18|29082.61|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103664.18|5175|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103664.18|12769|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103664.18|28007.84|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MULTIPLAN [1680]|HMA [168003]|103664.18|77.73|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103664.18|20403.03|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103664.18|35492.67|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103664.18|1450|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103664.18|13600|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103664.18|60218.53|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103664.18|11013.07|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103664.18|26174.35|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103664.18|10488.64|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103664.18|24188.66|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103664.18|26128.46|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103664.18|26753.95|60218.53|77.73|||| MS052|DRG||Spinal Disorders And Injuries With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103664.18|12769|60218.53|77.73|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|GEHA [1415]|GEHA [141500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66124.90|26236.02|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66124.90|28848.11|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66124.90|5100|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66124.90||||||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66124.90|14490|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66124.90|28848.11|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66124.90|8112|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66124.90|28848.11|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|||66124.90|19837.47|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66124.90|24986.69|28848.11|5100|||| MS053|DRG||Spinal Disorders And Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66124.90|10502.94|28848.11|5100|||| MS054|DRG||Nervous System Neoplasms With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67353.64|70296.33|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|CORESOURCE [1315]|CORESOURCE [131500]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|CHAMPVA [1240]|CHAMP VA [124000]|67353.64|35827.9|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67353.64|9509.55|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67353.64|21097.32|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|||67353.64|20206.09|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67353.64|15585.36|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67353.64|36318.32|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67353.64|17778.8|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67353.64|10536.26|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MULTIPLAN [1680]|HMA [168003]|67353.64|270.95|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|HEALTHNET [1495]|HEALTHNET [149500]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|GEHA [1415]|GEHA [141500]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|TRUSTMARK [2030]|STARMARK [203000]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67353.64|9509.55|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|AETNA [1015]|AETNA ACO WILCO [101532]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67353.64|23606.9|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|UMR [2035]|UMR OPTIONS [203501]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67353.64|725|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67353.64|8500|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67353.64|70296.33|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67353.64|19804.1|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67353.64|19341.09|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67353.64|32686.49|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67353.64|8700.53|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67353.64|10536.26|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67353.64|19900.07|70296.33|270.95|||| MS054|DRG||Nervous System Neoplasms With McC|MULTIPLAN [1680]|IHC HS [168011]|67353.64|32686.49|70296.33|270.95|||| MS055|DRG||Nervous System Neoplasms Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71001.28|7170.57|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71001.28|6039|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71001.28|15129.3|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71001.28|22470.91|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71001.28|39595.96|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71001.28|9350|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|TRUSTMARK [2030]|STARMARK [203000]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|HEALTHNET [1495]|HEALTHNET [149500]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MULTIPLAN [1680]|HMA [168003]|71001.28|140.22|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71001.28|19255.39|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|UMR [2035]|UMR OPTIONS [203501]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71001.28|10350|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MULTIPLAN [1680]|IHC HS [168011]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71001.28|10260|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71001.28|13513.24|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71001.28|6525|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71001.28|62176.63|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71001.28|11467.18|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71001.28|40414.81|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71001.28|10260|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71001.28|8613|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|||71001.28|21300.38|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71001.28|36118.41|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71001.28|4973.31|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71001.28|21400.87|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|CHAMPVA [1240]|CHAMP VA [124000]|71001.28|55688.84|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|GEHA [1415]|GEHA [141500]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71001.28|39595.96|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|CORESOURCE [1315]|CORESOURCE [131500]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71001.28|5368|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71001.28|15548|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71001.28|55958.97|62176.63|140.22|||| MS055|DRG||Nervous System Neoplasms Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|71001.28|55958.97|62176.63|140.22|||| MS056|DRG||Degenerative Nervous System Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|99315.47|62636.64|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|99315.47|24388.4|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99315.47|22984|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99315.47|42285.9|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|GEHA [1415]|GEHA [141500]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|||99315.47|29794.64|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99315.47|47315.95|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|99315.47|24388.4|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99315.47|25497.61|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99315.47|72793.76|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99315.47|24388.4|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99315.47|15525|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MULTIPLAN [1680]|HMA [168003]|99315.47|682.95|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99315.47|25870.52|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99315.47|24388.4|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|99315.47|24388.4|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|99315.47|29758.33|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|99315.47|24388.4|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|99315.47|5800|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99315.47|14450|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99315.47|24388.4|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|99315.47|75600.35|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99315.47|62636.64|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99315.47|24420.5|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|99315.47|6373.84|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99315.47|65514.38|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|99315.47|5368|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99315.47|4420.72|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99315.47|23257.62|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99315.47|9120|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99315.47|7656|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99315.47|30569.49|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99315.47|9120|75600.35|682.95|||| MS056|DRG||Degenerative Nervous System Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99315.47|24388.4|75600.35|682.95|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88886.35|49348.22|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88886.35|14820|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|88886.35|10357.49|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|88886.35|8723|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88886.35|18330.9|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88886.35|24420.5|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88886.35|33237|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88886.35|10200|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|88886.35|9425|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88886.35|13544.41|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|88886.35|13544.41|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|TRUSTMARK [2030]|STARMARK [203000]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MULTIPLAN [1680]|IHC HS [168011]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MULTIPLAN [1680]|HMA [168003]|88886.35|271.12|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|88886.35|21005.88|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88886.35|15525|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|UMR [2035]|UMR OPTIONS [203501]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88886.35|14820|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88886.35|13544.41|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88886.35|15346.55|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88886.35|79645.02|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88886.35|14081.6|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|88886.35|13544.41|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88886.35|51769.27|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|||88886.35|26665.9|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88886.35|46265.78|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88886.35|33237|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88886.35|12441|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88886.35|7183.67|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88886.35|16900|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|CORESOURCE [1315]|CORESOURCE [131500]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|HEALTHNET [1495]|HEALTHNET [149500]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|GEHA [1415]|GEHA [141500]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|88886.35|49348.22|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|88886.35|13544.41|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|CHAMPVA [1240]|CHAMP VA [124000]|88886.35|61616.25|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88886.35|71680.52|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|88886.35|13544.41|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88886.35|23257.62|79645.02|271.12|||| MS057|DRG||Degenerative Nervous System Disorders Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88886.35|71680.52|79645.02|271.12|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|CORESOURCE [1315]|CORESOURCE [131500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|CHAMPVA [1240]|CHAMP VA [124000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MULTIPLAN [1680]|IHC HS [168011]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|TRUSTMARK [2030]|STARMARK [203000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|HEALTHNET [1495]|HEALTHNET [149500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|AETNA [1015]|AETNA ACO WILCO [101532]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MULTIPLAN [1680]|HMA [168003]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|GEHA [1415]|GEHA [141500]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|||68676.76|20603.03|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68676.76|12177.91|20603.03|12177.91|||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|UMR [2035]|UMR OPTIONS [203501]|68676.76||||||| MS058|DRG||Multiple Sclerosis And Cerebellar Ataxia With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68676.76|12177.91|20603.03|12177.91|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|CHAMPVA [1240]|CHAMP VA [124000]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60257.23|12540|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60257.23|8764.03|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60257.23|6078.49|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60257.23|10527|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60257.23|16334.25|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60257.23|35493|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60257.23|8500|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60257.23|7975|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MULTIPLAN [1680]|HMA [168003]|60257.23|64.77|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|HEALTHNET [1495]|HEALTHNET [149500]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MULTIPLAN [1680]|IHC HS [168011]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60257.23|17504.9|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60257.23|12540|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|UMR [2035]|UMR OPTIONS [203501]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|TRUSTMARK [2030]|STARMARK [203000]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60257.23|7381|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60257.23|14500.2|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60257.23|60257.23|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60257.23|12682.52|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60257.23||||||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60257.23|39167.2|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|||60257.23|18077.17|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60257.23|35003.44|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|GEHA [1415]|GEHA [141500]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60257.23|35493|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|CORESOURCE [1315]|CORESOURCE [131500]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60257.23|13520|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60257.23|54231.5|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60257.23|13638.13|60257.23|64.77|||| MS059|DRG||Multiple Sclerosis And Cerebellar Ataxia With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60257.23|54231.5|60257.23|64.77|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|42238.94||||||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|GEHA [1415]|GEHA [141500]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42238.94|24898.54|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|||42238.94|12671.68|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42238.94|25156.57|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42238.94|10254.17|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42238.94|38702.42|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42238.94|12253.43|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42238.94|7980|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|42238.94|87.55|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42238.94|11421.7|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42238.94|22482.24|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42238.94|5075|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42238.94|5950|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42238.94|9464|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42238.94|24898.54|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42238.94|6699|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42238.94|7980|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42238.94|5577.11|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42238.94|34832.18|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42238.94|6037.86|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42238.94|5902.73|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42238.94|4697|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42238.94|3868.13|38702.42|87.55|||| MS060|DRG||Multiple Sclerosis And Cerebellar Ataxia Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42238.94|13276.2|38702.42|87.55|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119459.88||||||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119459.88||||||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119459.88||||||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119459.88||||||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|CHAMPVA [1240]|CHAMP VA [124000]|119459.88||||||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119459.88|40899.8|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119459.88|41878.9|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119459.88|6525|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|TRUSTMARK [2030]|STARMARK [203000]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MULTIPLAN [1680]|IHC HS [168011]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119459.88|100019.43|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|UMR [2035]|UMR OPTIONS [203501]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MULTIPLAN [1680]|HMA [168003]|119459.88|9190.26|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119459.88|37827.61|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119459.88|192345.05|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119459.88|100019.43|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|HEALTHNET [1495]|HEALTHNET [149500]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|AETNA [1015]|AETNA ACO WILCO [101532]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119459.88|32488.41|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119459.88|125024.28|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|||119459.88|35837.96|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119459.88|111733.26|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119459.88|18161.62|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119459.88|33765.99|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119459.88||||||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|GEHA [1415]|GEHA [141500]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|CORESOURCE [1315]|CORESOURCE [131500]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119459.88|173110.55|192345.05|6525|||| MS061|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119459.88|18161.62|192345.05|6525|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75829.92|38868.29|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|CHAMPVA [1240]|CHAMP VA [124000]|75829.92||||||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|GEHA [1415]|GEHA [141500]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|CORESOURCE [1315]|CORESOURCE [131500]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|||75829.92|22748.98|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75829.92|43491.81|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75829.92|23390.26|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75829.92|66910.48|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75829.92|26121.99|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75829.92|14983.16|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MULTIPLAN [1680]|HMA [168003]|75829.92|7681.37|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MULTIPLAN [1680]|IHC HS [168011]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|HEALTHNET [1495]|HEALTHNET [149500]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|TRUSTMARK [2030]|STARMARK [203000]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75829.92|18713.53|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|UMR [2035]|UMR OPTIONS [203501]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75829.92|725|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75829.92|850|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75829.92|39243|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75829.92|18713.53|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75829.92|39243|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75829.92|28140.74|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75829.92|12562.27|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75829.92|14983.16|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75829.92|29865.7|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75829.92|28814.4|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75829.92|60219.43|66910.48|725|||| MS062|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75829.92|29865.7|66910.48|725|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63112.75|24793.55|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63112.75||||||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63112.75||||||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63112.75||||||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63112.75||||||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63112.75|12191.64|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63112.75|24213.89|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63112.75|1450|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63112.75|12191.64|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63112.75|21860.49|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63112.75|59002.21|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63112.75|19547.7|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63112.75||||||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|63112.75|7638.37|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63112.75|38351.44|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|||63112.75|18933.82|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63112.75|34274.4|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|GEHA [1415]|GEHA [141500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|63112.75|55646.11|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63112.75|53101.99|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63112.75|10838.97|59002.21|1450|||| MS063|DRG||Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63112.75|53101.99|59002.21|1450|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|||61727.92|18518.38|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61727.92|28236.65|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61727.92|21803.92|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61727.92|11962.91|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61727.92|43441|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61727.92|23910.12|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|UMR [2035]|UMR OPTIONS [203501]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61727.92|14035.16|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61727.92|13294.09|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MULTIPLAN [1680]|IHC HS [168011]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MULTIPLAN [1680]|HMA [168003]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|AETNA [1015]|AETNA ACO WILCO [101532]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|TRUSTMARK [2030]|STARMARK [203000]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61727.92|3625|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61727.92|4250|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|HEALTHNET [1495]|HEALTHNET [149500]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61727.92|10810.99|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61727.92|79447.09|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61727.92|23446.83|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61727.92|25234.86|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61727.92|12001.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61727.92|23446.83|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61727.92|23446.83|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61727.92|12101.15|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61727.92|14035.16|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61727.92|27089.99|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61727.92|27738.5|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|GEHA [1415]|GEHA [141500]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61727.92|79447.09|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|CORESOURCE [1315]|CORESOURCE [131500]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61727.92|27840.2|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|CHAMPVA [1240]|CHAMP VA [124000]|61727.92|106827.02|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61727.92|39096.9|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61727.92|13294.09|106827.02|3625|||| MS064|DRG||Intracranial Hemorrhage Or Cerebral Infarction With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61727.92|39096.9|106827.02|3625|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41292.61|15092.64|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41292.61|15092.64|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41292.61|14418.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41292.61|14763.9|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41292.61|1450|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|AETNA [1015]|AETNA ACO WILCO [101532]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|TRUSTMARK [2030]|STARMARK [203000]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|HEALTHNET [1495]|HEALTHNET [149500]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MULTIPLAN [1680]|IHC HS [168011]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MULTIPLAN [1680]|HMA [168003]|41292.61|204.18|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|FMH BENEFIT SERVICES [1390]|FMH [139000]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|FIRST HEALTH [1375]|QUALCHOICE [137513]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41292.61|11699.63|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41292.61|8594.22|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|UMR [2035]|UMR OPTIONS [203501]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41292.61|850|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41292.61|13940.47|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41292.61|24557.52|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41292.61|37334.55|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41292.61|11952.15|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41292.61|24267.45|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41292.61|8594.22|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|||41292.61|12387.78|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41292.61|21687.63|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41292.61|6540.32|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41292.61|11699.63|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|CHAMPVA [1240]|CHAMP VA [124000]|41292.61|37765.91|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41292.61|12852.73|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|CORESOURCE [1315]|CORESOURCE [131500]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41292.61|24557.52|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|GEHA [1415]|GEHA [141500]|41292.61|33601.09|37765.91|204.18|||| MS065|DRG||Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41292.61|33601.09|37765.91|204.18|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|GEHA [1415]|GEHA [141500]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32562.38|5952.48|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|32562.38|20440.5|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32562.38|15297.74|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|||32562.38|9768.71|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32562.38|8338.71|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32562.38|26334.54|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32562.38|10094.03|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32562.38|6080.48|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32562.38|6718.69|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|32562.38|82.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32562.38|17117.45|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32562.38|2175|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32562.38|850|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32562.38|6718.69|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32562.38|5952.48|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32562.38|23701.09|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32562.38|10308.05|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32562.38|10067.05|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32562.38|6080.48|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32562.38|4630.6|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32562.38|8967.02|26334.54|82.09|||| MS066|DRG||Intracranial Hemorrhage Or Cerebral Infarction Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32562.38|23701.09|26334.54|82.09|||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|TRUSTMARK [2030]|STARMARK [203000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|HEALTHNET [1495]|HEALTHNET [149500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MULTIPLAN [1680]|IHC HS [168011]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MULTIPLAN [1680]|HMA [168003]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|AETNA [1015]|AETNA ACO WILCO [101532]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|UMR [2035]|UMR OPTIONS [203501]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|CHAMPVA [1240]|CHAMP VA [124000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|CORESOURCE [1315]|CORESOURCE [131500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|GEHA [1415]|GEHA [141500]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71664.45||||||| MS067|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction With McC|||71664.45|21499.33|21499.33|21499.33|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|CHAMPVA [1240]|CHAMP VA [124000]|39875.83||||||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|GEHA [1415]|GEHA [141500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39875.83|13360.58|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|CORESOURCE [1315]|CORESOURCE [131500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39875.83|10427.2|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|||39875.83|11962.75|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|UMR [2035]|UMR OPTIONS [203501]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39875.83|10427.2|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MULTIPLAN [1680]|IHC HS [168011]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MULTIPLAN [1680]|HMA [168003]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|HEALTHNET [1495]|HEALTHNET [149500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|TRUSTMARK [2030]|STARMARK [203000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39875.83|850|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39875.83|13360.58|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39875.83|5734.94|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39875.83|13020.39|13360.58|850|||| MS068|DRG||Nonspecific Cva And Precerebral Occlusion Without Infarction Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39875.83|13020.39|13360.58|850|||| MS069|DRG||Transient Ischemia Without Thrombolytic|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34159.81|5640.39|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34159.81|11398.45|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34159.81|5145.91|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34159.81|725|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|AETNA [1015]|AETNA ACO WILCO [101532]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|TRUSTMARK [2030]|STARMARK [203000]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|HEALTHNET [1495]|HEALTHNET [149500]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MULTIPLAN [1680]|IHC HS [168011]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MULTIPLAN [1680]|HMA [168003]|34159.81|77|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|FMH BENEFIT SERVICES [1390]|FMH [139000]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|FIRST HEALTH [1375]|QUALCHOICE [137513]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34159.81|6572.84|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34159.81|5640.39|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|UMR [2035]|UMR OPTIONS [203501]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34159.81|850|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34159.81|10168.39|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34159.81|35836.19|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34159.81|15152.39|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34159.81|11131.96|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34159.81|9074.89|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34159.81|23293.52|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|||34159.81|10247.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34159.81|20817.25|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34159.81|5097.94|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34159.81|6572.84|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|CHAMPVA [1240]|CHAMP VA [124000]|34159.81|16811.39|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34159.81|11587.21|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|CORESOURCE [1315]|CORESOURCE [131500]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34159.81|15152.39|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|GEHA [1415]|GEHA [141500]|34159.81|32252.57|35836.19|77|||| MS069|DRG||Transient Ischemia Without Thrombolytic|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34159.81|32252.57|35836.19|77|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|69443.44||||||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|GEHA [1415]|GEHA [141500]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69443.44|13520|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69443.44|51151.4|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|||69443.44|20833.03|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69443.44|19455.83|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69443.44|88055.43|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69443.44|22289.07|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69443.44|13273.69|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69443.44|17504.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MULTIPLAN [1680]|HMA [168003]|69443.44|287.02|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69443.44|57236.03|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|69443.44|21388.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69443.44|2175|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69443.44|8500|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69443.44|35803.71|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69443.44|35803.71|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69443.44|79249.9|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69443.44|24307.8|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69443.44|23739.5|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69443.44|13273.69|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69443.44|10630.78|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69443.44|18691.86|88055.43|287.02|||| MS070|DRG||Nonspecific Cerebrovascular Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69443.44|79249.9|88055.43|287.02|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77350.26|21820.59|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77350.26|9120|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77350.26|6373.84|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77350.26|5368|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77350.26|7656|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77350.26|14656.6|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77350.26|7178.61|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77350.26|1700|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77350.26|19836.9|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77350.26|31802.52|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|77350.26|34990.04|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77350.26|7128.95|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77350.26|9120|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|77350.26|12815.4|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77350.26|5800|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77350.26|32334.15|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77350.26|13379.39|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77350.26|21820.59|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77350.26|55405.85|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77350.26|11568.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77350.26|4420.72|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77350.26|12440.03|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77350.26|36013.8|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|||77350.26|23205.08|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77350.26|32185.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77350.26|6494.36|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77350.26|7128.95|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|77350.26|74717.63|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77350.26|31802.52|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77350.26|7178.61|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|GEHA [1415]|GEHA [141500]|77350.26|49865.27|74717.63|1700|||| MS071|DRG||Nonspecific Cerebrovascular Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77350.26|49865.27|74717.63|1700|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86264.78|19474.08|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86264.78|8112|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86264.78|13050.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|||86264.78|25879.43|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86264.78|14602.9|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86264.78|8588.76|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86264.78|22466|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86264.78|5609.7|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86264.78|10502.94|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86264.78|10277.9|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|86264.78|9646|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86264.78|725|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86264.78|5100|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|86264.78|72200.05|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86264.78|19474.08|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|86264.78|20219.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86264.78|11182.4|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86264.78|10920.96|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86264.78|5609.7|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86264.78|5005.34|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86264.78|10966.5|72200.05|725|||| MS072|DRG||Nonspecific Cerebrovascular Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86264.78|20219.4|72200.05|725|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67880.61||||||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67880.61||||||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67880.61||||||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67880.61||||||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67880.61||||||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67880.61|10731.68|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67880.61|20524.95|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67880.61|21016.3|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67880.61|3625|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MULTIPLAN [1680]|HMA [168003]|67880.61|1419.91|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67880.61|10731.68|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67880.61|18979.38|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67880.61|67880.61|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67880.61|16463.43|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|67880.61||||||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67880.61|44122.39|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|||67880.61|20364.18|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67880.61|39431.84|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67880.61|9220.06|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67880.61|21021.22|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|GEHA [1415]|GEHA [141500]|67880.61|61092.54|67880.61|1419.91|||| MS073|DRG||Cranial And Peripheral Nerve Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67880.61|61092.54|67880.61|1419.91|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|GEHA [1415]|GEHA [141500]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77200.74|20738.87|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|CORESOURCE [1315]|CORESOURCE [131500]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|CHAMPVA [1240]|CHAMP VA [124000]|77200.74|129302.96|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77200.74|16257.32|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|||77200.74|23160.22|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77200.74|11491.6|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77200.74|27986.39|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77200.74|12891.32|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77200.74|7143.95|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77200.74|4129.95|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MULTIPLAN [1680]|IHC HS [168011]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|UMR [2035]|UMR OPTIONS [203501]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MULTIPLAN [1680]|HMA [168003]|77200.74|236.52|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|HEALTHNET [1495]|HEALTHNET [149500]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77200.74|18191.15|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|TRUSTMARK [2030]|STARMARK [203000]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77200.74|4129.95|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77200.74|1450|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77200.74|2550|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77200.74|20738.87|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77200.74|25187.75|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77200.74|14766.8|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77200.74|14421.56|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77200.74|7143.95|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77200.74|6541.58|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77200.74|12127.48|129302.96|236.52|||| MS074|DRG||Cranial And Peripheral Nerve Disorders Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77200.74|25187.75|129302.96|236.52|||| MS075|DRG||Viral Meningitis With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24228.02|13400.46|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24228.02|23025.79|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24228.02|23577|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24228.02|725|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MULTIPLAN [1680]|HMA [168003]|24228.02|65.34|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24228.02|13400.46|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24228.02|22312.06|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24228.02|24228.02|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24228.02|18703.37|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24228.02||||||| MS075|DRG||Viral Meningitis With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24228.02|15748.21|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|||24228.02|7268.41|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24228.02|14074.06|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24228.02|21465.47|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|GEHA [1415]|GEHA [141500]|24228.02|21805.22|24228.02|65.34|||| MS075|DRG||Viral Meningitis With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24228.02|21805.22|24228.02|65.34|||| MS076|DRG||Viral Meningitis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|GEHA [1415]|GEHA [141500]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15830.14|9195.73|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|||15830.14|4749.04|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15830.14|10289.59|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15830.14|10496.08|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15830.14|15830.14|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15830.14|12999.48|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15830.14|6967.92|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|15830.14|774.95|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|15830.14||||||| MS076|DRG||Viral Meningitis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15830.14|1450|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15830.14|14247.13|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15830.14|14223.05|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15830.14|13890.52|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15830.14|6967.92|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15830.14|7338.34|15830.14|774.95|||| MS076|DRG||Viral Meningitis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15830.14|14247.13|15830.14|774.95|||| MS077|DRG||Hypertensive Encephalopathy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|TRUSTMARK [2030]|STARMARK [203000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|HEALTHNET [1495]|HEALTHNET [149500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MULTIPLAN [1680]|IHC HS [168011]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MULTIPLAN [1680]|HMA [168003]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|UMR [2035]|UMR OPTIONS [203501]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|CHAMPVA [1240]|CHAMP VA [124000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|CORESOURCE [1315]|CORESOURCE [131500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|GEHA [1415]|GEHA [141500]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70963.82||||||| MS077|DRG||Hypertensive Encephalopathy With McC|||70963.82|21289.15|21289.15|21289.15|||| MS078|DRG||Hypertensive Encephalopathy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|GEHA [1415]|GEHA [141500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MULTIPLAN [1680]|IHC HS [168011]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MULTIPLAN [1680]|HMA [168003]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|TRUSTMARK [2030]|STARMARK [203000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|UMR [2035]|UMR OPTIONS [203501]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41352.76||||||| MS078|DRG||Hypertensive Encephalopathy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|||41352.76|12405.83|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41352.76|6110.28|12405.83|6110.28|||| MS078|DRG||Hypertensive Encephalopathy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41352.76|6110.28|12405.83|6110.28|||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|GEHA [1415]|GEHA [141500]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88681.46||||||| MS079|DRG||Hypertensive Encephalopathy Without Cc/McC|||88681.46|26604.44|26604.44|26604.44|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|CORESOURCE [1315]|CORESOURCE [131500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|CHAMPVA [1240]|CHAMP VA [124000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|UMR [2035]|UMR OPTIONS [203501]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MULTIPLAN [1680]|IHC HS [168011]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|HEALTHNET [1495]|HEALTHNET [149500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|TRUSTMARK [2030]|STARMARK [203000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MULTIPLAN [1680]|HMA [168003]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|AETNA [1015]|AETNA ACO WILCO [101532]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35946.17|69959.65|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35946.17|11531.22|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|||35946.17|10783.85|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|GEHA [1415]|GEHA [141500]|35946.17||||||| MS080|DRG||Nontraumatic Stupor And Coma With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35946.17|11531.22|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35946.17|7650|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35946.17|69959.65|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35946.17|32228.33|69959.65|7650|||| MS080|DRG||Nontraumatic Stupor And Coma With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35946.17|32228.33|69959.65|7650|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|TRUSTMARK [2030]|STARMARK [203000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|HEALTHNET [1495]|HEALTHNET [149500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MULTIPLAN [1680]|IHC HS [168011]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MULTIPLAN [1680]|HMA [168003]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|UMR [2035]|UMR OPTIONS [203501]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|CHAMPVA [1240]|CHAMP VA [124000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|CORESOURCE [1315]|CORESOURCE [131500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|GEHA [1415]|GEHA [141500]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52587.24|39465.11|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52587.24|9350|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52587.24|19255.39|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52587.24|3176|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52587.24||||||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|||52587.24|15776.17|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52587.24|39465.11|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52587.24|5010.32|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52587.24|14872|39465.11|3176|||| MS081|DRG||Nontraumatic Stupor And Coma Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52587.24|39465.11|39465.11|3176|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|CHAMPVA [1240]|CHAMP VA [124000]|67251.76||||||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|GEHA [1415]|GEHA [141500]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|CORESOURCE [1315]|CORESOURCE [131500]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67251.76|39066.55|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|||67251.76|20175.53|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67251.76|26188.43|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67251.76|67251.76|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67251.76|29116.67|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|UMR [2035]|UMR OPTIONS [203501]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67251.76|15457.17|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67251.76|20444.9|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MULTIPLAN [1680]|IHC HS [168011]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MULTIPLAN [1680]|HMA [168003]|67251.76|1774.77|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|HEALTHNET [1495]|HEALTHNET [149500]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67251.76|43713.64|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|TRUSTMARK [2030]|STARMARK [203000]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|AETNA [1015]|AETNA ACO WILCO [101532]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67251.76|5075|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67251.76|3400|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67251.76|20444.9|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67251.76|38976.51|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67251.76|38976.51|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67251.76|60526.58|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67251.76|32742.45|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67251.76|31976.95|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67251.76|15457.17|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67251.76|14245.81|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67251.76|24170.87|67251.76|1774.77|||| MS082|DRG||Traumatic Stupor And Coma >1 Hour With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67251.76|60526.58|67251.76|1774.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|TRUSTMARK [2030]|STARMARK [203000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|HEALTHNET [1495]|HEALTHNET [149500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MULTIPLAN [1680]|IHC HS [168011]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MULTIPLAN [1680]|HMA [168003]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|UMR [2035]|UMR OPTIONS [203501]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|CHAMPVA [1240]|CHAMP VA [124000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|CORESOURCE [1315]|CORESOURCE [131500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|GEHA [1415]|GEHA [141500]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36621.01||||||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|||36621.01|10986.3|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36621.01|8550.77|10986.3|8550.77|||| MS083|DRG||Traumatic Stupor And Coma >1 Hour With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36621.01|8550.77|10986.3|8550.77|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|GEHA [1415]|GEHA [141500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31919.47||||||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|||31919.47|9575.84|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31919.47|5831.87|9575.84|5831.87|||| MS084|DRG||Traumatic Stupor And Coma >1 Hour Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31919.47|5831.87|9575.84|5831.87|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69457.30||||||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69457.30||||||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69457.30||||||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|CHAMPVA [1240]|CHAMP VA [124000]|69457.30||||||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69457.30||||||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69457.30|15964.28|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69457.30|32660.93|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69457.30|33442.8|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69457.30|3625|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|AETNA [1015]|AETNA ACO WILCO [101532]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|TRUSTMARK [2030]|STARMARK [203000]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|HEALTHNET [1495]|HEALTHNET [149500]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MULTIPLAN [1680]|IHC HS [168011]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MULTIPLAN [1680]|HMA [168003]|69457.30|243.38|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69457.30|15964.28|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|UMR [2035]|UMR OPTIONS [203501]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69457.30|27686.26|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69457.30|72297.03|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69457.30|26118.65|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69457.30|46993.07|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|||69457.30|20837.19|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69457.30||||||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69457.30|41997.36|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69457.30|14545.97|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69457.30|33349.43|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|CORESOURCE [1315]|CORESOURCE [131500]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|GEHA [1415]|GEHA [141500]|69457.30|65067.32|72297.03|243.38|||| MS085|DRG||Traumatic Stupor And Coma <1 Hour With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69457.30|65067.32|72297.03|243.38|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25607.44||||||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|CHAMPVA [1240]|CHAMP VA [124000]|25607.44||||||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25607.44||||||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25607.44||||||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25607.44||||||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|GEHA [1415]|GEHA [141500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|CORESOURCE [1315]|CORESOURCE [131500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25607.44|13284.7|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|||25607.44|7682.23|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25607.44|14864.96|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25607.44|14395.61|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25607.44|22869.16|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25607.44|15984.7|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|UMR [2035]|UMR OPTIONS [203501]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25607.44|9028.66|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MULTIPLAN [1680]|IHC HS [168011]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MULTIPLAN [1680]|HMA [168003]|25607.44|26.9|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|HEALTHNET [1495]|HEALTHNET [149500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|TRUSTMARK [2030]|STARMARK [203000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25607.44|1450|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25607.44||||||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25607.44|18457.05|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25607.44|18025.54|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25607.44|9028.66|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25607.44|8123.2|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25607.44|20582.24|22869.16|26.9|||| MS086|DRG||Traumatic Stupor And Coma <1 Hour With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25607.44|20582.24|22869.16|26.9|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|GEHA [1415]|GEHA [141500]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16507.08|7948.85|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16507.08||||||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16507.08|850|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16507.08|6737.08|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|||16507.08|4952.12|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16507.08|5573.35|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16507.08|6737.08|7948.85|850|||| MS087|DRG||Traumatic Stupor And Coma <1 Hour Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16507.08|7948.85|7948.85|850|||| MS088|DRG||Concussion With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35942.45||||||| MS088|DRG||Concussion With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35942.45||||||| MS088|DRG||Concussion With McC|CORESOURCE [1315]|CORESOURCE [131500]|35942.45||||||| MS088|DRG||Concussion With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35942.45||||||| MS088|DRG||Concussion With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35942.45||||||| MS088|DRG||Concussion With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35942.45||||||| MS088|DRG||Concussion With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35942.45||||||| MS088|DRG||Concussion With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35942.45||||||| MS088|DRG||Concussion With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35942.45||||||| MS088|DRG||Concussion With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35942.45||||||| MS088|DRG||Concussion With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35942.45||||||| MS088|DRG||Concussion With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35942.45||||||| MS088|DRG||Concussion With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35942.45||||||| MS088|DRG||Concussion With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35942.45||||||| MS088|DRG||Concussion With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35942.45||||||| MS088|DRG||Concussion With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35942.45||||||| MS088|DRG||Concussion With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35942.45||||||| MS088|DRG||Concussion With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35942.45||||||| MS088|DRG||Concussion With McC|UMR [2035]|UMR OPTIONS [203501]|35942.45||||||| MS088|DRG||Concussion With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35942.45||||||| MS088|DRG||Concussion With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|35942.45||||||| MS088|DRG||Concussion With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35942.45||||||| MS088|DRG||Concussion With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|35942.45||||||| MS088|DRG||Concussion With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35942.45||||||| MS088|DRG||Concussion With McC|MULTIPLAN [1680]|IHC HS [168011]|35942.45||||||| MS088|DRG||Concussion With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35942.45||||||| MS088|DRG||Concussion With McC|MULTIPLAN [1680]|HMA [168003]|35942.45||||||| MS088|DRG||Concussion With McC|HEALTHNET [1495]|HEALTHNET [149500]|35942.45||||||| MS088|DRG||Concussion With McC|TRUSTMARK [2030]|STARMARK [203000]|35942.45||||||| MS088|DRG||Concussion With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35942.45||||||| MS088|DRG||Concussion With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35942.45||||||| MS088|DRG||Concussion With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35942.45||||||| MS088|DRG||Concussion With McC|AETNA [1015]|AETNA ACO WILCO [101532]|35942.45||||||| MS088|DRG||Concussion With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35942.45||||||| MS088|DRG||Concussion With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35942.45||||||| MS088|DRG||Concussion With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35942.45||||||| MS088|DRG||Concussion With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35942.45||||||| MS088|DRG||Concussion With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35942.45||||||| MS088|DRG||Concussion With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35942.45||||||| MS088|DRG||Concussion With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35942.45||||||| MS088|DRG||Concussion With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35942.45||||||| MS088|DRG||Concussion With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35942.45||||||| MS088|DRG||Concussion With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35942.45||||||| MS088|DRG||Concussion With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35942.45||||||| MS088|DRG||Concussion With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35942.45||||||| MS088|DRG||Concussion With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35942.45||||||| MS088|DRG||Concussion With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35942.45||||||| MS088|DRG||Concussion With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35942.45||||||| MS088|DRG||Concussion With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35942.45||||||| MS088|DRG||Concussion With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35942.45||||||| MS088|DRG||Concussion With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35942.45||||||| MS088|DRG||Concussion With McC|CHAMPVA [1240]|CHAMP VA [124000]|35942.45||||||| MS088|DRG||Concussion With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35942.45||||||| MS088|DRG||Concussion With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|||35942.45|10782.73|10782.73|9281.6|||| MS088|DRG||Concussion With McC|GEHA [1415]|GEHA [141500]|35942.45||||||| MS088|DRG||Concussion With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35942.45|9281.6|10782.73|9281.6|||| MS088|DRG||Concussion With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35942.45|9281.6|10782.73|9281.6|||| MS089|DRG||Concussion With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41701.95||||||| MS089|DRG||Concussion With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41701.95||||||| MS089|DRG||Concussion With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41701.95||||||| MS089|DRG||Concussion With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41701.95||||||| MS089|DRG||Concussion With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41701.95||||||| MS089|DRG||Concussion With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41701.95||||||| MS089|DRG||Concussion With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41701.95||||||| MS089|DRG||Concussion With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41701.95||||||| MS089|DRG||Concussion With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41701.95||||||| MS089|DRG||Concussion With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41701.95||||||| MS089|DRG||Concussion With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41701.95||||||| MS089|DRG||Concussion With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41701.95||||||| MS089|DRG||Concussion With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41701.95||||||| MS089|DRG||Concussion With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41701.95||||||| MS089|DRG||Concussion With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41701.95||||||| MS089|DRG||Concussion With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41701.95||||||| MS089|DRG||Concussion With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41701.95||||||| MS089|DRG||Concussion With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41701.95||||||| MS089|DRG||Concussion With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|41701.95||||||| MS089|DRG||Concussion With Cc|TRUSTMARK [2030]|STARMARK [203000]|41701.95||||||| MS089|DRG||Concussion With Cc|HEALTHNET [1495]|HEALTHNET [149500]|41701.95||||||| MS089|DRG||Concussion With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41701.95||||||| MS089|DRG||Concussion With Cc|MULTIPLAN [1680]|IHC HS [168011]|41701.95||||||| MS089|DRG||Concussion With Cc|MULTIPLAN [1680]|HMA [168003]|41701.95||||||| MS089|DRG||Concussion With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41701.95||||||| MS089|DRG||Concussion With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|41701.95||||||| MS089|DRG||Concussion With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41701.95||||||| MS089|DRG||Concussion With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41701.95||||||| MS089|DRG||Concussion With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|41701.95||||||| MS089|DRG||Concussion With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41701.95||||||| MS089|DRG||Concussion With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41701.95||||||| MS089|DRG||Concussion With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41701.95||||||| MS089|DRG||Concussion With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41701.95||||||| MS089|DRG||Concussion With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41701.95||||||| MS089|DRG||Concussion With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41701.95||||||| MS089|DRG||Concussion With Cc|UMR [2035]|UMR OPTIONS [203501]|41701.95||||||| MS089|DRG||Concussion With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41701.95||||||| MS089|DRG||Concussion With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41701.95||||||| MS089|DRG||Concussion With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41701.95||||||| MS089|DRG||Concussion With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41701.95||||||| MS089|DRG||Concussion With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41701.95||||||| MS089|DRG||Concussion With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41701.95||||||| MS089|DRG||Concussion With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41701.95||||||| MS089|DRG||Concussion With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41701.95||||||| MS089|DRG||Concussion With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41701.95||||||| MS089|DRG||Concussion With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41701.95||||||| MS089|DRG||Concussion With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41701.95||||||| MS089|DRG||Concussion With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41701.95||||||| MS089|DRG||Concussion With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41701.95||||||| MS089|DRG||Concussion With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41701.95||||||| MS089|DRG||Concussion With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41701.95||||||| MS089|DRG||Concussion With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41701.95||||||| MS089|DRG||Concussion With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41701.95||||||| MS089|DRG||Concussion With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41701.95||||||| MS089|DRG||Concussion With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41701.95||||||| MS089|DRG||Concussion With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41701.95||||||| MS089|DRG||Concussion With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41701.95||||||| MS089|DRG||Concussion With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41701.95||||||| MS089|DRG||Concussion With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41701.95||||||| MS089|DRG||Concussion With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41701.95||||||| MS089|DRG||Concussion With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41701.95||||||| MS089|DRG||Concussion With Cc|CORESOURCE [1315]|CORESOURCE [131500]|41701.95||||||| MS089|DRG||Concussion With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41701.95||||||| MS089|DRG||Concussion With Cc|GEHA [1415]|GEHA [141500]|41701.95||||||| MS089|DRG||Concussion With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41701.95||||||| MS089|DRG||Concussion With Cc|||41701.95|12510.58|31217.93|12510.58|||| MS089|DRG||Concussion With Cc|CHAMPVA [1240]|CHAMP VA [124000]|41701.95|31217.93|31217.93|12510.58|||| MS091|DRG||Other Disorders Of Nervous System With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|GEHA [1415]|GEHA [141500]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|115406.68|19166.82|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|CORESOURCE [1315]|CORESOURCE [131500]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|CHAMPVA [1240]|CHAMP VA [124000]|115406.68|118264.7|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|115406.68|88018.32|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|||115406.68|34622|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|115406.68|18202.11|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|115406.68|151520.59|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|115406.68|20820.8|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|115406.68|78790.71|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|115406.68|8871.21|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|UMR [2035]|UMR OPTIONS [203501]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MULTIPLAN [1680]|IHC HS [168011]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MULTIPLAN [1680]|HMA [168003]|115406.68|588.94|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|HEALTHNET [1495]|HEALTHNET [149500]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|115406.68|98488.38|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|TRUSTMARK [2030]|STARMARK [203000]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|AETNA [1015]|AETNA ACO WILCO [101532]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|115406.68|8871.21|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|115406.68|5075|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|115406.68|1700|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|115406.68|19166.82|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|115406.68|136368.53|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|115406.68|23909.05|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|115406.68|23350.07|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|115406.68|78790.71|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|115406.68|10459.88|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|115406.68|23241.25|151520.59|588.94|||| MS091|DRG||Other Disorders Of Nervous System With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|115406.68|136368.53|151520.59|588.94|||| MS092|DRG||Other Disorders Of Nervous System With Cc|CHAMPVA [1240]|CHAMP VA [124000]|100806.34||||||| MS092|DRG||Other Disorders Of Nervous System With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100806.34|73952.07|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|100806.34|71249.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100806.34|49917.64|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|100806.34|60583.79|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100806.34|15312|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100806.34|66078.5|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100806.34|13600|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|100806.34|11600|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|TRUSTMARK [2030]|STARMARK [203000]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MULTIPLAN [1680]|IHC HS [168011]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MULTIPLAN [1680]|HMA [168003]|100806.34|615.52|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|HEALTHNET [1495]|HEALTHNET [149500]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|100806.34|28007.84|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100806.34|73952.07|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|UMR [2035]|UMR OPTIONS [203501]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100806.34|14298.45|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100806.34|12665.54|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100806.34|142215.51|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100806.34|11235.74|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100806.34|92440.08|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|||100806.34|30241.9|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100806.34|66078.5|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100806.34|6340.85|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100806.34|21632|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|100806.34|24692.59|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|CORESOURCE [1315]|CORESOURCE [131500]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|100806.34|66078.5|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|GEHA [1415]|GEHA [141500]|100806.34|127993.96|142215.51|615.52|||| MS092|DRG||Other Disorders Of Nervous System With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100806.34|127993.96|142215.51|615.52|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31848.36|23881.33|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31848.36|5937.64|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|||31848.36|9554.51|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31848.36|12430.41|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31848.36|8852.76|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31848.36|19123.71|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31848.36|2070|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31848.36|5477.27|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31848.36|5937.64|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31848.36|9856.08|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31848.36|31.5|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31848.36|11108.94|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31848.36|725|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31848.36|850|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31848.36|10791.88|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31848.36|23881.33|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|GEHA [1415]|GEHA [141500]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31848.36|17211.34|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31848.36|3137.3|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31848.36|11328.85|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31848.36|11063.99|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31848.36|5477.27|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31848.36|2987.9|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31848.36|9519.8|23881.33|31.5|||| MS093|DRG||Other Disorders Of Nervous System Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31848.36|17211.34|23881.33|31.5|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126322.69|85421.44|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126322.69|14450|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|126322.69|725|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|AETNA [1015]|AETNA ACO WILCO [101532]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|HEALTHNET [1495]|HEALTHNET [149500]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MULTIPLAN [1680]|IHC HS [168011]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MULTIPLAN [1680]|HMA [168003]|126322.69|154.35|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|TRUSTMARK [2030]|STARMARK [203000]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|126322.69|29758.33|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|UMR [2035]|UMR OPTIONS [203501]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126322.69|13882.01|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|||126322.69|37896.81|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126322.69|12406.25|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|CHAMPVA [1240]|CHAMP VA [124000]|126322.69||||||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126322.69|22368.42|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126322.69|22984|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|126322.69|21356.93|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|CORESOURCE [1315]|CORESOURCE [131500]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|126322.69|85421.44|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|GEHA [1415]|GEHA [141500]|126322.69|19221.24|85421.44|154.35|||| MS094|DRG||Bacterial And Tuberculous Infections Of Nervous System With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126322.69|19221.24|85421.44|154.35|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141952.82|109989.32|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|141952.82|33259.31|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MULTIPLAN [1680]|IHC HS [168011]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|HEALTHNET [1495]|HEALTHNET [149500]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|TRUSTMARK [2030]|STARMARK [203000]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MULTIPLAN [1680]|HMA [168003]|141952.82|54069.19|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|141952.82|4350|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141952.82|16150|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141952.82|68470.63|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|UMR [2035]|UMR OPTIONS [203501]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141952.82|36366|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141952.82|35515.79|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141952.82|109989.32|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141952.82|122870.78|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|GEHA [1415]|GEHA [141500]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|||141952.82|42585.85|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|CHAMPVA [1240]|CHAMP VA [124000]|141952.82||||||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141952.82|25688|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141952.82|211517.93|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141952.82|31790.93|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141952.82|27994.57|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|CORESOURCE [1315]|CORESOURCE [131500]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|141952.82|30103.94|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141952.82|137486.65|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|141952.82|68470.63|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141952.82|190366.14|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141952.82|19836.9|211517.93|4350|||| MS095|DRG||Bacterial And Tuberculous Infections Of Nervous System With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141952.82|190366.14|211517.93|4350|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|GEHA [1415]|GEHA [141500]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|131185.15|193214.23|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|131185.15|39898.17|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|131185.15|11561.2|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|131185.15|172958.15|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|||131185.15|39355.54|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|131185.15|149675.32|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|131185.15|332611.83|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|131185.15|172958.15|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|131185.15|3625|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|131185.15|26308.22|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|131185.15|166305.92|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|131185.15|11561.2|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|131185.15|33591.48|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|131185.15|149675.32|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|131185.15|850|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|131185.15||||||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|131185.15|216197.69|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|131185.15|39898.17|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|131185.15|299350.64|332611.83|850|||| MS096|DRG||Bacterial And Tuberculous Infections Of Nervous System Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|131185.15|101223.56|332611.83|850|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|226574.10|44616|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|226574.10|149155.59|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|226574.10|149155.59|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|226574.10|28050|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|HEALTHNET [1495]|HEALTHNET [149500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|CORESOURCE [1315]|CORESOURCE [131500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|||226574.10|67972.23|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|CHAMPVA [1240]|CHAMP VA [124000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|TRUSTMARK [2030]|STARMARK [203000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MULTIPLAN [1680]|IHC HS [168011]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MULTIPLAN [1680]|HMA [168003]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|UMR [2035]|UMR OPTIONS [203501]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|GEHA [1415]|GEHA [141500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|226574.10|57766.17|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|226574.10|25348.14|149155.59|25348.14|||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|226574.10||||||| MS097|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|226574.10||||||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112725.17|17226|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112725.17|62501.76|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112725.17|23805|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|112725.17||||||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112725.17|42188.7|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|112725.17|51203.37|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|112725.17|14341.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|112725.17|13050|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112725.17|34785.37|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112725.17|30608.05|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112725.17|25331.07|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|TRUSTMARK [2030]|STARMARK [203000]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MULTIPLAN [1680]|IHC HS [168011]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112725.17|62501.76|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112725.17|69821.69|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112725.17|6800|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|UMR [2035]|UMR OPTIONS [203501]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112725.17|22736.65|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|GEHA [1415]|GEHA [141500]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112725.17|120195.7|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112725.17|10816|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112725.17|14541.14|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112725.17|78127.21|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|112725.17|34785.37|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112725.17|108176.13|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112725.17|36187.62|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|112725.17|14003.92|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|||112725.17|33817.55|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MULTIPLAN [1680]|HMA [168003]|112725.17|521.11|120195.7|521.11|||| MS098|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112725.17|37997|120195.7|521.11|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26126.07|21820.59|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26126.07|4560|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26126.07|21820.59|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26126.07|2900|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26126.07|2210.36|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26126.07|4560|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|26126.07|21820.59|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26126.07|3828|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26126.07|3186.92|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26126.07|19836.9|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26126.07|2684|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26126.07|20260.85|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26126.07|31802.52|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|26126.07|26126.07|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26126.07|31802.52|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26126.07|32334.15|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26126.07|21820.59|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|||26126.07|7837.82|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26126.07|16981.95|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26126.07|15176.63|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26126.07|14914.31|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|GEHA [1415]|GEHA [141500]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26126.07|26126.07|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26126.07|23513.46|32334.15|2210.36|||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26126.07||||||| MS099|DRG||Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26126.07|16303.77|32334.15|2210.36|||| MS100|DRG||Seizures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48571.16|22615.96|37600.08|220.23|||| MS100|DRG||Seizures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48571.16|725|37600.08|220.23|||| MS100|DRG||Seizures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48571.16|12357.98|37600.08|220.23|||| MS100|DRG||Seizures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|CHAMPVA [1240]|CHAMP VA [124000]|48571.16||||||| MS100|DRG||Seizures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48571.16|27167.2|37600.08|220.23|||| MS100|DRG||Seizures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48571.16|850|37600.08|220.23|||| MS100|DRG||Seizures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|TRUSTMARK [2030]|STARMARK [203000]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|HEALTHNET [1495]|HEALTHNET [149500]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|MULTIPLAN [1680]|HMA [168003]|48571.16|220.23|37600.08|220.23|||| MS100|DRG||Seizures With McC|MULTIPLAN [1680]|IHC HS [168011]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48571.16|21841.89|37600.08|220.23|||| MS100|DRG||Seizures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|||48571.16|14571.35|37600.08|220.23|||| MS100|DRG||Seizures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48571.16|37600.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48571.16|5476.64|37600.08|220.23|||| MS100|DRG||Seizures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48571.16|22278.26|37600.08|220.23|||| MS100|DRG||Seizures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|UMR [2035]|UMR OPTIONS [203501]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48571.16|21168.93|37600.08|220.23|||| MS100|DRG||Seizures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48571.16|26532.05|37600.08|220.23|||| MS100|DRG||Seizures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48571.16|24440.05|37600.08|220.23|||| MS100|DRG||Seizures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48571.16|5476.64|37600.08|220.23|||| MS100|DRG||Seizures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|CORESOURCE [1315]|CORESOURCE [131500]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48571.16|12357.98|37600.08|220.23|||| MS100|DRG||Seizures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48571.16|20392.82|37600.08|220.23|||| MS100|DRG||Seizures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|GEHA [1415]|GEHA [141500]|48571.16|33840.08|37600.08|220.23|||| MS100|DRG||Seizures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48571.16|22615.96|37600.08|220.23|||| MS100|DRG||Seizures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48571.16|11856.29|37600.08|220.23|||| MS100|DRG||Seizures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48571.16|33840.08|37600.08|220.23|||| MS101|DRG||Seizures Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|CHAMPVA [1240]|CHAMP VA [124000]|37372.24|19563.83|46204.81|310.87|||| MS101|DRG||Seizures Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|CORESOURCE [1315]|CORESOURCE [131500]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37372.24|46204.81|46204.81|310.87|||| MS101|DRG||Seizures Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|||37372.24|11211.67|46204.81|310.87|||| MS101|DRG||Seizures Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37372.24|5378.69|46204.81|310.87|||| MS101|DRG||Seizures Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37372.24|11202.67|46204.81|310.87|||| MS101|DRG||Seizures Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|GEHA [1415]|GEHA [141500]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|HEALTHNET [1495]|HEALTHNET [149500]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37372.24|6110.35|46204.81|310.87|||| MS101|DRG||Seizures Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37372.24|5378.69|46204.81|310.87|||| MS101|DRG||Seizures Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37372.24|30033.12|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MULTIPLAN [1680]|IHC HS [168011]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37372.24|17187.93|46204.81|310.87|||| MS101|DRG||Seizures Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37372.24|26840.38|46204.81|310.87|||| MS101|DRG||Seizures Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37372.24|1700|46204.81|310.87|||| MS101|DRG||Seizures Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37372.24|17187.93|46204.81|310.87|||| MS101|DRG||Seizures Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|TRUSTMARK [2030]|STARMARK [203000]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MULTIPLAN [1680]|HMA [168003]|37372.24|310.87|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37372.24|6110.35|46204.81|310.87|||| MS101|DRG||Seizures Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37372.24|12560.81|46204.81|310.87|||| MS101|DRG||Seizures Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37372.24|12861.5|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37372.24|10268.13|46204.81|310.87|||| MS101|DRG||Seizures Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37372.24|11041.82|46204.81|310.87|||| MS101|DRG||Seizures Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37372.24|5724.99|46204.81|310.87|||| MS101|DRG||Seizures Without McC|UMR [2035]|UMR OPTIONS [203501]|37372.24|41584.33|46204.81|310.87|||| MS101|DRG||Seizures Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37372.24|1450|46204.81|310.87|||| MS101|DRG||Seizures Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37372.24|41584.33|46204.81|310.87|||| MS102|DRG||Headaches With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48720.49||||||| MS102|DRG||Headaches With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48720.49||||||| MS102|DRG||Headaches With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48720.49||||||| MS102|DRG||Headaches With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48720.49||||||| MS102|DRG||Headaches With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48720.49||||||| MS102|DRG||Headaches With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48720.49||||||| MS102|DRG||Headaches With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48720.49||||||| MS102|DRG||Headaches With McC|TRUSTMARK [2030]|STARMARK [203000]|48720.49||||||| MS102|DRG||Headaches With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48720.49||||||| MS102|DRG||Headaches With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48720.49||||||| MS102|DRG||Headaches With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48720.49||||||| MS102|DRG||Headaches With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48720.49||||||| MS102|DRG||Headaches With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48720.49||||||| MS102|DRG||Headaches With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48720.49||||||| MS102|DRG||Headaches With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48720.49||||||| MS102|DRG||Headaches With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48720.49||||||| MS102|DRG||Headaches With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48720.49||||||| MS102|DRG||Headaches With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48720.49||||||| MS102|DRG||Headaches With McC|AETNA [1015]|AETNA ACO WILCO [101532]|48720.49||||||| MS102|DRG||Headaches With McC|HEALTHNET [1495]|HEALTHNET [149500]|48720.49||||||| MS102|DRG||Headaches With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48720.49||||||| MS102|DRG||Headaches With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48720.49||||||| MS102|DRG||Headaches With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48720.49||||||| MS102|DRG||Headaches With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48720.49||||||| MS102|DRG||Headaches With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48720.49||||||| MS102|DRG||Headaches With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48720.49||||||| MS102|DRG||Headaches With McC|MULTIPLAN [1680]|IHC HS [168011]|48720.49||||||| MS102|DRG||Headaches With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48720.49||||||| MS102|DRG||Headaches With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|48720.49||||||| MS102|DRG||Headaches With McC|MULTIPLAN [1680]|HMA [168003]|48720.49||||||| MS102|DRG||Headaches With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48720.49||||||| MS102|DRG||Headaches With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48720.49||||||| MS102|DRG||Headaches With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48720.49||||||| MS102|DRG||Headaches With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48720.49||||||| MS102|DRG||Headaches With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48720.49||||||| MS102|DRG||Headaches With McC|UMR [2035]|UMR OPTIONS [203501]|48720.49||||||| MS102|DRG||Headaches With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48720.49||||||| MS102|DRG||Headaches With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48720.49||||||| MS102|DRG||Headaches With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|48720.49||||||| MS102|DRG||Headaches With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48720.49||||||| MS102|DRG||Headaches With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48720.49||||||| MS102|DRG||Headaches With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48720.49||||||| MS102|DRG||Headaches With McC|CHAMPVA [1240]|CHAMP VA [124000]|48720.49||||||| MS102|DRG||Headaches With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48720.49||||||| MS102|DRG||Headaches With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48720.49||||||| MS102|DRG||Headaches With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48720.49||||||| MS102|DRG||Headaches With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48720.49||||||| MS102|DRG||Headaches With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48720.49||||||| MS102|DRG||Headaches With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48720.49||||||| MS102|DRG||Headaches With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48720.49||||||| MS102|DRG||Headaches With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48720.49||||||| MS102|DRG||Headaches With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48720.49||||||| MS102|DRG||Headaches With McC|GEHA [1415]|GEHA [141500]|48720.49||||||| MS102|DRG||Headaches With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48720.49|28301.74|28301.74|1700|||| MS102|DRG||Headaches With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48720.49||||||| MS102|DRG||Headaches With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48720.49|1700|28301.74|1700|||| MS102|DRG||Headaches With McC|||48720.49|14616.15|28301.74|1700|||| MS102|DRG||Headaches With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48720.49||||||| MS102|DRG||Headaches With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48720.49||||||| MS102|DRG||Headaches With McC|CORESOURCE [1315]|CORESOURCE [131500]|48720.49||||||| MS102|DRG||Headaches With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48720.49||||||| MS102|DRG||Headaches With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48720.49|6045.08|28301.74|1700|||| MS102|DRG||Headaches With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48720.49||||||| MS102|DRG||Headaches With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48720.49||||||| MS102|DRG||Headaches With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48720.49|28301.74|28301.74|1700|||| MS102|DRG||Headaches With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48720.49|6045.08|28301.74|1700|||| MS102|DRG||Headaches With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48720.49||||||| MS103|DRG||Headaches Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33901.77|11728.14|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33901.77|5583.86|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33901.77|26141.63|26141.63|14.59|||| MS103|DRG||Headaches Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33901.77|12008.9|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33901.77|10135.94|26141.63|14.59|||| MS103|DRG||Headaches Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|GEHA [1415]|GEHA [141500]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33901.77|26141.63|26141.63|14.59|||| MS103|DRG||Headaches Without McC|CORESOURCE [1315]|CORESOURCE [131500]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33901.77|4624.99|26141.63|14.59|||| MS103|DRG||Headaches Without McC|CHAMPVA [1240]|CHAMP VA [124000]|33901.77|24936.06|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|||33901.77|10170.53|26141.63|14.59|||| MS103|DRG||Headaches Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33901.77|13951.23|26141.63|14.59|||| MS103|DRG||Headaches Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33901.77|15610.77|26141.63|14.59|||| MS103|DRG||Headaches Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33901.77|9298.19|26141.63|14.59|||| MS103|DRG||Headaches Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|UMR [2035]|UMR OPTIONS [203501]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33901.77|5583.86|26141.63|14.59|||| MS103|DRG||Headaches Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33901.77|4624.99|26141.63|14.59|||| MS103|DRG||Headaches Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33901.77|24016.58|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MULTIPLAN [1680]|IHC HS [168011]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MULTIPLAN [1680]|HMA [168003]|33901.77|14.59|26141.63|14.59|||| MS103|DRG||Headaches Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33901.77|3400|26141.63|14.59|||| MS103|DRG||Headaches Without McC|HEALTHNET [1495]|HEALTHNET [149500]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|TRUSTMARK [2030]|STARMARK [203000]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33901.77|9998.79|26141.63|14.59|||| MS103|DRG||Headaches Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33901.77|5359.57|26141.63|14.59|||| MS103|DRG||Headaches Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33901.77|725|26141.63|14.59|||| MS103|DRG||Headaches Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33901.77|21614.92|26141.63|14.59|||| MS103|DRG||Headaches Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33901.77|21614.92|26141.63|14.59|||| MS113|DRG||Orbital Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|||44192.26|13257.68|13257.68|13257.68|||| MS113|DRG||Orbital Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44192.26||||||| MS113|DRG||Orbital Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44192.26||||||| MS115|DRG||Extraocular Procedures Except Orbit|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|GEHA [1415]|GEHA [141500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|CORESOURCE [1315]|CORESOURCE [131500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MULTIPLAN [1680]|IHC HS [168011]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|UMR [2035]|UMR OPTIONS [203501]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|FIRST HEALTH [1375]|QUALCHOICE [137513]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|FMH BENEFIT SERVICES [1390]|FMH [139000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MULTIPLAN [1680]|HMA [168003]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|HEALTHNET [1495]|HEALTHNET [149500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|TRUSTMARK [2030]|STARMARK [203000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|AETNA [1015]|AETNA ACO WILCO [101532]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|CHAMPVA [1240]|CHAMP VA [124000]|55085.01|41313.76|41313.76|16525.5|||| MS115|DRG||Extraocular Procedures Except Orbit|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|||55085.01|16525.5|41313.76|16525.5|||| MS115|DRG||Extraocular Procedures Except Orbit|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55085.01||||||| MS115|DRG||Extraocular Procedures Except Orbit|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55085.01||||||| MS116|DRG||Intraocular Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43834.63|98581.55|98581.55|6418.27|||| MS116|DRG||Intraocular Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43834.63|6418.27|98581.55|6418.27|||| MS116|DRG||Intraocular Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43834.63|11050|98581.55|6418.27|||| MS116|DRG||Intraocular Procedures With Cc/McC|||43834.63|13150.39|98581.55|6418.27|||| MS116|DRG||Intraocular Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43834.63|98581.55|98581.55|6418.27|||| MS116|DRG||Intraocular Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43834.63|6418.27|98581.55|6418.27|||| MS116|DRG||Intraocular Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43834.63||||||| MS116|DRG||Intraocular Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43834.63||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|||74256.80|22277.04|22277.04|22277.04|||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74256.80||||||| MS117|DRG||Intraocular Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74256.80||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MULTIPLAN [1680]|HMA [168003]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|||36805.63|11041.69|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|GEHA [1415]|GEHA [141500]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36805.63||||||| MS121|DRG||Acute Major Eye Infections With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36805.63|7599.93|11041.69|7599.93|||| MS121|DRG||Acute Major Eye Infections With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36805.63|7599.93|11041.69|7599.93|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|GEHA [1415]|GEHA [141500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|||34749.53|10424.86|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34749.53|4213.61|10424.86|4213.61|||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34749.53||||||| MS122|DRG||Acute Major Eye Infections Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34749.53||||||| MS123|DRG||Neurological Eye Disorders|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28249.16|5436.09|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|TRUSTMARK [2030]|STARMARK [203000]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MULTIPLAN [1680]|IHC HS [168011]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|HEALTHNET [1495]|HEALTHNET [149500]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28249.16|2900|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28249.16|9080.7|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28249.16|5436.09|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|FIRST HEALTH [1375]|QUALCHOICE [137513]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|AETNA [1015]|AETNA ACO WILCO [101532]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|FMH BENEFIT SERVICES [1390]|FMH [139000]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MULTIPLAN [1680]|HMA [168003]|28249.16|316.75|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28249.16|28017.99|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28249.16|10837.41|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28249.16|10125.13|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28249.16|18211.69|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28249.16|16275.66|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|UMR [2035]|UMR OPTIONS [203501]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|GEHA [1415]|GEHA [141500]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|||28249.16|8474.75|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|CORESOURCE [1315]|CORESOURCE [131500]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28249.16|11096.85|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28249.16|4968.67|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28249.16||||||| MS123|DRG||Neurological Eye Disorders|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28249.16||||||| MS123|DRG||Neurological Eye Disorders|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28249.16||||||| MS123|DRG||Neurological Eye Disorders|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28249.16||||||| MS123|DRG||Neurological Eye Disorders|CHAMPVA [1240]|CHAMP VA [124000]|28249.16||||||| MS123|DRG||Neurological Eye Disorders|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28249.16||||||| MS123|DRG||Neurological Eye Disorders|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28249.16|25216.19|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28249.16|8791.22|28017.99|316.75|||| MS123|DRG||Neurological Eye Disorders|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28249.16|4968.67|28017.99|316.75|||| MS125|DRG||Other Disorders Of The Eye Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27074.95||||||| MS125|DRG||Other Disorders Of The Eye Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27074.95||||||| MS125|DRG||Other Disorders Of The Eye Without McC|CHAMPVA [1240]|CHAMP VA [124000]|27074.95||||||| MS125|DRG||Other Disorders Of The Eye Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27074.95||||||| MS125|DRG||Other Disorders Of The Eye Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27074.95||||||| MS125|DRG||Other Disorders Of The Eye Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27074.95||||||| MS125|DRG||Other Disorders Of The Eye Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|GEHA [1415]|GEHA [141500]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|CORESOURCE [1315]|CORESOURCE [131500]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27074.95|15320.75|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27074.95|9180.72|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27074.95|26374.2|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27074.95|5532.99|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|UMR [2035]|UMR OPTIONS [203501]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27074.95|10440.14|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27074.95|17143.23|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MULTIPLAN [1680]|IHC HS [168011]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|||27074.95|8122.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MULTIPLAN [1680]|HMA [168003]|27074.95|31.5|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|HEALTHNET [1495]|HEALTHNET [149500]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|TRUSTMARK [2030]|STARMARK [203000]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27074.95|725|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27074.95|11830.1|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27074.95|5532.99|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27074.95|5404.31|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27074.95|9872.48|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27074.95|12113.3|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27074.95|23736.78|26374.2|31.5|||| MS125|DRG||Other Disorders Of The Eye Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|27074.95|9872.48|26374.2|31.5|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156014.77|3625|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156014.77|156014.77|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|AETNA [1015]|AETNA ACO WILCO [101532]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|TRUSTMARK [2030]|STARMARK [203000]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|HEALTHNET [1495]|HEALTHNET [149500]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156014.77|81127.68|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MULTIPLAN [1680]|IHC HS [168011]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MULTIPLAN [1680]|HMA [168003]|156014.77|307.86|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|CHAMPVA [1240]|CHAMP VA [124000]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|FMH BENEFIT SERVICES [1390]|FMH [139000]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|FIRST HEALTH [1375]|QUALCHOICE [137513]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156014.77|81127.68|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|UMR [2035]|UMR OPTIONS [203501]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156014.77|90628.99|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|CORESOURCE [1315]|CORESOURCE [131500]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156014.77||||||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|GEHA [1415]|GEHA [141500]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|||156014.77|46804.43|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156014.77|101409.6|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156014.77|26624.56|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156014.77|156014.77|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156014.77|30993.25|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156014.77|28630.7|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156014.77|140413.29|156014.77|307.86|||| MS129|DRG||Major Head & Neck Procedures W Cc/McC Or Major Device|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156014.77|140413.29|156014.77|307.86|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59906.13|16812.33|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59906.13|38938.98|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59906.13|59906.13|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59906.13|19440.41|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|||59906.13|17971.84|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|GEHA [1415]|GEHA [141500]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|UMR [2035]|UMR OPTIONS [203501]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59906.13|10173.69|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MULTIPLAN [1680]|HMA [168003]|59906.13|1779.9|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59906.13||||||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59906.13|59906.13|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59906.13|10173.69|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59906.13|725|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59906.13|21466.71|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59906.13|53915.52|59906.13|725|||| MS130|DRG||Major Head & Neck Procedures W/O Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59906.13|34799.47|59906.13|725|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56339.46|19140.17|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56339.46|56339.46|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56339.46|725|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MULTIPLAN [1680]|HMA [168003]|56339.46|241.41|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56339.46|19140.17|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|UMR [2035]|UMR OPTIONS [203501]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56339.46|34762.62|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56339.46|56339.46|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56339.46|36620.65|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56339.46||||||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|GEHA [1415]|GEHA [141500]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56339.46|32727.6|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56339.46|31276.56|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|||56339.46|16901.84|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56339.46|50705.52|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56339.46|39935.27|56339.46|241.41|||| MS131|DRG||Cranial/Facial Procedures W Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56339.46|50705.52|56339.46|241.41|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|GEHA [1415]|GEHA [141500]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65948.46|38217.18|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65948.46|6729.75|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65948.46|38430.86|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65948.46|21031.71|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65948.46|66157.43|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|||65948.46|19784.54|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65948.46|43002.33|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|UMR [2035]|UMR OPTIONS [203501]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65948.46|11505.26|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65948.46|18485.89|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65948.46|6729.75|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MULTIPLAN [1680]|HMA [168003]|65948.46|1549.95|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65948.46|850|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65948.46||||||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65948.46|66157.43|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65948.46|11505.26|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65948.46|19878.78|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65948.46|38217.18|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65948.46|59541.69|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65948.46|725|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65948.46|23603.58|66157.43|725|||| MS132|DRG||Cranial/Facial Procedures W/O Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65948.46|59541.69|66157.43|725|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|UMR [2035]|UMR OPTIONS [203501]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MULTIPLAN [1680]|HMA [168003]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|||80925.39|24277.62|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80925.39|13811.96|24277.62|13811.96|||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|GEHA [1415]|GEHA [141500]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80925.39||||||| MS133|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|80925.39||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|GEHA [1415]|GEHA [141500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|UMR [2035]|UMR OPTIONS [203501]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MULTIPLAN [1680]|HMA [168003]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32516.57|18888.89|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|||32516.57|9754.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32516.57|4819.2|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32516.57|850|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32516.57||||||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32516.57|18888.89|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32516.57|8018.97|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32516.57|4819.2|18888.89|850|||| MS134|DRG||Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32516.57||||||| MS137|DRG||Mouth Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128727.98|74778.09|74778.09|6553.86|||| MS137|DRG||Mouth Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128727.98|6553.86|74778.09|6553.86|||| MS137|DRG||Mouth Procedures With Cc/McC|||128727.98|38618.39|74778.09|6553.86|||| MS137|DRG||Mouth Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128727.98|6553.86|74778.09|6553.86|||| MS137|DRG||Mouth Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128727.98|74778.09|74778.09|6553.86|||| MS137|DRG||Mouth Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128727.98|7650|74778.09|6553.86|||| MS137|DRG||Mouth Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128727.98||||||| MS137|DRG||Mouth Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128727.98||||||| MS139|DRG||Salivary Gland Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|GEHA [1415]|GEHA [141500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|CORESOURCE [1315]|CORESOURCE [131500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|CHAMPVA [1240]|CHAMP VA [124000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|UMR [2035]|UMR OPTIONS [203501]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MULTIPLAN [1680]|IHC HS [168011]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MULTIPLAN [1680]|HMA [168003]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|HEALTHNET [1495]|HEALTHNET [149500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|TRUSTMARK [2030]|STARMARK [203000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|||51324.49|15397.35|15397.35|15397.35|||| MS139|DRG||Salivary Gland Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51324.49||||||| MS139|DRG||Salivary Gland Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51324.49||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|125555.03|28790.73|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|125555.03|7975|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125555.03|29479.95|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|TRUSTMARK [2030]|STARMARK [203000]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|HEALTHNET [1495]|HEALTHNET [149500]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MULTIPLAN [1680]|IHC HS [168011]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MULTIPLAN [1680]|HMA [168003]|125555.03|5097.7|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|CHAMPVA [1240]|CHAMP VA [124000]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|125555.03|65288.62|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|UMR [2035]|UMR OPTIONS [203501]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125555.03|22429.62|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|125555.03|72934.93|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|125555.03||||||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|CORESOURCE [1315]|CORESOURCE [131500]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|GEHA [1415]|GEHA [141500]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|||125555.03|37666.51|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|125555.03|81610.78|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|125555.03|65288.62|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|125555.03|125555.03|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|125555.03|25994.9|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|125555.03|112999.53|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|125555.03|24119.67|125555.03|5097.7|||| MS146|DRG||Ear, Nose, Mouth And Throat Malignancy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|125555.03|24119.67|125555.03|5097.7|||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|GEHA [1415]|GEHA [141500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|UMR [2035]|UMR OPTIONS [203501]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MULTIPLAN [1680]|IHC HS [168011]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MULTIPLAN [1680]|HMA [168003]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|TRUSTMARK [2030]|STARMARK [203000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|||21140.17|6342.05|6342.05|6342.05|||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21140.17||||||| MS147|DRG||Ear, Nose, Mouth And Throat Malignancy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21140.17||||||| MS149|DRG||Dysequilibrium|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32987.07|5121.17|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32987.07|10415.42|41041.73|81.68|||| MS149|DRG||Dysequilibrium|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32987.07|10664.75|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32987.07|19160.55|41041.73|81.68|||| MS149|DRG||Dysequilibrium|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32987.07|850|41041.73|81.68|||| MS149|DRG||Dysequilibrium|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|AETNA [1015]|AETNA ACO WILCO [101532]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|HEALTHNET [1495]|HEALTHNET [149500]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MULTIPLAN [1680]|IHC HS [168011]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|FMH BENEFIT SERVICES [1390]|FMH [139000]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|FIRST HEALTH [1375]|QUALCHOICE [137513]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MULTIPLAN [1680]|HMA [168003]|32987.07|81.68|41041.73|81.68|||| MS149|DRG||Dysequilibrium|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32987.07|3644.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|TRUSTMARK [2030]|STARMARK [203000]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32987.07|5121.17|41041.73|81.68|||| MS149|DRG||Dysequilibrium|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|UMR [2035]|UMR OPTIONS [203501]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32987.07|1450|41041.73|81.68|||| MS149|DRG||Dysequilibrium|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32987.07|9520.78|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32987.07|41041.73|41041.73|81.68|||| MS149|DRG||Dysequilibrium|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32987.07|8495.72|41041.73|81.68|||| MS149|DRG||Dysequilibrium|||32987.07|9896.12|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32987.07|3644.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|CORESOURCE [1315]|CORESOURCE [131500]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32987.07|19160.55|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|GEHA [1415]|GEHA [141500]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|CHAMPVA [1240]|CHAMP VA [124000]|32987.07|12196.27|41041.73|81.68|||| MS149|DRG||Dysequilibrium|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32987.07|23841.13|41041.73|81.68|||| MS149|DRG||Dysequilibrium|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32987.07|26677.13|41041.73|81.68|||| MS149|DRG||Dysequilibrium|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32987.07|10847.7|41041.73|81.68|||| MS149|DRG||Dysequilibrium|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32987.07|4783.48|41041.73|81.68|||| MS149|DRG||Dysequilibrium|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32987.07|36937.56|41041.73|81.68|||| MS149|DRG||Dysequilibrium|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32987.07|10847.7|41041.73|81.68|||| MS150|DRG||Epistaxis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61698.85||||||| MS150|DRG||Epistaxis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61698.85||||||| MS150|DRG||Epistaxis With McC|GEHA [1415]|GEHA [141500]|61698.85||||||| MS150|DRG||Epistaxis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61698.85||||||| MS150|DRG||Epistaxis With McC|CORESOURCE [1315]|CORESOURCE [131500]|61698.85||||||| MS150|DRG||Epistaxis With McC|CHAMPVA [1240]|CHAMP VA [124000]|61698.85||||||| MS150|DRG||Epistaxis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61698.85||||||| MS150|DRG||Epistaxis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61698.85||||||| MS150|DRG||Epistaxis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61698.85||||||| MS150|DRG||Epistaxis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61698.85||||||| MS150|DRG||Epistaxis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61698.85||||||| MS150|DRG||Epistaxis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61698.85||||||| MS150|DRG||Epistaxis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61698.85||||||| MS150|DRG||Epistaxis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61698.85||||||| MS150|DRG||Epistaxis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61698.85||||||| MS150|DRG||Epistaxis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61698.85||||||| MS150|DRG||Epistaxis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61698.85||||||| MS150|DRG||Epistaxis With McC|UMR [2035]|UMR OPTIONS [203501]|61698.85||||||| MS150|DRG||Epistaxis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61698.85||||||| MS150|DRG||Epistaxis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61698.85||||||| MS150|DRG||Epistaxis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61698.85||||||| MS150|DRG||Epistaxis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|61698.85||||||| MS150|DRG||Epistaxis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61698.85||||||| MS150|DRG||Epistaxis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61698.85||||||| MS150|DRG||Epistaxis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|61698.85||||||| MS150|DRG||Epistaxis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61698.85||||||| MS150|DRG||Epistaxis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61698.85||||||| MS150|DRG||Epistaxis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61698.85||||||| MS150|DRG||Epistaxis With McC|MULTIPLAN [1680]|IHC HS [168011]|61698.85||||||| MS150|DRG||Epistaxis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61698.85||||||| MS150|DRG||Epistaxis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61698.85||||||| MS150|DRG||Epistaxis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61698.85||||||| MS150|DRG||Epistaxis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61698.85||||||| MS150|DRG||Epistaxis With McC|MULTIPLAN [1680]|HMA [168003]|61698.85||||||| MS150|DRG||Epistaxis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61698.85||||||| MS150|DRG||Epistaxis With McC|HEALTHNET [1495]|HEALTHNET [149500]|61698.85||||||| MS150|DRG||Epistaxis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61698.85||||||| MS150|DRG||Epistaxis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61698.85||||||| MS150|DRG||Epistaxis With McC|TRUSTMARK [2030]|STARMARK [203000]|61698.85||||||| MS150|DRG||Epistaxis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61698.85||||||| MS150|DRG||Epistaxis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61698.85||||||| MS150|DRG||Epistaxis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|61698.85||||||| MS150|DRG||Epistaxis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61698.85||||||| MS150|DRG||Epistaxis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61698.85||||||| MS150|DRG||Epistaxis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61698.85||||||| MS150|DRG||Epistaxis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61698.85||||||| MS150|DRG||Epistaxis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61698.85||||||| MS150|DRG||Epistaxis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61698.85||||||| MS150|DRG||Epistaxis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61698.85||||||| MS150|DRG||Epistaxis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61698.85||||||| MS150|DRG||Epistaxis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61698.85||||||| MS150|DRG||Epistaxis With McC|||61698.85|18509.65|18509.65|18509.65|||| MS150|DRG||Epistaxis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61698.85||||||| MS150|DRG||Epistaxis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61698.85||||||| MS150|DRG||Epistaxis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61698.85||||||| MS150|DRG||Epistaxis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61698.85||||||| MS150|DRG||Epistaxis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61698.85||||||| MS150|DRG||Epistaxis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61698.85||||||| MS150|DRG||Epistaxis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61698.85||||||| MS150|DRG||Epistaxis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61698.85||||||| MS151|DRG||Epistaxis Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50459.80||||||| MS151|DRG||Epistaxis Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50459.80||||||| MS151|DRG||Epistaxis Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50459.80||||||| MS151|DRG||Epistaxis Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50459.80||||||| MS151|DRG||Epistaxis Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50459.80||||||| MS151|DRG||Epistaxis Without McC|HEALTHNET [1495]|HEALTHNET [149500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MULTIPLAN [1680]|HMA [168003]|50459.80||||||| MS151|DRG||Epistaxis Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|50459.80||||||| MS151|DRG||Epistaxis Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MULTIPLAN [1680]|IHC HS [168011]|50459.80||||||| MS151|DRG||Epistaxis Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50459.80||||||| MS151|DRG||Epistaxis Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|TRUSTMARK [2030]|STARMARK [203000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|UMR [2035]|UMR OPTIONS [203501]|50459.80||||||| MS151|DRG||Epistaxis Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|50459.80||||||| MS151|DRG||Epistaxis Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50459.80||||||| MS151|DRG||Epistaxis Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50459.80||||||| MS151|DRG||Epistaxis Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50459.80||||||| MS151|DRG||Epistaxis Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50459.80||||||| MS151|DRG||Epistaxis Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50459.80||||||| MS151|DRG||Epistaxis Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50459.80||||||| MS151|DRG||Epistaxis Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50459.80||||||| MS151|DRG||Epistaxis Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50459.80||||||| MS151|DRG||Epistaxis Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50459.80||||||| MS151|DRG||Epistaxis Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50459.80||||||| MS151|DRG||Epistaxis Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50459.80||||||| MS151|DRG||Epistaxis Without McC|CORESOURCE [1315]|CORESOURCE [131500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50459.80|2550|29312.1|2550|||| MS151|DRG||Epistaxis Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50459.80||||||| MS151|DRG||Epistaxis Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50459.80|5246.26|29312.1|2550|||| MS151|DRG||Epistaxis Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50459.80|29312.1|29312.1|2550|||| MS151|DRG||Epistaxis Without McC|||50459.80|15137.94|29312.1|2550|||| MS151|DRG||Epistaxis Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50459.80|5246.26|29312.1|2550|||| MS151|DRG||Epistaxis Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50459.80|29312.1|29312.1|2550|||| MS151|DRG||Epistaxis Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|CHAMPVA [1240]|CHAMP VA [124000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50459.80||||||| MS151|DRG||Epistaxis Without McC|GEHA [1415]|GEHA [141500]|50459.80||||||| MS151|DRG||Epistaxis Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50459.80||||||| MS151|DRG||Epistaxis Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50459.80||||||| MS151|DRG||Epistaxis Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50459.80||||||| MS152|DRG||Otitis Media And Uri With McC|CHAMPVA [1240]|CHAMP VA [124000]|22145.56||||||| MS152|DRG||Otitis Media And Uri With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|GEHA [1415]|GEHA [141500]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22145.56|8237.17|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|CORESOURCE [1315]|CORESOURCE [131500]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22145.56|3767.7|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22145.56|12864.36|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22145.56|14394.61|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22145.56|12083.57|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22145.56|22145.56|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22145.56|14210.87|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|UMR [2035]|UMR OPTIONS [203501]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22145.56|3767.7|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22145.56|8205.82|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MULTIPLAN [1680]|IHC HS [168011]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MULTIPLAN [1680]|HMA [168003]|22145.56|35.9|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|HEALTHNET [1495]|HEALTHNET [149500]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|TRUSTMARK [2030]|STARMARK [203000]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|||22145.56|6643.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|AETNA [1015]|AETNA ACO WILCO [101532]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22145.56|725|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22145.56|15615.05|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22145.56|13231.67|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22145.56|8205.82|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22145.56|15249.98|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22145.56|19931.01|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22145.56|8237.17|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22145.56|6905.14|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22145.56|850|22145.56|35.9|||| MS152|DRG||Otitis Media And Uri With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22145.56|19931.01|22145.56|35.9|||| MS153|DRG||Otitis Media And Uri Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38845.27|4435.62|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|CHAMPVA [1240]|CHAMP VA [124000]|38845.27|2701.7|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|CORESOURCE [1315]|CORESOURCE [131500]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38845.27|34194.04|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|GEHA [1415]|GEHA [141500]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38845.27|5558.83|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38845.27|10062.81|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38845.27|34194.04|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38845.27|3400|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38845.27|2175|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|TRUSTMARK [2030]|STARMARK [203000]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|HEALTHNET [1495]|HEALTHNET [149500]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MULTIPLAN [1680]|IHC HS [168011]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MULTIPLAN [1680]|HMA [168003]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38845.27|4435.62|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38845.27|5558.83|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|UMR [2035]|UMR OPTIONS [203501]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38845.27|10303.7|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38845.27|9668.15|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38845.27|86764|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38845.27|8215.43|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38845.27|8834.46|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38845.27|56396.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|||38845.27|11653.58|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38845.27|50401.22|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38845.27|4628.74|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38845.27|78087.6|86764|2175|||| MS153|DRG||Otitis Media And Uri Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38845.27|78087.6|86764|2175|||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|GEHA [1415]|GEHA [141500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40412.60||||||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|40412.60|23475.69|23475.69|1700|||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40412.60|6585.89|23475.69|1700|||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|||40412.60|12123.78|23475.69|1700|||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|40412.60|6585.89|23475.69|1700|||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40412.60|1700|23475.69|1700|||| MS154|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40412.60|23475.69|23475.69|1700|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|TRUSTMARK [2030]|STARMARK [203000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|HEALTHNET [1495]|HEALTHNET [149500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MULTIPLAN [1680]|HMA [168003]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|UMR [2035]|UMR OPTIONS [203501]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MULTIPLAN [1680]|IHC HS [168011]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|CHAMPVA [1240]|CHAMP VA [124000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|CORESOURCE [1315]|CORESOURCE [131500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|GEHA [1415]|GEHA [141500]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70326.24|32989.33|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70326.24|2550|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70326.24||||||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70326.24|5770.99|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|||70326.24|21097.87|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70326.24|6756.05|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70326.24|5770.99|32989.33|2550|||| MS155|DRG||Other Ear, Nose, Mouth And Throat Diagnoses With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70326.24|32989.33|32989.33|2550|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|GEHA [1415]|GEHA [141500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|||26982.74|8094.82|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26982.74|42055.04|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26982.74|18282.36|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26982.74|64700.06|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26982.74|21396.75|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26982.74|37584.27|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26982.74|12462.96|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|26982.74|843.66|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26982.74||||||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26982.74|725|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26982.74|23147.8|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26982.74|22606.62|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26982.74|12462.96|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26982.74|58230.05|64700.06|725|||| MS156|DRG||Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26982.74|58230.05|64700.06|725|||| MS157|DRG||Dental And Oral Diseases With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|AETNA [1015]|AETNA ACO WILCO [101532]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|TRUSTMARK [2030]|STARMARK [203000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|HEALTHNET [1495]|HEALTHNET [149500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MULTIPLAN [1680]|HMA [168003]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|UMR [2035]|UMR OPTIONS [203501]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MULTIPLAN [1680]|IHC HS [168011]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|CHAMPVA [1240]|CHAMP VA [124000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|CORESOURCE [1315]|CORESOURCE [131500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|GEHA [1415]|GEHA [141500]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34983.47||||||| MS157|DRG||Dental And Oral Diseases With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|||34983.47|10495.04|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34983.47|9984.47|10495.04|9984.47|||| MS157|DRG||Dental And Oral Diseases With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34983.47|9984.47|10495.04|9984.47|||| MS158|DRG||Dental And Oral Diseases With Cc|CHAMPVA [1240]|CHAMP VA [124000]|30590.55||||||| MS158|DRG||Dental And Oral Diseases With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30590.55||||||| MS158|DRG||Dental And Oral Diseases With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30590.55||||||| MS158|DRG||Dental And Oral Diseases With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30590.55||||||| MS158|DRG||Dental And Oral Diseases With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30590.55||||||| MS158|DRG||Dental And Oral Diseases With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|GEHA [1415]|GEHA [141500]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|||30590.55|9177.16|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30590.55|21340.87|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30590.55|10078.56|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30590.55|32832.11|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|UMR [2035]|UMR OPTIONS [203501]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30590.55|6879.09|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MULTIPLAN [1680]|IHC HS [168011]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30590.55|12012.52|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MULTIPLAN [1680]|HMA [168003]|30590.55|243.11|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|HEALTHNET [1495]|HEALTHNET [149500]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30590.55|19072.17|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|TRUSTMARK [2030]|STARMARK [203000]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|CORESOURCE [1315]|CORESOURCE [131500]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30590.55|1450|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30590.55|29548.9|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30590.55||||||| MS158|DRG||Dental And Oral Diseases With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30590.55|12891.95|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30590.55|12590.55|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30590.55|6879.09|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30590.55|5738.04|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30590.55|10837.97|32832.11|243.11|||| MS158|DRG||Dental And Oral Diseases With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30590.55|29548.9|32832.11|243.11|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24061.12|9509.1|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24061.12|12258.19|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24061.12|850|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24061.12|725|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|24061.12|210.96|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24061.12|4283.88|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24061.12|4792.51|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24061.12|9286.78|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24061.12|4792.51|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24061.12|9101.66|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24061.12|61197.75|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24061.12|7825.83|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24061.12||||||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24061.12|39778.54|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|||24061.12|7218.34|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24061.12|35549.78|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24061.12|4283.88|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24061.12|9992.36|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24061.12|12258.19|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|GEHA [1415]|GEHA [141500]|24061.12|55077.99|61197.75|210.96|||| MS159|DRG||Dental And Oral Diseases Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24061.12|55077.99|61197.75|210.96|||| MS163|DRG||Major Chest Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|156936.49||||||| MS163|DRG||Major Chest Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|156936.49|91164.4|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156936.49|44033.2|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156936.49|71727.21|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156936.49|80259.42|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156936.49|123476.03|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156936.49|66818.54|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156936.49|64207.54|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|156936.49|44033.2|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MULTIPLAN [1680]|HMA [168003]|156936.49|665.02|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156936.49|56681.13|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|||156936.49|47080.95|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156936.49|2900|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156936.49|8500|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|GEHA [1415]|GEHA [141500]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156936.49|91164.4|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156936.49|111128.43|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156936.49|71914.2|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156936.49|70232.9|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156936.49|64207.54|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156936.49|31034.52|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156936.49|72372.93|123476.03|665.02|||| MS163|DRG||Major Chest Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156936.49|111128.43|123476.03|665.02|||| MS164|DRG||Major Chest Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132232.48|62912.07|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132232.48|37325.56|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132232.48|57132.56|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132232.48|1700|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132232.48|3625|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|132232.48|794.31|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132232.48|18222.2|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132232.48|62912.07|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132232.48|34849.15|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132232.48|120984.75|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132232.48|29442.51|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132232.48|38219.1|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132232.48|78640.09|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|||132232.48|39669.74|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132232.48|70280.04|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132232.48|16593.06|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132232.48|18222.2|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|132232.48|94557.67|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132232.48|37593.48|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132232.48|57132.56|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|GEHA [1415]|GEHA [141500]|132232.48|108886.27|120984.75|794.31|||| MS164|DRG||Major Chest Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132232.48|108886.27|120984.75|794.31|||| MS165|DRG||Major Chest Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|135388.53||||||| MS165|DRG||Major Chest Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135388.53|79331.97|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135388.53|18306.53|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135388.53|43634.59|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|||135388.53|40616.56|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135388.53|48825.07|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135388.53|21506.2|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135388.53|25021.46|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135388.53|14712.65|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135388.53|18306.53|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|135388.53|468.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135388.53|75115.48|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135388.53|1450|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135388.53|7650|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135388.53|79331.97|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135388.53|67603.94|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135388.53|27674.7|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135388.53|27027.68|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135388.53|14712.65|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135388.53|12073.81|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135388.53|27460.05|79331.97|468.94|||| MS165|DRG||Major Chest Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135388.53|67603.94|79331.97|468.94|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|114043.96||||||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114043.96|25590.53|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114043.96|80602.65|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114043.96|53665.94|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114043.96|54950.65|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114043.96|47132.42|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114043.96|4250|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|114043.96|3625|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|114043.96|5828.85|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|114043.96|21262.51|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114043.96|80602.65|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114043.96|47955.44|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114043.96|155005.1|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114043.96|43388.04|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114043.96|100753.32|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|||114043.96|34213.19|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114043.96|90042.44|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114043.96|23764.06|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114043.96|21262.51|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|114043.96|46657.29|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|114043.96|47132.42|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|114043.96|139504.59|155005.1|3625|||| MS166|DRG||Other Respiratory System O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114043.96|139504.59|155005.1|3625|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|105692.09|77590.84|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105692.09|12863.96|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|||105692.09|31707.63|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|105692.09|12863.96|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|105692.09||||||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105692.09|5950|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105692.09|77590.84|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105692.09|12990|77590.84|5950|||| MS167|DRG||Other Respiratory System O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105692.09|12990|77590.84|5950|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120310.68|62561.55|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120310.68|19392.07|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120310.68|19856.3|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|120310.68|4350|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|120310.68|630.81|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120310.68|62561.55|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120310.68|17446.21|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120310.68|120310.68|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120310.68|15429.52|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120310.68||||||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120310.68|78201.94|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|||120310.68|36093.2|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120310.68|69888.49|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|120310.68|16592.12|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|120310.68|108279.62|120310.68|630.81|||| MS168|DRG||Other Respiratory System O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120310.68|108279.62|120310.68|630.81|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|GEHA [1415]|GEHA [141500]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|47290.45|31603.19|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|CORESOURCE [1315]|CORESOURCE [131500]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|CHAMPVA [1240]|CHAMP VA [124000]|47290.45|31262.68|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47290.45|19253.33|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47290.45|24462.67|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|||47290.45|14187.13|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47290.45|27372.59|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47290.45|16798.37|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47290.45|19844.66|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|UMR [2035]|UMR OPTIONS [203501]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47290.45|12331.33|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|47290.45|19253.33|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|FIRST HEALTH [1375]|QUALCHOICE [137513]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|FMH BENEFIT SERVICES [1390]|FMH [139000]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MULTIPLAN [1680]|IHC HS [168011]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MULTIPLAN [1680]|HMA [168003]|47290.45|138.58|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47290.45|42111.68|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|HEALTHNET [1495]|HEALTHNET [149500]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|TRUSTMARK [2030]|STARMARK [203000]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|AETNA [1015]|AETNA ACO WILCO [101532]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|47290.45|1450|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47290.45|1700|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47290.45|31603.19|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47290.45|37900.52|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47290.45|22390.9|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47290.45|21867.42|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47290.45|12331.33|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|47290.45|20183.77|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47290.45|20183.77|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|47290.45|18064.11|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47290.45|9809.21|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47290.45|18645.63|42111.68|138.58|||| MS175|DRG||Pulmonary Embolism With McC Or Acute Cor Pulmonale|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47290.45|37900.52|42111.68|138.58|||| MS176|DRG||Pulmonary Embolism Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30761.97|7808.53|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30761.97|12556.56|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30761.97|12857.15|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30761.97|14952.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30761.97|1700|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30761.97|725|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|HEALTHNET [1495]|HEALTHNET [149500]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MULTIPLAN [1680]|HMA [168003]|30761.97|243.6|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MULTIPLAN [1680]|IHC HS [168011]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30761.97|10926.92|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30761.97|7808.53|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|TRUSTMARK [2030]|STARMARK [203000]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|UMR [2035]|UMR OPTIONS [203501]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30761.97|12103.1|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30761.97|33295.49|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30761.97|5723.12|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30761.97|9866.89|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30761.97|21642.07|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|||30761.97|9228.59|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30761.97|19341.37|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30761.97|5754.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30761.97|10926.92|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|CHAMPVA [1240]|CHAMP VA [124000]|30761.97|21421.65|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30761.97|10610.35|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|CORESOURCE [1315]|CORESOURCE [131500]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30761.97|14952.47|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|GEHA [1415]|GEHA [141500]|30761.97|29965.95|33295.49|243.6|||| MS176|DRG||Pulmonary Embolism Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30761.97|29965.95|33295.49|243.6|||| MS177|DRG||Respiratory Infections And Inflammations With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|GEHA [1415]|GEHA [141500]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69351.77|39868.86|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|CORESOURCE [1315]|CORESOURCE [131500]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|CHAMPVA [1240]|CHAMP VA [124000]|69351.77|47679.58|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69351.77|17054.53|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69351.77|37116.56|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69351.77|41531.69|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69351.77|21994.66|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69351.77|11553.37|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69351.77|63894.9|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69351.77|25021.46|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|UMR [2035]|UMR OPTIONS [203501]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69351.77|15739.79|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69351.77|17054.53|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MULTIPLAN [1680]|IHC HS [168011]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MULTIPLAN [1680]|HMA [168003]|69351.77|1998.96|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|HEALTHNET [1495]|HEALTHNET [149500]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|TRUSTMARK [2030]|STARMARK [203000]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|||69351.77|20805.53|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|AETNA [1015]|AETNA ACO WILCO [101532]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69351.77|5800|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69351.77|2550|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69351.77|12195.02|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69351.77|39868.86|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69351.77|57505.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69351.77|26756.85|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69351.77|26131.29|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69351.77|15739.79|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69351.77|23651.93|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69351.77|23651.93|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69351.77|23651.93|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69351.77|11680.41|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69351.77|26000.45|63894.9|1998.96|||| MS177|DRG||Respiratory Infections And Inflammations With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69351.77|57505.41|63894.9|1998.96|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|CHAMPVA [1240]|CHAMP VA [124000]|46011.57||||||| MS178|DRG||Respiratory Infections And Inflammations With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46011.57|55817.56|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46011.57|17485.55|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46011.57|7975|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|TRUSTMARK [2030]|STARMARK [203000]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|HEALTHNET [1495]|HEALTHNET [149500]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MULTIPLAN [1680]|IHC HS [168011]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MULTIPLAN [1680]|HMA [168003]|46011.57|7225.06|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46011.57|11289.4|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46011.57|55817.56|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|UMR [2035]|UMR OPTIONS [203501]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46011.57|2550|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46011.57|18441.42|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46011.57|17511.1|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46011.57|107341.46|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46011.57|17076.75|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46011.57|14459.58|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46011.57|69771.96|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|||46011.57|13803.47|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46011.57|62354.66|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46011.57|7685.41|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46011.57|11289.4|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46011.57|18462.62|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|CORESOURCE [1315]|CORESOURCE [131500]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46011.57|18441.42|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|GEHA [1415]|GEHA [141500]|46011.57|96607.32|107341.46|2550|||| MS178|DRG||Respiratory Infections And Inflammations With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46011.57|96607.32|107341.46|2550|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|GEHA [1415]|GEHA [141500]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33270.08|26494.77|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33270.08|7562.9|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33270.08|57558.78|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|||33270.08|9981.02|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33270.08|64405.6|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33270.08|10072.74|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33270.08|12573.6|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33270.08|7827.1|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33270.08|7562.9|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|33270.08|2885.48|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33270.08|99085.53|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33270.08|4350|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33270.08|850|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33270.08|26494.77|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33270.08|89176.98|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|33270.08||||||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33270.08|12630.95|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33270.08|12335.65|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33270.08|7827.1|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33270.08|5539.15|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33270.08|12861.32|99085.53|850|||| MS179|DRG||Respiratory Infections And Inflammations Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33270.08|89176.98|99085.53|850|||| MS180|DRG||Respiratory Neoplasms With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82060.33|13621.72|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82060.33|24608.99|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82060.33|25198.1|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82060.33|44619.54|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82060.33|6800|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82060.33|2900|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|AETNA [1015]|AETNA ACO WILCO [101532]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|HEALTHNET [1495]|HEALTHNET [149500]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MULTIPLAN [1680]|IHC HS [168011]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MULTIPLAN [1680]|HMA [168003]|82060.33|194.24|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82060.33|13195.1|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82060.33|13621.72|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|TRUSTMARK [2030]|STARMARK [203000]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|UMR [2035]|UMR OPTIONS [203501]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82060.33|22840.69|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82060.33|67854.85|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82060.33|11012.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82060.33|20060.59|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82060.33|44105.65|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|||82060.33|24618.1|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82060.33|39416.89|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82060.33|11998.11|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82060.33|13195.1|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|CHAMPVA [1240]|CHAMP VA [124000]|82060.33|88350.63|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82060.33|21969.88|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|CORESOURCE [1315]|CORESOURCE [131500]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82060.33|44619.54|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|GEHA [1415]|GEHA [141500]|82060.33|61069.36|88350.63|194.24|||| MS180|DRG||Respiratory Neoplasms With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82060.33|61069.36|88350.63|194.24|||| MS181|DRG||Respiratory Neoplasms With Cc|CHAMPVA [1240]|CHAMP VA [124000]|31565.50||||||| MS181|DRG||Respiratory Neoplasms With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31565.50|14479.5|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|CORESOURCE [1315]|CORESOURCE [131500]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31565.50|8308.18|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31565.50|30246.56|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|||31565.50|9469.65|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31565.50|33844.48|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31565.50|52068.44|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31565.50|15629.12|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|UMR [2035]|UMR OPTIONS [203501]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31565.50|9352.47|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31565.50|8308.18|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MULTIPLAN [1680]|IHC HS [168011]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MULTIPLAN [1680]|HMA [168003]|31565.50|197.23|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|HEALTHNET [1495]|HEALTHNET [149500]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31565.50|13397.76|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|TRUSTMARK [2030]|STARMARK [203000]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31565.50|2175|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31565.50|1700|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|GEHA [1415]|GEHA [141500]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31565.50|14479.5|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31565.50|46861.59|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31565.50|16253.05|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31565.50|15873.06|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31565.50|9352.47|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31565.50|4500.3|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31565.50|17106.84|52068.44|197.23|||| MS181|DRG||Respiratory Neoplasms With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31565.50|46861.59|52068.44|197.23|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40333.83|6531.06|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40333.83|11151.79|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|40333.83|3625|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40333.83|11418.75|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|40333.83|377.46|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40333.83|6531.06|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40333.83|11421.7|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40333.83|40333.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40333.83||||||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40333.83|9801.76|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40333.83|26216.99|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|||40333.83|12100.15|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40333.83|23429.91|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|40333.83|37791.83|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|GEHA [1415]|GEHA [141500]|40333.83|36300.45|40333.83|377.46|||| MS182|DRG||Respiratory Neoplasms Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40333.83|36300.45|40333.83|377.46|||| MS183|DRG||Major Chest Trauma With McC|GEHA [1415]|GEHA [141500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|CORESOURCE [1315]|CORESOURCE [131500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|CHAMPVA [1240]|CHAMP VA [124000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|UMR [2035]|UMR OPTIONS [203501]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MULTIPLAN [1680]|IHC HS [168011]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MULTIPLAN [1680]|HMA [168003]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|HEALTHNET [1495]|HEALTHNET [149500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|TRUSTMARK [2030]|STARMARK [203000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|AETNA [1015]|AETNA ACO WILCO [101532]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113899.24||||||| MS183|DRG||Major Chest Trauma With McC|||113899.24|34169.77|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113899.24|9880.06|34169.77|9880.06|||| MS183|DRG||Major Chest Trauma With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113899.24|9880.06|34169.77|9880.06|||| MS184|DRG||Major Chest Trauma With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|HEALTHNET [1495]|HEALTHNET [149500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MULTIPLAN [1680]|IHC HS [168011]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MULTIPLAN [1680]|HMA [168003]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|UMR [2035]|UMR OPTIONS [203501]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|TRUSTMARK [2030]|STARMARK [203000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|CHAMPVA [1240]|CHAMP VA [124000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|CORESOURCE [1315]|CORESOURCE [131500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|GEHA [1415]|GEHA [141500]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27991.45||||||| MS184|DRG||Major Chest Trauma With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|||27991.45|8397.43|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27991.45|6678.2|8397.43|6678.2|||| MS184|DRG||Major Chest Trauma With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27991.45|6678.2|8397.43|6678.2|||| MS185|DRG||Major Chest Trauma Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|GEHA [1415]|GEHA [141500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34765.18||||||| MS185|DRG||Major Chest Trauma Without Cc/McC|||34765.18|10429.55|10429.55|10429.55|||| MS186|DRG||Pleural Effusion With McC|CHAMPVA [1240]|CHAMP VA [124000]|46991.96||||||| MS186|DRG||Pleural Effusion With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46991.96|22376.4|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46991.96|23533.36|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46991.96|2175|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|AETNA [1015]|AETNA ACO WILCO [101532]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|TRUSTMARK [2030]|STARMARK [203000]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|HEALTHNET [1495]|HEALTHNET [149500]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MULTIPLAN [1680]|IHC HS [168011]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MULTIPLAN [1680]|HMA [168003]|46991.96|487.77|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46991.96|8856.99|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46991.96|12477.49|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|UMR [2035]|UMR OPTIONS [203501]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46991.96|3400|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46991.96|20612.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46991.96|35994.74|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46991.96|21853.26|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46991.96|17943.93|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46991.96|23396.58|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46991.96|12477.49|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|||46991.96|14097.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46991.96|20909.34|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46991.96|9803|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46991.96|8856.99|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46991.96|22512.59|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|CORESOURCE [1315]|CORESOURCE [131500]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46991.96|23533.36|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|GEHA [1415]|GEHA [141500]|46991.96|32395.27|35994.74|487.77|||| MS186|DRG||Pleural Effusion With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46991.96|32395.27|35994.74|487.77|||| MS187|DRG||Pleural Effusion With Cc|CHAMPVA [1240]|CHAMP VA [124000]|39283.37||||||| MS187|DRG||Pleural Effusion With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|GEHA [1415]|GEHA [141500]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39283.37|18628.61|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39283.37|6816.68|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39283.37|15372.98|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|||39283.37|11785.01|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39283.37|17201.64|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39283.37|11954.48|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39283.37|14287.94|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|UMR [2035]|UMR OPTIONS [203501]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39283.37|8632.98|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39283.37|6816.68|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MULTIPLAN [1680]|IHC HS [168011]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MULTIPLAN [1680]|HMA [168003]|39283.37|184.63|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39283.37|26464.06|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|HEALTHNET [1495]|HEALTHNET [149500]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|TRUSTMARK [2030]|STARMARK [203000]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39283.37|1450|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39283.37|4250|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|CORESOURCE [1315]|CORESOURCE [131500]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39283.37|18628.61|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39283.37|23817.65|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39283.37|11225.18|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39283.37|14616.98|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39283.37|8632.98|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39283.37|6627.34|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39283.37|12794.24|26464.06|184.63|||| MS187|DRG||Pleural Effusion With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39283.37|23817.65|26464.06|184.63|||| MS188|DRG||Pleural Effusion Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|GEHA [1415]|GEHA [141500]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38690.56||||||| MS188|DRG||Pleural Effusion Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38690.56|12450.42|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38690.56|850|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38690.56|4923|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|||38690.56|11607.17|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38690.56|37614.46|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38690.56|4737.49|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38690.56|4923|37614.46|850|||| MS188|DRG||Pleural Effusion Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38690.56|12450.42|37614.46|850|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|GEHA [1415]|GEHA [141500]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|CORESOURCE [1315]|CORESOURCE [131500]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|CHAMPVA [1240]|CHAMP VA [124000]|42397.03|41647.39|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42397.03|9124.62|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42397.03|15493.12|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42397.03|17336.09|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42397.03|26670.9|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42397.03|16488.99|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|UMR [2035]|UMR OPTIONS [203501]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42397.03|9799.82|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42397.03|10502.05|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|FIRST HEALTH [1375]|QUALCHOICE [137513]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|FMH BENEFIT SERVICES [1390]|FMH [139000]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MULTIPLAN [1680]|IHC HS [168011]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MULTIPLAN [1680]|HMA [168003]|42397.03|14.59|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|HEALTHNET [1495]|HEALTHNET [149500]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42397.03|14138.59|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|TRUSTMARK [2030]|STARMARK [203000]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|||42397.03|12719.11|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|AETNA [1015]|AETNA ACO WILCO [101532]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42397.03|725|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42397.03|850|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42397.03|18832.88|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42397.03|18832.88|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42397.03|24003.81|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42397.03|17759.6|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42397.03|17344.39|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42397.03|9799.82|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42397.03|7824.27|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42397.03|18052.77|41647.39|14.59|||| MS189|DRG||Pulmonary Edema And Respiratory Failure|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42397.03|24003.81|41647.39|14.59|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47094.37|9482.47|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47094.37|15915.55|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47094.37|16296.55|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47094.37|28392.17|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47094.37|2550|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|47094.37|2175|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|AETNA [1015]|AETNA ACO WILCO [101532]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|TRUSTMARK [2030]|STARMARK [203000]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|HEALTHNET [1495]|HEALTHNET [149500]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MULTIPLAN [1680]|IHC HS [168011]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MULTIPLAN [1680]|HMA [168003]|47094.37|695.55|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|47094.37|8715.29|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47094.37|9482.47|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|UMR [2035]|UMR OPTIONS [203501]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47094.37|15583.15|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47094.37|45952.04|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47094.37|13304.72|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47094.37|29868.82|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|||47094.37|14128.31|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47094.37|26693.54|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47094.37|7197.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47094.37|8715.29|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|CHAMPVA [1240]|CHAMP VA [124000]|47094.37|7189.37|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|47094.37|14307.22|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|CORESOURCE [1315]|CORESOURCE [131500]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|47094.37|28392.17|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|GEHA [1415]|GEHA [141500]|47094.37|41356.83|45952.04|695.55|||| MS190|DRG||Chronic Obstructive Pulmonary Disease With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47094.37|41356.83|45952.04|695.55|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|UMR [2035]|UMR OPTIONS [203501]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MULTIPLAN [1680]|IHC HS [168011]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MULTIPLAN [1680]|HMA [168003]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|HEALTHNET [1495]|HEALTHNET [149500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|TRUSTMARK [2030]|STARMARK [203000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39379.28|25354.64|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39379.28|9872.5|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|||39379.28|11813.78|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39379.28|9872.5|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39379.28|2550|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39379.28|25354.64|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39379.28|5700.75|25354.64|2550|||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|CHAMPVA [1240]|CHAMP VA [124000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|GEHA [1415]|GEHA [141500]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39379.28||||||| MS191|DRG||Chronic Obstructive Pulmonary Disease With Cc|CORESOURCE [1315]|CORESOURCE [131500]|39379.28||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26070.25|9840.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26070.25|22900.06|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26070.25|39421.68|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26070.25|25624.1|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26070.25|3234.78|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|||26070.25|7821.07|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26070.25|9822.28|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|26070.25|19552.69|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26070.25|10076.05|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26070.25|18843.4|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26070.25|8619.81|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|26070.25|545.77|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26070.25|1450|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26070.25|8248|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26070.25|8619.81|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26070.25|18815.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|26070.25|35479.52|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26070.25|8869.48|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26070.25|5805.93|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26070.25||||||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26070.25|5805.93|39421.68|545.77|||| MS192|DRG||Chronic Obstructive Pulmonary Disease Without Cc/McC|GEHA [1415]|GEHA [141500]|26070.25|35479.52|39421.68|545.77|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49732.78|18564.31|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MULTIPLAN [1680]|HMA [168003]|49732.78|566.52|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49732.78|21496.69|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49732.78|11701.48|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49732.78|11628.53|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49732.78|30240.32|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49732.78|46523.56|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|UMR [2035]|UMR OPTIONS [203501]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49732.78|21496.69|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MULTIPLAN [1680]|IHC HS [168011]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|HEALTHNET [1495]|HEALTHNET [149500]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|CORESOURCE [1315]|CORESOURCE [131500]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49732.78|15508.61|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|TRUSTMARK [2030]|STARMARK [203000]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49732.78|18560.82|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|GEHA [1415]|GEHA [141500]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|CHAMPVA [1240]|CHAMP VA [124000]|49732.78|65588.97|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49732.78|19802.06|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49732.78|19005.15|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49732.78|11701.48|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49732.78|16677.16|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|||49732.78|14919.83|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49732.78|2550|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49732.78|2175|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49732.78|27025.54|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49732.78|9914.9|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49732.78|8358.11|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49732.78|41871.21|65588.97|566.52|||| MS193|DRG||Simple Pneumonia And Pleurisy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49732.78|41871.21|65588.97|566.52|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37770.84|13042.12|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37770.84|12220.94|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37770.84|12513.5|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37770.84|13042.12|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37770.84|2550|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37770.84|16277.7|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37770.84|7823.06|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MULTIPLAN [1680]|HMA [168003]|37770.84|41.65|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37770.84|1450|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MULTIPLAN [1680]|IHC HS [168011]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|UMR [2035]|UMR OPTIONS [203501]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37770.84|10334.42|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37770.84|7823.06|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37770.84|7503.46|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|||37770.84|11331.25|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37770.84|22118.41|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|37770.84|10683.41|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37770.84|19767.07|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|TRUSTMARK [2030]|STARMARK [203000]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37770.84|6527.36|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37770.84|34028.32|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37770.84|16277.7|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|GEHA [1415]|GEHA [141500]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37770.84|11113.11|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37770.84|12616.86|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37770.84|5611.1|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37770.84|30625.49|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37770.84|5575.85|34028.32|41.65|||| MS194|DRG||Simple Pneumonia And Pleurisy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37770.84|13042.12|34028.32|41.65|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27717.66|5688.03|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27717.66|9597.85|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27717.66|4509.55|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27717.66|30849.51|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27717.66|2900|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27717.66|2550|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27717.66|15381.51|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27717.66|5688.03|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|27717.66|54.25|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27717.66|9642.5|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27717.66|10128.97|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27717.66|9417.07|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27717.66|10128.97|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27717.66|10128.97|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|GEHA [1415]|GEHA [141500]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|27717.66||||||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27717.66|8805.91|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27717.66|15381.51|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|||27717.66|8315.3|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27717.66|20052.18|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27717.66|27764.56|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27717.66|17920.49|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27717.66|7932.82|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27717.66|4509.55|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27717.66|4345.36|30849.51|54.25|||| MS195|DRG||Simple Pneumonia And Pleurisy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27717.66|27764.56|30849.51|54.25|||| MS196|DRG||Interstitial Lung Disease With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|CHAMPVA [1240]|CHAMP VA [124000]|65666.26||||||| MS196|DRG||Interstitial Lung Disease With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65666.26|13432.76|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65666.26|25173.45|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65666.26|13432.76|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|AETNA [1015]|AETNA ACO WILCO [101532]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65666.26|3625|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|HEALTHNET [1495]|HEALTHNET [149500]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65666.26|1700|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65666.26|16055.42|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65666.26|11038.37|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65666.26|21583.33|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|TRUSTMARK [2030]|STARMARK [203000]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65666.26|42885.92|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65666.26|19484.9|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|UMR [2035]|UMR OPTIONS [203501]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65666.26|65978.34|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|||65666.26|19699.88|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65666.26|11038.37|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65666.26|24584.91|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65666.26|38326.84|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|GEHA [1415]|GEHA [141500]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|CORESOURCE [1315]|CORESOURCE [131500]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65666.26|24879.17|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65666.26|11113.07|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MULTIPLAN [1680]|IHC HS [168011]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65666.26|59380.51|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|MULTIPLAN [1680]|HMA [168003]|65666.26|2663.2|65978.34|1700|||| MS196|DRG||Interstitial Lung Disease With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65666.26|16055.42|65978.34|1700|||| MS197|DRG||Interstitial Lung Disease With Cc|CHAMPVA [1240]|CHAMP VA [124000]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28072.57|16369.84|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28072.57|11880.05|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|||28072.57|8421.77|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28072.57||||||| MS197|DRG||Interstitial Lung Disease With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|UMR [2035]|UMR OPTIONS [203501]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28072.57|14127.05|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28072.57|7677.48|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28072.57|27382.66|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|HEALTHNET [1495]|HEALTHNET [149500]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28072.57|42127.17|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MULTIPLAN [1680]|HMA [168003]|28072.57|457.86|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28072.57|16369.84|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28072.57|2175|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MULTIPLAN [1680]|IHC HS [168011]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28072.57|24471.69|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28072.57|8571.61|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28072.57|1700|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28072.57|15168.96|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|GEHA [1415]|GEHA [141500]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28072.57|14240.3|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28072.57|7677.48|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|TRUSTMARK [2030]|STARMARK [203000]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28072.57|14581.2|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28072.57|8571.61|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28072.57|37914.45|42127.17|457.86|||| MS197|DRG||Interstitial Lung Disease With Cc|CORESOURCE [1315]|CORESOURCE [131500]|28072.57|37914.45|42127.17|457.86|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|||86658.43|25997.53|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|GEHA [1415]|GEHA [141500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86658.43||||||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|86658.43|10989.17|25997.53|10989.17|||| MS198|DRG||Interstitial Lung Disease Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86658.43|10989.17|25997.53|10989.17|||| MS199|DRG||Pneumothorax With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|TRUSTMARK [2030]|STARMARK [203000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53251.62|850|25829.26|850|||| MS199|DRG||Pneumothorax With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53251.62|13148.83|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|HEALTHNET [1495]|HEALTHNET [149500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|AETNA [1015]|AETNA ACO WILCO [101532]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MULTIPLAN [1680]|IHC HS [168011]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MULTIPLAN [1680]|HMA [168003]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53251.62|13148.83|25829.26|850|||| MS199|DRG||Pneumothorax With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|CHAMPVA [1240]|CHAMP VA [124000]|53251.62||||||| MS199|DRG||Pneumothorax With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|||53251.62|15975.49|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53251.62|11182.1|25829.26|850|||| MS199|DRG||Pneumothorax With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|UMR [2035]|UMR OPTIONS [203501]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|CORESOURCE [1315]|CORESOURCE [131500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53251.62|11182.1|25829.26|850|||| MS199|DRG||Pneumothorax With McC|GEHA [1415]|GEHA [141500]|53251.62|25829.26|25829.26|850|||| MS199|DRG||Pneumothorax With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53251.62|11321.84|25829.26|850|||| MS199|DRG||Pneumothorax With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|53251.62|25829.26|25829.26|850|||| MS200|DRG||Pneumothorax With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|CHAMPVA [1240]|CHAMP VA [124000]|28033.18||||||| MS200|DRG||Pneumothorax With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MULTIPLAN [1680]|HMA [168003]|28033.18|10.15|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28033.18|15223.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28033.18|6875.55|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MULTIPLAN [1680]|IHC HS [168011]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28033.18|15587.5|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28033.18|8142.83|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|UMR [2035]|UMR OPTIONS [203501]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28033.18|10462.53|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|TRUSTMARK [2030]|STARMARK [203000]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|HEALTHNET [1495]|HEALTHNET [149500]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28033.18|12790.15|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28033.18|1700|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28033.18|14346.07|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28033.18|16096.2|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|||28033.18|8409.95|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28033.18|725|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28033.18|6875.55|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|CORESOURCE [1315]|CORESOURCE [131500]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28033.18|12790.15|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|GEHA [1415]|GEHA [141500]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28033.18|12584.82|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28033.18|9350.28|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28033.18|6893.33|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28033.18|8142.83|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28033.18|14486.58|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28033.18|13533.08|16096.2|10.15|||| MS200|DRG||Pneumothorax With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28033.18|14486.58|16096.2|10.15|||| MS201|DRG||Pneumothorax Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18674.89|8187.89|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|18674.89||||||| MS201|DRG||Pneumothorax Without Cc/McC|GEHA [1415]|GEHA [141500]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|18674.89|4207.2|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18674.89|8350.34|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|||18674.89|5602.47|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18674.89|7640.24|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|18674.89|10275.2|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18674.89|5730.02|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|18674.89|4207.2|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|18674.89|11754.21|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|18674.89|6828.02|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|18674.89|8187.89|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|18674.89|850|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18674.89|10287.75|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|18674.89|5730.02|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|18674.89|725|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|18674.89|10578.79|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|18674.89|8979.53|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|18674.89|8.82|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|18674.89|10047.23|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|18674.89|4621.9|11754.21|8.82|||| MS201|DRG||Pneumothorax Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|18674.89|10578.79|11754.21|8.82|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26084.36|7085.81|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26084.36|1450|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26084.36|1700|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26084.36|14565.67|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26084.36|13673.86|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MULTIPLAN [1680]|HMA [168003]|26084.36|233.52|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26084.36|5030.44|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26084.36|14001.2|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26084.36|12519.52|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|26084.36|35702.42|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26084.36|17691.98|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26084.36|5030.44|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26084.36|11025.24|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26084.36|19796.5|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|GEHA [1415]|GEHA [141500]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|||26084.36|7825.31|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26084.36|14077.51|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26084.36|6213.45|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26084.36|27410.54|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26084.36|30456.16|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26084.36|7085.81|35702.42|233.52|||| MS202|DRG||Bronchitis And Asthma With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26084.36|14565.67|35702.42|233.52|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12465.31|4533.28|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|GEHA [1415]|GEHA [141500]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12465.31|7838.59|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12465.31|4210.74|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|12465.31|14857.79|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12465.31|7248.63|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12465.31|7248.63|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12465.31|7248.63|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12465.31|5277.01|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12465.31|725|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12465.31|4711.61|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12465.31||||||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|||12465.31|3739.59|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12465.31|850|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12465.31|7248.63|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|12465.31|7|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12465.31|5277.01|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12465.31|6887|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12465.31|4533.28|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12465.31|7248.63|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12465.31|6523.77|14857.79|7|||| MS203|DRG||Bronchitis And Asthma Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12465.31|7838.59|14857.79|7|||| MS204|DRG||Respiratory Signs And Symptoms|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|CHAMPVA [1240]|CHAMP VA [124000]|23249.67||||||| MS204|DRG||Respiratory Signs And Symptoms|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23249.67|11491.25|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23249.67|5685.61|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23249.67|11222.59|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23249.67|3400|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|AETNA [1015]|AETNA ACO WILCO [101532]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23249.67|4143.26|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MULTIPLAN [1680]|HMA [168003]|23249.67|240.8|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|FMH BENEFIT SERVICES [1390]|FMH [139000]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23249.67|26072.73|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MULTIPLAN [1680]|IHC HS [168011]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|FIRST HEALTH [1375]|QUALCHOICE [137513]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|TRUSTMARK [2030]|STARMARK [203000]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|HEALTHNET [1495]|HEALTHNET [149500]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23249.67|5685.61|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23249.67|725|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|UMR [2035]|UMR OPTIONS [203501]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23249.67|12147.29|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23249.67|18688.14|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23249.67|9449.38|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23249.67|10359.02|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23249.67|4143.26|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|||23249.67|6974.9|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|CORESOURCE [1315]|CORESOURCE [131500]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23249.67|26072.73|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|GEHA [1415]|GEHA [141500]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23249.67|10855.94|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23249.67|12065.37|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23249.67|5137.71|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23249.67|16819.33|26072.73|240.8|||| MS204|DRG||Respiratory Signs And Symptoms|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23249.67|16819.33|26072.73|240.8|||| MS205|DRG||Other Respiratory System Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50518.62|21308.65|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|50518.62||||||| MS205|DRG||Other Respiratory System Diagnoses With McC|GEHA [1415]|GEHA [141500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50518.62|7087.86|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|||50518.62|15155.59|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50518.62|7087.86|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50518.62|850|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50518.62|21308.65|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50518.62|20706.16|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50518.62|10667.46|21308.65|850|||| MS205|DRG||Other Respiratory System Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50518.62|10667.46|21308.65|850|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39321.34|6413.17|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39321.34|3625|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39321.34|850|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39321.34|10218.03|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39321.34|12820.9|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|TRUSTMARK [2030]|STARMARK [203000]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39321.34|6413.17|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39321.34|12521.16|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MULTIPLAN [1680]|IHC HS [168011]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MULTIPLAN [1680]|HMA [168003]|39321.34|82.25|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39321.34|6540.3|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|HEALTHNET [1495]|HEALTHNET [149500]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|||39321.34|11796.4|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39321.34|11516.34|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39321.34|41910.52|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|CORESOURCE [1315]|CORESOURCE [131500]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39321.34|24345.82|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39321.34|27241.84|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|CHAMPVA [1240]|CHAMP VA [124000]|39321.34|31476.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|GEHA [1415]|GEHA [141500]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39321.34|10218.03|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39321.34|12956.35|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39321.34|10147.18|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|UMR [2035]|UMR OPTIONS [203501]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39321.34|37719.47|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39321.34|5707.6|41910.52|82.25|||| MS206|DRG||Other Respiratory System Diagnoses Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39321.34|6540.3|41910.52|82.25|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|261454.75|81091.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|261454.75|86951.03|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|261454.75|83032.8|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|CHAMPVA [1240]|CHAMP VA [124000]|261454.75||||||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|GEHA [1415]|GEHA [141500]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|261454.75|166954.19|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|CORESOURCE [1315]|CORESOURCE [131500]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|261454.75|97134.33|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|261454.75|66705.03|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|261454.75|167213.51|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|UMR [2035]|UMR OPTIONS [203501]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|||261454.75|78436.42|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|261454.75|63549.16|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|261454.75|86951.03|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|261454.75|74150.44|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|261454.75|108688.79|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|261454.75|63549.16|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|FIRST HEALTH [1375]|QUALCHOICE [137513]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|FMH BENEFIT SERVICES [1390]|FMH [139000]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MULTIPLAN [1680]|IHC HS [168011]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MULTIPLAN [1680]|HMA [168003]|261454.75|2314.46|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|AETNA [1015]|COVENTRY HEALTHCARE [101502]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|AETNA [1015]|AETNA ACO WILCO [101532]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|TRUSTMARK [2030]|STARMARK [203000]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|261454.75|6525|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|HEALTHNET [1495]|HEALTHNET [149500]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|261454.75|11050|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|261454.75|46085.55|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|261454.75|166954.19|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|261454.75|35799.86|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|261454.75|150492.17|167213.51|2314.46|||| MS207|DRG||Respiratory System Diagnosis With Ventilator Support >96 Hours|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|261454.75|35799.86|167213.51|2314.46|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116630.74|15911.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|116630.74|31066.92|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|116630.74|31066.92|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|AETNA [1015]|AETNA ACO WILCO [101532]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|TRUSTMARK [2030]|STARMARK [203000]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|HEALTHNET [1495]|HEALTHNET [149500]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116630.74|36863.35|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116630.74|2550|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MULTIPLAN [1680]|IHC HS [168011]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MULTIPLAN [1680]|HMA [168003]|116630.74|1923.79|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116630.74|36001.51|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|FMH BENEFIT SERVICES [1390]|FMH [139000]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116630.74|31066.92|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|FIRST HEALTH [1375]|QUALCHOICE [137513]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|116630.74|24456.2|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116630.74|60647.98|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116630.74|60647.98|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|116630.74|5075|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116630.74|116630.74|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116630.74|32012.66|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116630.74|75809.98|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|||116630.74|34989.22|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116630.74|67750.83|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116630.74|24456.2|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|CHAMPVA [1240]|CHAMP VA [124000]|116630.74|74150.25|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116630.74|58406.54|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|116630.74|36888.11|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|CORESOURCE [1315]|CORESOURCE [131500]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|116630.74|58406.54|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|UMR [2035]|UMR OPTIONS [203501]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|GEHA [1415]|GEHA [141500]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116630.74|16011.99|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116630.74|104967.67|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116630.74|28890.08|116630.74|1923.79|||| MS208|DRG||Respiratory System Diagnosis With Ventilator Support <=96 Hours|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116630.74|104967.67|116630.74|1923.79|||| MS215|DRG||Other Heart Assist System Implant|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|GEHA [1415]|GEHA [141500]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|381582.22|269210.03|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|CORESOURCE [1315]|CORESOURCE [131500]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|CHAMPVA [1240]|CHAMP VA [124000]|381582.22|174592.29|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|||381582.22|114474.67|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|381582.22|248326.89|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|381582.22|149865.34|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|381582.22|382041.36|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|381582.22|191020.68|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|381582.22|198661.51|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|FIRST HEALTH [1375]|QUALCHOICE [137513]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|381582.22|53305.47|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|381582.22|53305.47|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|UMR [2035]|UMR OPTIONS [203501]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|381582.22|221927.86|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|FMH BENEFIT SERVICES [1390]|FMH [139000]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MULTIPLAN [1680]|IHC HS [168011]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|HEALTHNET [1495]|HEALTHNET [149500]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|AETNA [1015]|AETNA ACO WILCO [101532]|381582.22|53061.43|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|381582.22|1700|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|381582.22|269210.03|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|381582.22|7975|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|381582.22|171918.61|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|381582.22|171918.61|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|381582.22|198661.51|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|381582.22|69989.99|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|TRUSTMARK [2030]|STARMARK [203000]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|MULTIPLAN [1680]|HMA [168003]|381582.22|41282.75|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|381582.22|161157.56|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|AETNA [1015]|COVENTRY HEALTHCARE [101502]|381582.22|343837.23|382041.36|1700|||| MS215|DRG||Other Heart Assist System Implant|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|381582.22|343837.23|382041.36|1700|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|452007.65||||||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|452007.65||||||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|452007.65||||||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|452007.65||||||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|CHAMPVA [1240]|CHAMP VA [124000]|452007.65||||||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|452007.65|243173.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|TRUSTMARK [2030]|STARMARK [203000]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|452007.65|281000|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|HEALTHNET [1495]|HEALTHNET [149500]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MULTIPLAN [1680]|IHC HS [168011]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|452007.65|243173.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MULTIPLAN [1680]|HMA [168003]|452007.65|24570.22|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|452007.65|138974.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|452007.65|13775|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|UMR [2035]|UMR OPTIONS [203501]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|452007.65|270192.31|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|452007.65|540384.62|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|452007.65|351250|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|452007.65|116793.11|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|||452007.65|135602.29|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|452007.65|313909.43|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|452007.65|71232.08|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|452007.65||||||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|452007.65|128766.25|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|CORESOURCE [1315]|CORESOURCE [131500]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|GEHA [1415]|GEHA [141500]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|452007.65|281000|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|452007.65|486346.16|540384.62|13775|||| MS216|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|452007.65|71232.08|540384.62|13775|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|344281.45||||||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|CHAMPVA [1240]|CHAMP VA [124000]|344281.45||||||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|344281.45||||||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|344281.45||||||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|344281.45||||||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|CORESOURCE [1315]|CORESOURCE [131500]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|344281.45|199993.11|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|||344281.45|103284.43|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|344281.45|172140.73|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|UMR [2035]|UMR OPTIONS [203501]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|GEHA [1415]|GEHA [141500]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|344281.45|179026.35|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|344281.45|223782.94|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|344281.45||||||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|344281.45|344281.45|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|344281.45|77358.11|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MULTIPLAN [1680]|HMA [168003]|344281.45|9620.54|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|HEALTHNET [1495]|HEALTHNET [149500]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|344281.45|89016.4|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|344281.45|8700|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|344281.45|154926.65|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|344281.45|154926.65|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|344281.45|179026.35|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|TRUSTMARK [2030]|STARMARK [203000]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|344281.45|40562.72|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|344281.45|83186.97|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|MULTIPLAN [1680]|IHC HS [168011]|344281.45|309853.3|344281.45|8700|||| MS217|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|344281.45|309853.3|344281.45|8700|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|GEHA [1415]|GEHA [141500]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|||409426.75|122828.02|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|409426.75||||||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|409426.75|35621.5|122828.02|35621.5|||| MS218|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|409426.75||||||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|GEHA [1415]|GEHA [141500]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|386021.02|212874.5|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|386021.02|64906.92|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|||386021.02|115806.31|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|386021.02|91180.36|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|386021.02|328615.45|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|386021.02|170880.03|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|CHAMPVA [1240]|CHAMP VA [124000]|386021.02|416556.4|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|386021.02|64906.92|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|386021.02|190892.73|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|UMR [2035]|UMR OPTIONS [203501]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|386021.02|213600.05|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MULTIPLAN [1680]|IHC HS [168011]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|HEALTHNET [1495]|HEALTHNET [149500]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|386021.02|164307.73|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|TRUSTMARK [2030]|STARMARK [203000]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|386021.02|117057.93|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|386021.02|5100|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|386021.02|212874.5|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|386021.02|147876.95|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|386021.02|5075|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|386021.02|147876.95|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|CORESOURCE [1315]|CORESOURCE [131500]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|386021.02|170880.03|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|386021.02|50271.76|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|386021.02|295753.9|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|MULTIPLAN [1680]|HMA [168003]|386021.02|20666.22|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|386021.02|98057.08|416556.4|5075|||| MS219|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|386021.02|295753.9|416556.4|5075|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|287514.52|75430.54|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|287514.52|161687.37|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|287514.52|78790.97|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|287514.52|139921.76|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|287514.52|78790.97|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|287514.52|139921.76|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|287514.52|166270.61|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|287514.52|2900|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|287514.52|6800|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|287514.52|75430.54|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|TRUSTMARK [2030]|STARMARK [203000]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|HEALTHNET [1495]|HEALTHNET [149500]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MULTIPLAN [1680]|IHC HS [168011]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|287514.52|75430.54|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MULTIPLAN [1680]|HMA [168003]|287514.52|13938.84|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|287514.52|78790.97|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|287514.52|47538.04|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|287514.52|161687.37|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|287514.52|75430.54|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|287514.52|78690.96|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|287514.52|75430.54|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|287514.52|155468.63|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|287514.52|33836.47|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|287514.52|61707.62|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|287514.52|75430.54|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|287514.52|180623.44|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|||287514.52|86254.36|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|287514.52|202109.2|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|287514.52|47538.04|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|287514.52|310937.25|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|CHAMPVA [1240]|CHAMP VA [124000]|287514.52|255328.56|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|287514.52|75430.54|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|CORESOURCE [1315]|CORESOURCE [131500]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|287514.52|166270.61|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|GEHA [1415]|GEHA [141500]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|UMR [2035]|UMR OPTIONS [203501]|287514.52|279843.52|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|287514.52|33770.79|310937.25|2900|||| MS220|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|287514.52|279843.52|310937.25|2900|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|GEHA [1415]|GEHA [141500]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|235324.32|72945.76|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|235324.32|142495.3|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|||235324.32|70597.3|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|235324.32|53453.81|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|235324.32|61972.98|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|235324.32|245300.92|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|235324.32|127556.48|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|235324.32|36549.61|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|235324.32|159445.61|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|235324.32|36549.61|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|235324.32|2175|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|235324.32|2550|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|235324.32|72945.76|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|235324.32|66008.35|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|235324.32|64465.12|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|235324.32|127556.48|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|235324.32||||||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|235324.32|90934.2|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|235324.32|31850.46|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|235324.32|71145.07|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|235324.32|220770.83|245300.92|2175|||| MS221|DRG||Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|235324.32|220770.83|245300.92|2175|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|CHAMPVA [1240]|CHAMP VA [124000]|281466.88||||||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|281466.88|230034.54|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|281466.88|199068.35|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|281466.88|10200|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|281466.88|10150|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|AETNA [1015]|AETNA ACO WILCO [101532]|281466.88|142615.16|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|HEALTHNET [1495]|HEALTHNET [149500]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MULTIPLAN [1680]|HMA [168003]|281466.88|40722.99|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|281466.88|199068.35|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MULTIPLAN [1680]|IHC HS [168011]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|281466.88|160635.97|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|TRUSTMARK [2030]|STARMARK [203000]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|281466.88|80111.41|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|281466.88|230034.54|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|281466.88|221187.06|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|281466.88|442374.12|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|281466.88|287543.18|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|281466.88|256975.16|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|||281466.88|84440.06|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|281466.88|97047.7|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|281466.88|52546.29|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|281466.88|80111.41|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|281466.88|123914.72|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|CORESOURCE [1315]|CORESOURCE [131500]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|UMR [2035]|UMR OPTIONS [203501]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|281466.88|160635.97|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|GEHA [1415]|GEHA [141500]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|281466.88|398136.71|442374.12|10150|||| MS222|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|281466.88|52546.29|442374.12|10150|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|GEHA [1415]|GEHA [141500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|CORESOURCE [1315]|CORESOURCE [131500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|CHAMPVA [1240]|CHAMP VA [124000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MULTIPLAN [1680]|IHC HS [168011]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MULTIPLAN [1680]|HMA [168003]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|HEALTHNET [1495]|HEALTHNET [149500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|TRUSTMARK [2030]|STARMARK [203000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|UMR [2035]|UMR OPTIONS [203501]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|||283657.73|85097.32|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|283657.73||||||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|283657.73|38818.28|85097.32|38818.28|||| MS223|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|283657.73|38818.28|85097.32|38818.28|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|244990.18|133163.67|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|244990.18|129062.75|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|AETNA [1015]|AETNA ACO WILCO [101532]|244990.18|114617.51|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|TRUSTMARK [2030]|STARMARK [203000]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|244990.18|3625|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|HEALTHNET [1495]|HEALTHNET [149500]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MULTIPLAN [1680]|IHC HS [168011]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MULTIPLAN [1680]|HMA [168003]|244990.18|19650.55|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|244990.18|133163.67|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|244990.18|61116.58|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|244990.18|153878.02|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|244990.18|153878.02|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|244990.18|147959.63|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|244990.18|171899.5|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|244990.18|192347.53|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|||244990.18|73497.05|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|244990.18|86017.81|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|244990.18|61116.58|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|244990.18|295919.26|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|CHAMPVA [1240]|CHAMP VA [124000]|244990.18|156524.81|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|244990.18|92499.17|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|CORESOURCE [1315]|CORESOURCE [131500]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|244990.18|129062.75|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|GEHA [1415]|GEHA [141500]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|244990.18|45965.66|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|UMR [2035]|UMR OPTIONS [203501]|244990.18|266327.35|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|244990.18|4250|295919.26|3625|||| MS224|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|244990.18|92499.17|295919.26|3625|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|CHAMPVA [1240]|CHAMP VA [124000]|271249.71||||||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|GEHA [1415]|GEHA [141500]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|271249.71|192165.09|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|CORESOURCE [1315]|CORESOURCE [131500]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|271249.71|131514.72|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|271249.71|65695.54|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|271249.71|226398.19|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|||271249.71|81374.91|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|271249.71|147158.83|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|UMR [2035]|UMR OPTIONS [203501]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|271249.71|117727.06|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|271249.71|43730.37|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|271249.71|43730.37|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|271249.71|76539.42|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MULTIPLAN [1680]|IHC HS [168011]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|HEALTHNET [1495]|HEALTHNET [149500]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|TRUSTMARK [2030]|STARMARK [203000]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|271249.71|5075|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|271249.71|192165.09|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|271249.71|81588.6|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|271249.71|79681.11|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|271249.71|4250|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|271249.71|117727.06|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|271249.71|35180.89|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|MULTIPLAN [1680]|HMA [168003]|271249.71|17408.24|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|271249.71|83877.73|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|271249.71|203758.38|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|271249.71|91405.61|226398.19|4250|||| MS225|DRG||Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|271249.71|203758.38|226398.19|4250|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|266623.37|95871.1|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|266623.37|109450.41|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|TRUSTMARK [2030]|STARMARK [203000]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|HEALTHNET [1495]|HEALTHNET [149500]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MULTIPLAN [1680]|IHC HS [168011]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MULTIPLAN [1680]|HMA [168003]|266623.37|21670.38|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|266623.37|5950|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|266623.37|125994.59|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|266623.37|66972.18|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|266623.37|125994.59|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|UMR [2035]|UMR OPTIONS [203501]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|266623.37|162697.2|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|266623.37|2900|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|266623.37|91899.5|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|266623.37|242297.29|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|266623.37|157493.23|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|266623.37|140750.47|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|266623.37|77777.95|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|266623.37|66972.18|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|CHAMPVA [1240]|CHAMP VA [124000]|266623.37|225321.61|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|||266623.37|79987.01|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|CORESOURCE [1315]|CORESOURCE [131500]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|266623.37|162697.2|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|GEHA [1415]|GEHA [141500]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|266623.37|41302.25|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|266623.37|83638.45|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|266623.37|218067.56|242297.29|2900|||| MS226|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|266623.37|93629.7|242297.29|2900|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|GEHA [1415]|GEHA [141500]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|237617.34|107958.1|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|||237617.34|71285.2|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|237617.34|60815.6|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|237617.34|248399.31|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|237617.34|129167.64|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|237617.34|34070.28|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|237617.34|34070.28|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|237617.34|144295.17|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|UMR [2035]|UMR OPTIONS [203501]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|237617.34|161459.55|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MULTIPLAN [1680]|IHC HS [168011]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|237617.34|73074.25|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|HEALTHNET [1495]|HEALTHNET [149500]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|TRUSTMARK [2030]|STARMARK [203000]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|237617.34|90817.11|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|237617.34|1450|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|237617.34|3400|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|237617.34|107958.1|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|237617.34|76152.55|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|237617.34|74372.16|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|CORESOURCE [1315]|CORESOURCE [131500]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|237617.34|129167.64|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|237617.34|32851.03|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|237617.34|80128|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|237617.34|223559.38|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|CHAMPVA [1240]|CHAMP VA [124000]|237617.34|143595.68|248399.31|1450|||| MS227|DRG||Cardiac Defibrillator Implant Without Cardiac Catheterization Without McC|MULTIPLAN [1680]|HMA [168003]|237617.34|21898.29|248399.31|1450|||| MS228|DRG||Other Cardiothoracic Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|||312071.16|93621.35|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|312071.16|47718.82|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|312071.16|284541.4|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|312071.16|103403.73|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|GEHA [1415]|GEHA [141500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|312071.16|130922.42|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|312071.16|103403.73|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|312071.16|3400|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|MULTIPLAN [1680]|HMA [168003]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|312071.16|38838.16|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|312071.16|47718.82|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|312071.16|85490.6|284541.4|3400|||| MS228|DRG||Other Cardiothoracic Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|312071.16|38838.16|284541.4|3400|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|CHAMPVA [1240]|CHAMP VA [124000]|174167.66||||||| MS229|DRG||Other Cardiothoracic Procedures Without McC|GEHA [1415]|GEHA [141500]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|174167.66|139337.81|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|CORESOURCE [1315]|CORESOURCE [131500]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|174167.66|35513.52|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|||174167.66|52250.3|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|174167.66|122543.49|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|174167.66|47739.99|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|174167.66|188528.44|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|174167.66|61978.38|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|UMR [2035]|UMR OPTIONS [203501]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|174167.66|98034.79|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|174167.66|35513.52|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MULTIPLAN [1680]|IHC HS [168011]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MULTIPLAN [1680]|HMA [168003]|174167.66|3227.36|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|HEALTHNET [1495]|HEALTHNET [149500]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|TRUSTMARK [2030]|STARMARK [203000]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|174167.66|109516.2|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|174167.66|60429.2|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|174167.66|2900|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|174167.66|4250|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|174167.66|139337.81|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|174167.66|169675.6|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|174167.66|57826|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|174167.66|56474.07|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|174167.66|98034.79|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|174167.66|24996.42|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|174167.66|52762.46|188528.44|2900|||| MS229|DRG||Other Cardiothoracic Procedures Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|174167.66|169675.6|188528.44|2900|||| MS231|DRG||Coronary Bypass With Ptca With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|355005.42||||||| MS231|DRG||Coronary Bypass With Ptca With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|355005.42||||||| MS231|DRG||Coronary Bypass With Ptca With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|355005.42||||||| MS231|DRG||Coronary Bypass With Ptca With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|355005.42||||||| MS231|DRG||Coronary Bypass With Ptca With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|355005.42|168485.18|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|355005.42|145804.49|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|355005.42|145804.49|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|355005.42|5075|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|AETNA [1015]|AETNA ACO WILCO [101532]|355005.42|106749.5|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|TRUSTMARK [2030]|STARMARK [203000]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|HEALTHNET [1495]|HEALTHNET [149500]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MULTIPLAN [1680]|IHC HS [168011]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MULTIPLAN [1680]|HMA [168003]|355005.42|5130.01|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|355005.42|168485.18|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|UMR [2035]|UMR OPTIONS [203501]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|355005.42|162004.99|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|355005.42|324009.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|355005.42|95499.75|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|CHAMPVA [1240]|CHAMP VA [124000]|355005.42||||||| MS231|DRG||Coronary Bypass With Ptca With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|355005.42|210606.47|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|||355005.42|106501.63|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|355005.42||||||| MS231|DRG||Coronary Bypass With Ptca With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|355005.42|188217.39|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|355005.42|52975.72|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|355005.42|102698.76|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|CORESOURCE [1315]|CORESOURCE [131500]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|GEHA [1415]|GEHA [141500]|355005.42|291608.97|324009.97|5075|||| MS231|DRG||Coronary Bypass With Ptca With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|355005.42|291608.97|324009.97|5075|||| MS232|DRG||Coronary Bypass With Ptca Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|GEHA [1415]|GEHA [141500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|CHAMPVA [1240]|CHAMP VA [124000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|UMR [2035]|UMR OPTIONS [203501]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MULTIPLAN [1680]|IHC HS [168011]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MULTIPLAN [1680]|HMA [168003]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|HEALTHNET [1495]|HEALTHNET [149500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|TRUSTMARK [2030]|STARMARK [203000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|CORESOURCE [1315]|CORESOURCE [131500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|315220.91||||||| MS232|DRG||Coronary Bypass With Ptca Without McC|||315220.91|94566.27|94566.27|94566.27|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|CHAMPVA [1240]|CHAMP VA [124000]|350237.92||||||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|350237.92|163043.65|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|350237.92|141095.47|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|350237.92|188464.07|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|350237.92|11900|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|350237.92|5075|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|350237.92|99290.1|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|TRUSTMARK [2030]|STARMARK [203000]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MULTIPLAN [1680]|IHC HS [168011]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MULTIPLAN [1680]|HMA [168003]|350237.92|4723.96|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|HEALTHNET [1495]|HEALTHNET [149500]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|350237.92|53069.84|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|350237.92|163043.65|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|UMR [2035]|UMR OPTIONS [203501]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|350237.92|156772.75|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|350237.92|313545.49|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|350237.92|52118.89|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|350237.92|90352.31|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|350237.92|141095.47|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|350237.92|203804.57|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|||350237.92|105071.38|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|350237.92|182138.58|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|350237.92|49078.04|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|350237.92|53069.84|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|350237.92|101312.88|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|CORESOURCE [1315]|CORESOURCE [131500]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|350237.92|188464.07|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|GEHA [1415]|GEHA [141500]|350237.92|282190.94|313545.49|4723.96|||| MS233|DRG||Coronary Bypass With Cardiac Catheterization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|350237.92|282190.94|313545.49|4723.96|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|286110.25||||||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|286110.25||||||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|286110.25||||||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|286110.25||||||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|286110.25||||||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|GEHA [1415]|GEHA [141500]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|CORESOURCE [1315]|CORESOURCE [131500]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|286110.25|172050.87|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|||286110.25|85833.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|286110.25|192516.87|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|286110.25|296179.8|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|286110.25|148089.9|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|UMR [2035]|UMR OPTIONS [203501]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|286110.25|154013.5|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|286110.25|60549.27|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MULTIPLAN [1680]|IHC HS [168011]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MULTIPLAN [1680]|HMA [168003]|286110.25|3006.24|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|HEALTHNET [1495]|HEALTHNET [149500]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|TRUSTMARK [2030]|STARMARK [203000]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|286110.25|85528.7|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|286110.25|5800|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|CHAMPVA [1240]|CHAMP VA [124000]|286110.25|165678.59|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|286110.25|33638.98|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|286110.25|266561.82|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|286110.25|133280.91|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|286110.25|133280.91|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|286110.25|154013.5|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|286110.25|33258.07|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|286110.25|65111.6|296179.8|3006.24|||| MS234|DRG||Coronary Bypass With Cardiac Catheterization Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|286110.25|266561.82|296179.8|3006.24|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|319551.58|74930.73|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|319551.58|161927.27|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|319551.58|73623.91|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|319551.58|73623.91|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|319551.58|73623.91|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|319551.58|140129.37|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|319551.58|74930.73|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|319551.58|5075|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|319551.58|74930.73|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|319551.58|75528.79|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|TRUSTMARK [2030]|STARMARK [203000]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|HEALTHNET [1495]|HEALTHNET [149500]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MULTIPLAN [1680]|IHC HS [168011]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MULTIPLAN [1680]|HMA [168003]|319551.58|3582.67|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|319551.58|74930.73|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|319551.58|47116.67|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|319551.58|161927.27|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|UMR [2035]|UMR OPTIONS [203501]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|319551.58|74930.73|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|319551.58|6800|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|319551.58|155699.3|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|319551.58|311398.6|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|319551.58|158346.46|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|319551.58|140129.37|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|319551.58|68437.9|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|319551.58|74930.73|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|319551.58|202409.09|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|||319551.58|95865.47|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|319551.58|180891.47|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|319551.58|45905.32|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|319551.58|47116.67|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|CHAMPVA [1240]|CHAMP VA [124000]|319551.58|239663.69|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|319551.58|74930.73|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|CORESOURCE [1315]|CORESOURCE [131500]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|319551.58|158346.46|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|GEHA [1415]|GEHA [141500]|319551.58|280258.74|311398.6|3582.67|||| MS235|DRG||Coronary Bypass Without Cardiac Catheterization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|319551.58|280258.74|311398.6|3582.67|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|GEHA [1415]|GEHA [141500]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|242271.13|133678.9|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|CHAMPVA [1240]|CHAMP VA [124000]|242271.13|263738.65|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|242271.13|46516.34|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|242271.13|131856.53|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|||242271.13|72681.34|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|242271.13|46858.43|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|242271.13|226986.61|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|242271.13|52508.98|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|242271.13|118033.04|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|242271.13|2965.84|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|UMR [2035]|UMR OPTIONS [203501]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MULTIPLAN [1680]|IHC HS [168011]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MULTIPLAN [1680]|HMA [168003]|242271.13|5562.79|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|HEALTHNET [1495]|HEALTHNET [149500]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|242271.13|147541.29|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|TRUSTMARK [2030]|STARMARK [203000]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|242271.13|54606.64|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|242271.13|2900|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|242271.13|3400|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|CORESOURCE [1315]|CORESOURCE [131500]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|242271.13|31108.48|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|242271.13|133678.9|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|242271.13|204287.94|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|242271.13|59171.6|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|242271.13|57788.21|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|242271.13|118033.04|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|242271.13|25573.14|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|242271.13|50389.17|263738.65|2900|||| MS236|DRG||Coronary Bypass Without Cardiac Catheterization Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|242271.13|204287.94|263738.65|2900|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|AETNA [1015]|AETNA ACO WILCO [101532]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|TRUSTMARK [2030]|STARMARK [203000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MULTIPLAN [1680]|IHC HS [168011]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MULTIPLAN [1680]|HMA [168003]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|UMR [2035]|UMR OPTIONS [203501]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|HEALTHNET [1495]|HEALTHNET [149500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|CHAMPVA [1240]|CHAMP VA [124000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|CORESOURCE [1315]|CORESOURCE [131500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|GEHA [1415]|GEHA [141500]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135277.90|72184.78|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135277.90|8500|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135277.90|26602.19|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135277.90||||||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|||135277.90|40583.37|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135277.90|28946.2|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135277.90|26602.19|72184.78|8500|||| MS239|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135277.90|72184.78|72184.78|8500|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|CHAMPVA [1240]|CHAMP VA [124000]|111770.79||||||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|GEHA [1415]|GEHA [141500]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111770.79|54703.63|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|CORESOURCE [1315]|CORESOURCE [131500]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111770.79|15807.37|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111770.79|18962.51|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|||111770.79|33531.24|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111770.79|21218.16|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111770.79|32098.8|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111770.79|32643.31|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|UMR [2035]|UMR OPTIONS [203501]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111770.79|22282.16|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111770.79|15807.37|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MULTIPLAN [1680]|IHC HS [168011]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MULTIPLAN [1680]|HMA [168003]|111770.79|251.03|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111770.79|32643.31|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|HEALTHNET [1495]|HEALTHNET [149500]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|TRUSTMARK [2030]|STARMARK [203000]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111770.79|725|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111770.79|5950|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111770.79|54703.63|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111770.79|29378.99|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111770.79|32643.31|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111770.79|32643.31|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111770.79|22282.16|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111770.79|17551.35|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111770.79|29378.98|54703.63|251.03|||| MS240|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111770.79|29378.99|54703.63|251.03|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|GEHA [1415]|GEHA [141500]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65085.66||||||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|||65085.66|19525.7|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65085.66|9794.97|19525.7|9794.97|||| MS241|DRG||Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65085.66|9794.97|19525.7|9794.97|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|GEHA [1415]|GEHA [141500]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|126408.98|68617.58|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|CORESOURCE [1315]|CORESOURCE [131500]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|CHAMPVA [1240]|CHAMP VA [124000]|126408.98|130233.32|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|126408.98|94470.16|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|||126408.98|37922.69|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126408.98|43160.09|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|126408.98|162627.19|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|126408.98|50098.36|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|126408.98|84566.14|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|126408.98|17030.75|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|UMR [2035]|UMR OPTIONS [203501]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MULTIPLAN [1680]|IHC HS [168011]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MULTIPLAN [1680]|HMA [168003]|126408.98|10487.1|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|HEALTHNET [1495]|HEALTHNET [149500]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|126408.98|105707.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|TRUSTMARK [2030]|STARMARK [203000]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|AETNA [1015]|AETNA ACO WILCO [101532]|126408.98|58718.59|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|126408.98|17030.75|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|126408.98|2900|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|126408.98|5950|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|126408.98|68617.58|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126408.98|146364.48|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126408.98|53976.25|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|126408.98|52714.32|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|126408.98|84566.14|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126408.98|23346.44|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|126408.98|55108.68|162627.19|2900|||| MS242|DRG||Permanent Cardiac Pacemaker Implant With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|126408.98|146364.48|162627.19|2900|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99492.77||||||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99492.77||||||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99492.77||||||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|CHAMPVA [1240]|CHAMP VA [124000]|99492.77||||||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|99492.77||||||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99492.77|36722.7|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|99492.77|4350|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|TRUSTMARK [2030]|STARMARK [203000]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|HEALTHNET [1495]|HEALTHNET [149500]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MULTIPLAN [1680]|IHC HS [168011]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MULTIPLAN [1680]|HMA [168003]|99492.77|5110.86|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|99492.77|37643.91|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99492.77|64645.84|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|UMR [2035]|UMR OPTIONS [203501]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99492.77|35864.15|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99492.77|64645.84|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99492.77|35270.98|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99492.77|124318.93|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99492.77|29416.92|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|99492.77||||||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99492.77|80807.3|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|||99492.77|29847.83|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99492.77|72216.85|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99492.77|15951.71|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|99492.77|37560.81|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|CORESOURCE [1315]|CORESOURCE [131500]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|GEHA [1415]|GEHA [141500]|99492.77|111887.04|124318.93|4350|||| MS243|DRG||Permanent Cardiac Pacemaker Implant With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99492.77|111887.04|124318.93|4350|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70834.22|47122.65|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70834.22|15648.74|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|||70834.22|21250.27|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70834.22|40899.93|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70834.22|24136.9|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70834.22|62922.97|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70834.22|17405.66|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70834.22|15648.74|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70834.22|28926.04|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|70834.22|4542.79|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70834.22|36551.94|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|70834.22|31878.41|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70834.22|1450|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70834.22|2550|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|70834.22|43528.22|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70834.22|47122.65|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|GEHA [1415]|GEHA [141500]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70834.22|56630.68|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70834.22|29952.65|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70834.22|29252.38|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70834.22|17405.66|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70834.22|13050.12|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70834.22|31256.05|62922.97|1450|||| MS244|DRG||Permanent Cardiac Pacemaker Implant Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70834.22|56630.68|62922.97|1450|||| MS245|DRG||Aicd Generator Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|TRUSTMARK [2030]|STARMARK [203000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|HEALTHNET [1495]|HEALTHNET [149500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MULTIPLAN [1680]|IHC HS [168011]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MULTIPLAN [1680]|HMA [168003]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|UMR [2035]|UMR OPTIONS [203501]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|CORESOURCE [1315]|CORESOURCE [131500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|GEHA [1415]|GEHA [141500]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|257717.06||||||| MS245|DRG||Aicd Generator Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|257717.06|166941.45|222178.04|3400|||| MS245|DRG||Aicd Generator Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|257717.06|3400|222178.04|3400|||| MS245|DRG||Aicd Generator Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|257717.06|22600.71|222178.04|3400|||| MS245|DRG||Aicd Generator Procedures|||257717.06|77315.12|222178.04|3400|||| MS245|DRG||Aicd Generator Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|257717.06|22600.71|222178.04|3400|||| MS245|DRG||Aicd Generator Procedures|CHAMPVA [1240]|CHAMP VA [124000]|257717.06|222178.04|222178.04|3400|||| MS245|DRG||Aicd Generator Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|257717.06|166941.45|222178.04|3400|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|GEHA [1415]|GEHA [141500]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|122684.59|66313.87|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|122684.59|47115.1|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CHAMPVA [1240]|CHAMP VA [124000]|122684.59|96180.91|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122684.59|72568.97|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|||122684.59|36805.38|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122684.59|81201.29|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|122684.59|47115.1|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122684.59|36899.66|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122684.59|124925.07|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122684.59|43403.26|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122684.59|64961.04|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|122684.59|47093.65|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|FIRST HEALTH [1375]|QUALCHOICE [137513]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UMR [2035]|UMR OPTIONS [203501]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122684.59|47115.1|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|FMH BENEFIT SERVICES [1390]|FMH [139000]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MULTIPLAN [1680]|IHC HS [168011]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|122684.59|47115.1|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MULTIPLAN [1680]|HMA [168003]|122684.59|5455.32|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHNET [1495]|HEALTHNET [149500]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|TRUSTMARK [2030]|STARMARK [203000]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122684.59|47115.1|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA [1015]|AETNA ACO WILCO [101532]|122684.59|47319.4|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|122684.59|2175|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122684.59|2550|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122684.59|47093.65|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122684.59|47115.1|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CORESOURCE [1315]|CORESOURCE [131500]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122684.59|66313.87|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122684.59|112432.57|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122684.59|45322.65|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122684.59|44263.04|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|122684.59|39680.02|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122684.59|64961.04|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|122684.59|40432.29|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122684.59|40432.29|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122684.59|19637.58|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122684.59|47115.1|124925.07|2175|||| MS246|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122684.59|112432.57|124925.07|2175|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87061.89|16623.2|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|87061.89|25446.59|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87061.89|28154.9|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87061.89|28828.9|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87061.89|53572.31|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87061.89|1700|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|87061.89|1450|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|TRUSTMARK [2030]|STARMARK [203000]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|HEALTHNET [1495]|HEALTHNET [149500]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MULTIPLAN [1680]|IHC HS [168011]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MULTIPLAN [1680]|HMA [168003]|87061.89|3244.85|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|87061.89|36659.02|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87061.89|16623.2|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|87061.89|30131.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|UMR [2035]|UMR OPTIONS [203501]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87061.89|28602.91|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87061.89|85022.55|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87061.89|23663.56|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87061.89|55264.66|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|||87061.89|26118.57|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87061.89|49389.61|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87061.89|30214.66|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87061.89|12568.49|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87061.89|36659.02|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|CHAMPVA [1240]|CHAMP VA [124000]|87061.89|65491.15|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|87061.89|30093.09|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|CORESOURCE [1315]|CORESOURCE [131500]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|87061.89|53572.31|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|GEHA [1415]|GEHA [141500]|87061.89|76520.3|85022.55|1450|||| MS247|DRG||Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87061.89|76520.3|85022.55|1450|||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CORESOURCE [1315]|CORESOURCE [131500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CHAMPVA [1240]|CHAMP VA [124000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UMR [2035]|UMR OPTIONS [203501]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|FIRST HEALTH [1375]|QUALCHOICE [137513]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|FMH BENEFIT SERVICES [1390]|FMH [139000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MULTIPLAN [1680]|IHC HS [168011]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MULTIPLAN [1680]|HMA [168003]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HEALTHNET [1495]|HEALTHNET [149500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|TRUSTMARK [2030]|STARMARK [203000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA [1015]|COVENTRY HEALTHCARE [101502]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA [1015]|AETNA ACO WILCO [101532]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|GEHA [1415]|GEHA [141500]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|192704.03||||||| MS248|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With McC Or 4+ Arteries Or Stents|||192704.03|57811.21|57811.21|57811.21|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72134.73||||||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72134.73||||||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72134.73||||||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72134.73||||||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72134.73|15187.46|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72134.73|26612.77|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72134.73|27249.85|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72134.73|1450|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|72134.73|26606.3|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|TRUSTMARK [2030]|STARMARK [203000]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|HEALTHNET [1495]|HEALTHNET [149500]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MULTIPLAN [1680]|IHC HS [168011]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MULTIPLAN [1680]|HMA [168003]|72134.73|881.67|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72134.73|15187.46|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|UMR [2035]|UMR OPTIONS [203501]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72134.73|26454.58|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72134.73|63601.39|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72134.73|22290.06|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|CHAMPVA [1240]|CHAMP VA [124000]|72134.73||||||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72134.73|41340.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|||72134.73|21640.42|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72134.73|36946.05|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72134.73||||||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72134.73|12416.91|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72134.73|19739.66|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|CORESOURCE [1315]|CORESOURCE [131500]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|GEHA [1415]|GEHA [141500]|72134.73|57241.25|63601.39|881.67|||| MS249|DRG||Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72134.73|57241.25|63601.39|881.67|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|CHAMPVA [1240]|CHAMP VA [124000]|75820.68||||||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|GEHA [1415]|GEHA [141500]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|CORESOURCE [1315]|CORESOURCE [131500]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75820.68|43978.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|||75820.68|22746.2|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75820.68|29657.66|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75820.68|75706.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75820.68|33879.77|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|UMR [2035]|UMR OPTIONS [203501]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75820.68|24132.14|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75820.68|15824.18|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MULTIPLAN [1680]|IHC HS [168011]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MULTIPLAN [1680]|HMA [168003]|75820.68|438.96|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|HEALTHNET [1495]|HEALTHNET [149500]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75820.68|49209.33|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|TRUSTMARK [2030]|STARMARK [203000]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|AETNA [1015]|AETNA ACO WILCO [101532]|75820.68|33628.4|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75820.68|2175|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75820.68|1700|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75820.68|15824.18|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75820.68|43137.34|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75820.68|43137.34|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75820.68|68136.01|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75820.68|36580.6|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75820.68|35725.37|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75820.68|24132.14|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75820.68|15890.8|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75820.68|75820.68|75820.68|438.96|||| MS250|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75820.68|68136.01|75820.68|438.96|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71775.27|16472.19|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71775.27|23504.43|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71775.27|24067.1|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71775.27|47854.89|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71775.27|2550|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|TRUSTMARK [2030]|STARMARK [203000]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|HEALTHNET [1495]|HEALTHNET [149500]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MULTIPLAN [1680]|IHC HS [168011]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MULTIPLAN [1680]|HMA [168003]|71775.27|196.7|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71775.27|12281.73|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71775.27|16472.19|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|71775.27|21811.4|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|UMR [2035]|UMR OPTIONS [203501]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71775.27|725|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71775.27|22479.7|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71775.27|52969.64|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71775.27|19573.29|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71775.27|34430.26|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|||71775.27|21532.58|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71775.27|30770.08|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71775.27|10527.62|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71775.27|12281.73|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|CHAMPVA [1240]|CHAMP VA [124000]|71775.27|48539.57|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71775.27|18107.51|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|CORESOURCE [1315]|CORESOURCE [131500]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71775.27|47854.89|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|GEHA [1415]|GEHA [141500]|71775.27|47672.68|52969.64|196.7|||| MS251|DRG||Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71775.27|47672.68|52969.64|196.7|||| MS252|DRG||Other Vascular Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|161392.77||||||| MS252|DRG||Other Vascular Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|GEHA [1415]|GEHA [141500]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|161392.77|35904.62|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161392.77|17569.18|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|||161392.77|48417.83|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161392.77|207937.81|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161392.77|38151.05|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161392.77|319904.31|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161392.77|166350.24|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|161392.77|17569.18|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161392.77|159952.16|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MULTIPLAN [1680]|HMA [168003]|161392.77|7708.2|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161392.77|185832.46|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|161392.77|42377.4|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|161392.77|15950|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161392.77|2550|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161392.77|35904.62|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161392.77|287913.88|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161392.77|143956.94|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161392.77|143956.94|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161392.77|166350.24|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161392.77|20849.42|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161392.77|48712.92|319904.31|2550|||| MS252|DRG||Other Vascular Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161392.77|287913.88|319904.31|2550|||| MS253|DRG||Other Vascular Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123650.35|71565.72|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123650.35|38478.65|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123650.35|5075|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|123650.35|37031.06|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|123650.35|4636.89|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123650.35|15297.9|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123650.35|71565.72|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123650.35|7650|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123650.35|34273.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123650.35|137626.38|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123650.35|59330.5|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123650.35|37579.05|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123650.35|30314.76|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123650.35|89457.16|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|||123650.35|37095.1|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123650.35|79947.17|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123650.35|16704.3|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123650.35|15297.9|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|123650.35|74312.59|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123650.35|38707.2|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123650.35|59330.5|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|GEHA [1415]|GEHA [141500]|123650.35|123863.75|137626.38|4636.89|||| MS253|DRG||Other Vascular Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123650.35|123863.75|137626.38|4636.89|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|86872.42||||||| MS254|DRG||Other Vascular Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86872.42|9279.33|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86872.42|40593.41|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|||86872.42|26061.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86872.42|21167.76|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86872.42|69880.22|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86872.42|24507.7|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86872.42|13972.98|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86872.42|9279.33|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|86872.42|10526.53|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86872.42|45422.14|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|86872.42|33937.6|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86872.42|725|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86872.42|2550|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86872.42|56608.05|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86872.42|56608.05|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86872.42|62892.2|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86872.42|26237.75|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86872.42|25624.33|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86872.42|13972.98|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86872.42|11457.94|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86872.42|22881.73|69880.22|725|||| MS254|DRG||Other Vascular Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86872.42|62892.2|69880.22|725|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|145560.75||||||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145560.75|21036.18|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145560.75|36011.42|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145560.75|36873.5|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145560.75|84556.26|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145560.75|10200|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|145560.75|4350|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MULTIPLAN [1680]|HMA [168003]|145560.75|2501.4|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|145560.75|15522.93|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145560.75|21036.18|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145560.75|34006.86|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145560.75|88112.44|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145560.75|30814.85|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145560.75|57273.08|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|||145560.75|43668.22|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145560.75|51184.53|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145560.75|16016.34|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145560.75|15522.93|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|145560.75|33136.72|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|145560.75|84556.26|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|GEHA [1415]|GEHA [141500]|145560.75|79301.19|88112.44|2501.4|||| MS255|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145560.75|79301.19|88112.44|2501.4|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|93861.94|40768.85|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93861.94|9841.06|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|||93861.94|28158.58|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|GEHA [1415]|GEHA [141500]|93861.94||||||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|93861.94|9841.06|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93861.94|4250|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93861.94|40768.85|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93861.94|10423.84|40768.85|4250|||| MS256|DRG||Upper Limb And Toe Amputation For Circulatory System Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93861.94|10423.84|40768.85|4250|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|CHAMPVA [1240]|CHAMP VA [124000]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65836.12|46418.85|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65836.12|4350|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|AETNA [1015]|AETNA ACO WILCO [101532]|65836.12|46415.8|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|TRUSTMARK [2030]|STARMARK [203000]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65836.12|45333.61|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|HEALTHNET [1495]|HEALTHNET [149500]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MULTIPLAN [1680]|IHC HS [168011]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MULTIPLAN [1680]|HMA [168003]|65836.12|8385.07|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65836.12|70984.01|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65836.12|70984.01|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|UMR [2035]|UMR OPTIONS [203501]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65836.12|41660.53|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65836.12||||||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65836.12|136507.71|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65836.12|35572.68|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65836.12|88730.01|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|||65836.12|19750.84|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65836.12|79297.33|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65836.12|27144.99|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|CORESOURCE [1315]|CORESOURCE [131500]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|GEHA [1415]|GEHA [141500]|65836.12|122856.94|136507.71|4350|||| MS258|DRG||Cardiac Pacemaker Device Replacement With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65836.12|122856.94|136507.71|4350|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|GEHA [1415]|GEHA [141500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|CORESOURCE [1315]|CORESOURCE [131500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|CHAMPVA [1240]|CHAMP VA [124000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MULTIPLAN [1680]|IHC HS [168011]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MULTIPLAN [1680]|HMA [168003]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|HEALTHNET [1495]|HEALTHNET [149500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|TRUSTMARK [2030]|STARMARK [203000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|UMR [2035]|UMR OPTIONS [203501]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73095.38||||||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|||73095.38|21928.61|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73095.38|13388.82|21928.61|13388.82|||| MS259|DRG||Cardiac Pacemaker Device Replacement Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73095.38|13388.82|21928.61|13388.82|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|CHAMPVA [1240]|CHAMP VA [124000]|155175.95||||||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|155175.95|62450.95|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|155175.95|50755.86|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|155175.95|226007.48|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|155175.95|21250|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|155175.95|3625|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|AETNA [1015]|AETNA ACO WILCO [101532]|155175.95|53556.5|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|TRUSTMARK [2030]|STARMARK [203000]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MULTIPLAN [1680]|IHC HS [168011]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MULTIPLAN [1680]|HMA [168003]|155175.95|7001.8|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|HEALTHNET [1495]|HEALTHNET [149500]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|155175.95|18857.99|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|155175.95|62450.95|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|UMR [2035]|UMR OPTIONS [203501]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|155175.95|51970.9|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|155175.95|48503|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|155175.95|120097.99|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|155175.95|43026.35|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|155175.95|78063.7|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|||155175.95|46552.78|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|155175.95|69764.91|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|155175.95|22486.97|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|155175.95|18857.99|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|155175.95|46477.34|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|CORESOURCE [1315]|CORESOURCE [131500]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|155175.95|226007.48|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|GEHA [1415]|GEHA [141500]|155175.95|108088.2|226007.48|3625|||| MS260|DRG||Cardiac Pacemaker Revision Except Device Replacement With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|155175.95|108088.2|226007.48|3625|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|CHAMPVA [1240]|CHAMP VA [124000]|104239.56||||||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|GEHA [1415]|GEHA [141500]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104239.56|50889.44|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|CORESOURCE [1315]|CORESOURCE [131500]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104239.56|9024.1|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|||104239.56|31271.87|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104239.56|48146.52|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104239.56|22661.06|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104239.56|74071.57|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|UMR [2035]|UMR OPTIONS [203501]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104239.56|14980.74|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104239.56|9024.1|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MULTIPLAN [1680]|IHC HS [168011]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104239.56|26203.11|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MULTIPLAN [1680]|HMA [168003]|104239.56|157.68|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|HEALTHNET [1495]|HEALTHNET [149500]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|TRUSTMARK [2030]|STARMARK [203000]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104239.56|43028.19|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|104239.56|25893.4|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104239.56|2175|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104239.56|850|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104239.56|50889.44|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104239.56|28873.85|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104239.56|28198.8|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104239.56|14980.74|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104239.56|66664.41|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104239.56|12583.72|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104239.56|28934.62|74071.57|157.68|||| MS261|DRG||Cardiac Pacemaker Revision Except Device Replacement With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104239.56|66664.41|74071.57|157.68|||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|GEHA [1415]|GEHA [141500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|||59514.30|17854.29|17854.29|17854.29|||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59514.30||||||| MS262|DRG||Cardiac Pacemaker Revision Except Device Replacement Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59514.30||||||| MS263|DRG||Vein Ligation And Stripping|CHAMPVA [1240]|CHAMP VA [124000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|||71296.43|21388.93|122020.49|7650|||| MS263|DRG||Vein Ligation And Stripping|CORESOURCE [1315]|CORESOURCE [131500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|GEHA [1415]|GEHA [141500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71296.43|122020.49|122020.49|7650|||| MS263|DRG||Vein Ligation And Stripping|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71296.43|122020.49|122020.49|7650|||| MS263|DRG||Vein Ligation And Stripping|AETNA [1015]|AETNA ACO WILCO [101532]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71296.43|8404.55|122020.49|7650|||| MS263|DRG||Vein Ligation And Stripping|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MULTIPLAN [1680]|IHC HS [168011]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|TRUSTMARK [2030]|STARMARK [203000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|FMH BENEFIT SERVICES [1390]|FMH [139000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MULTIPLAN [1680]|HMA [168003]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71296.43|8404.55|122020.49|7650|||| MS263|DRG||Vein Ligation And Stripping|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71296.43|7650|122020.49|7650|||| MS263|DRG||Vein Ligation And Stripping|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|FIRST HEALTH [1375]|QUALCHOICE [137513]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|UMR [2035]|UMR OPTIONS [203501]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|HEALTHNET [1495]|HEALTHNET [149500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71296.43||||||| MS263|DRG||Vein Ligation And Stripping|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71296.43||||||| MS264|DRG||Other Circulatory System O.R. Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|112937.14|43193.16|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|CORESOURCE [1315]|CORESOURCE [131500]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|CHAMPVA [1240]|CHAMP VA [124000]|112937.14||||||| MS264|DRG||Other Circulatory System O.R. Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112937.14|77330.05|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112937.14|43193.16|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112937.14|47093.1|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|GEHA [1415]|GEHA [141500]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|112937.14|7975|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112937.14|3400|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112937.14|148711.64|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MULTIPLAN [1680]|HMA [168003]|112937.14|1535.07|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|HEALTHNET [1495]|HEALTHNET [149500]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112937.14|77330.05|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112937.14|37657.94|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MULTIPLAN [1680]|IHC HS [168011]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112937.14|45992.1|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|112937.14|20895.72|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|TRUSTMARK [2030]|STARMARK [203000]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112937.14|43503.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112937.14|20396.39|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112937.14|86386.61|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|||112937.14|33881.14|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|UMR [2035]|UMR OPTIONS [203501]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112937.14|96662.56|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112937.14|20895.72|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112937.14|133840.48|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112937.14|48083.3|148711.64|1535.07|||| MS264|DRG||Other Circulatory System O.R. Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112937.14|20396.39|148711.64|1535.07|||| MS265|DRG||Aicd Lead Procedures|GEHA [1415]|GEHA [141500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|CHAMPVA [1240]|CHAMP VA [124000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|UMR [2035]|UMR OPTIONS [203501]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|CORESOURCE [1315]|CORESOURCE [131500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|MULTIPLAN [1680]|IHC HS [168011]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|MULTIPLAN [1680]|HMA [168003]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|TRUSTMARK [2030]|STARMARK [203000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|HEALTHNET [1495]|HEALTHNET [149500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|||107778.15|32333.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107778.15||||||| MS265|DRG||Aicd Lead Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107778.15|21110.44|32333.44|21110.44|||| MS265|DRG||Aicd Lead Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107778.15||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MULTIPLAN [1680]|HMA [168003]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|GEHA [1415]|GEHA [141500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|||278868.89|83660.67|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|278868.89|44320.29|83660.67|44320.29|||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|278868.89||||||| MS266|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|278868.89|44320.29|83660.67|44320.29|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|CHAMPVA [1240]|CHAMP VA [124000]|211400.82||||||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|CORESOURCE [1315]|CORESOURCE [131500]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|211400.82||||||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|211400.82||||||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|211400.82||||||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|211400.82|121230.97|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|GEHA [1415]|GEHA [141500]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|||211400.82|63420.25|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|211400.82|66007.23|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|211400.82|82561.23|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MULTIPLAN [1680]|IHC HS [168011]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211400.82|108521.42|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|HEALTHNET [1495]|HEALTHNET [149500]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|211400.82|122470.3|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|UMR [2035]|UMR OPTIONS [203501]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|211400.82||||||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|211400.82||||||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|211400.82|135651.79|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MULTIPLAN [1680]|HMA [168003]|211400.82|46831.07|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|211400.82|79314.34|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|TRUSTMARK [2030]|STARMARK [203000]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|211400.82|108521.42|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|211400.82|725|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|211400.82|35019.91|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|211400.82|187825.55|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|211400.82|70980.81|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|211400.82|81213.05|187825.55|725|||| MS267|DRG||Endovascular Cardiac Valve Replacement And Supplement Procedures Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|211400.82|70980.81|187825.55|725|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|297598.63|100841.7|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|297598.63||||||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|297598.63||||||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|297598.63||||||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|297598.63|116830.57|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|297598.63|98484.09|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|CHAMPVA [1240]|CHAMP VA [124000]|297598.63||||||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|297598.63||||||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MULTIPLAN [1680]|IHC HS [168011]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|TRUSTMARK [2030]|STARMARK [203000]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MULTIPLAN [1680]|HMA [168003]|297598.63|35503.46|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|HEALTHNET [1495]|HEALTHNET [149500]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|297598.63|3625|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|UMR [2035]|UMR OPTIONS [203501]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|297598.63|88242.34|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|||297598.63|89279.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|297598.63|78881.64|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|297598.63|130513.23|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|297598.63||||||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|AETNA [1015]|AETNA ACO WILCO [101532]|297598.63|121887.2|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|297598.63|146038.21|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|297598.63|116830.57|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|GEHA [1415]|GEHA [141500]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|297598.63|67548.4|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|CORESOURCE [1315]|CORESOURCE [131500]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|297598.63|43432.59|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|297598.63|202206.75|202206.75|3625|||| MS268|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|297598.63|67548.4|202206.75|3625|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|132941.92|56183.71|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|132941.92|11943.79|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|||132941.92|39882.58|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|132941.92|71780.4|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MULTIPLAN [1680]|IHC HS [168011]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|132941.92|87355.2|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|TRUSTMARK [2030]|STARMARK [203000]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|132941.92|84534.48|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|132941.92|3400|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|UMR [2035]|UMR OPTIONS [203501]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|132941.92|725|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|HEALTHNET [1495]|HEALTHNET [149500]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132941.92|61099.05|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|132941.92|71780.4|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132941.92|49618.23|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|132941.92|63352.4|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|132941.92|62561.7|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|132941.92|63352.4|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|132941.92|89725.51|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MULTIPLAN [1680]|HMA [168003]|132941.92|32234.85|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|132941.92|63352.4|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|CHAMPVA [1240]|CHAMP VA [124000]|132941.92||||||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|GEHA [1415]|GEHA [141500]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|132941.92|84534.48|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|132941.92|11943.79|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|CORESOURCE [1315]|CORESOURCE [131500]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|132941.92|27026.11|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|132941.92|53356.92|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|132941.92|124235.31|124235.31|725|||| MS269|DRG||Aortic And Heart Assist Procedures Except Pulsation Balloon Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|132941.92|80187|124235.31|725|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|206129.42|77133.17|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|206129.42|75133.2|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|206129.42|15300|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|206129.42|2900|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|206129.42|155591.76|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|206129.42|68282.9|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MULTIPLAN [1680]|HMA [168003]|206129.42|7598.43|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|206129.42|77133.17|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|206129.42|59431.63|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|206129.42|73376.64|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|206129.42|96416.46|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|||206129.42|61838.83|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|206129.42|86166.65|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|206129.42|66803.67|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|206129.42|52588.68|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|206129.42|52588.68|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|206129.42|75884.89|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|GEHA [1415]|GEHA [141500]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|206129.42|155591.76|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|206129.42|133499.71|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|206129.42|148526.46|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|206129.42|32414.14|155591.76|2900|||| MS270|DRG||Other Major Cardiovascular Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|206129.42|133499.71|155591.76|2900|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|GEHA [1415]|GEHA [141500]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146840.85|41263.24|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146840.85|45746.27|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|146840.85|4250.05|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146840.85|19959.94|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146840.85|76357.24|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146840.85|95446.56|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|||146840.85|44052.25|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|146840.85|47772.74|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146840.85|4350|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146840.85|74533.05|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146840.85|74533.05|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|146840.85|266071.56|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146840.85|85299.86|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146840.85|51686.7|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146840.85|50478.3|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146840.85|76357.24|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146840.85|45183.78|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146840.85|132156.77|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146840.85|1700|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146840.85|19959.94|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146840.85|22365.16|266071.56|1700|||| MS271|DRG||Other Major Cardiovascular Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146840.85|45183.78|266071.56|1700|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93514.91|69913.49|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93514.91|38076.1|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|93514.91|34035.3|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|93514.91|1450|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93514.91|50019.69|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|93514.91||||||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93514.91|69913.49|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|93514.91|331.18|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|||93514.91|28054.47|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93514.91|850|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93514.91|30253.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93514.91|38987.6|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93514.91|87391.86|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|93514.91|17317.15|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93514.91|78101.43|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93514.91|17317.15|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93514.91|33175.38|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93514.91|16922.42|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|93514.91|50019.69|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93514.91|121004.12|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|93514.91|33088.66|121004.12|331.18|||| MS272|DRG||Other Major Cardiovascular Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|93514.91|121004.12|121004.12|331.18|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|151384.18|78932.11|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|||151384.18|45415.25|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|151384.18|43150.79|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|151384.18|112515.14|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|151384.18|24087.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|GEHA [1415]|GEHA [141500]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|151384.18|48389.43|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|151384.18|90012.1|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|151384.18|850|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MULTIPLAN [1680]|HMA [168003]|151384.18|450.35|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|151384.18|78932.11|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|151384.18|47482.5|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|151384.18|46625.46|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|151384.18|5075|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|151384.18|100553.9|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|151384.18|108935.06|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|151384.18|55639.4|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|151384.18|54338.59|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|151384.18|90012.1|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|151384.18|55006.8|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|151384.18|46625.46|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|151384.18|24059.26|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|151384.18|155790.19|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|151384.18|47250.67|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|151384.18|55006.8|155790.19|450.35|||| MS273|DRG||Percutaneous And Other Intracardiac Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|151384.18|55006.8|155790.19|450.35|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130194.68|46524.55|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130194.68|47638.3|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130194.68|61586.16|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130194.68|1700|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|130194.68|725|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|130194.68|39517.44|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|130194.68|38717.9|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|HEALTHNET [1495]|HEALTHNET [149500]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MULTIPLAN [1680]|IHC HS [168011]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|130194.68|38494.52|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|UMR [2035]|UMR OPTIONS [203501]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130194.68|68404.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130194.68|37428.77|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MULTIPLAN [1680]|HMA [168003]|130194.68|347.76|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130194.68|76415.91|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130194.68|68404.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|TRUSTMARK [2030]|STARMARK [203000]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130194.68|85505.79|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|||130194.68|39058.4|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130194.68|20630.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|CHAMPVA [1240]|CHAMP VA [124000]|130194.68|97994.28|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|GEHA [1415]|GEHA [141500]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|130194.68|61586.16|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130194.68|118392.64|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130194.68|38494.52|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130194.68|36748.47|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130194.68|46922.05|118392.64|347.76|||| MS274|DRG||Percutaneous And Other Intracardiac Procedures Without McC|CORESOURCE [1315]|CORESOURCE [131500]|130194.68|118392.64|118392.64|347.76|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|CORESOURCE [1315]|CORESOURCE [131500]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63326.06|24008.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|GEHA [1415]|GEHA [141500]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63326.06|19610.52|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|||63326.06|18997.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63326.06|64041.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63326.06|37201.51|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63326.06|41626.72|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63326.06|18967.37|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63326.06|22412.1|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63326.06|35772.37|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63326.06|24008.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MULTIPLAN [1680]|HMA [168003]|63326.06|273.07|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MULTIPLAN [1680]|IHC HS [168011]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63326.06|18307.53|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63326.06|24008.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63326.06|1450|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|AETNA [1015]|AETNA ACO WILCO [101532]|63326.06|24008.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|CHAMPVA [1240]|CHAMP VA [124000]|63326.06|72787.05|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|TRUSTMARK [2030]|STARMARK [203000]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63326.06|35772.37|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63326.06|24008.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63326.06|24008.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63326.06|1700|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|HEALTHNET [1495]|HEALTHNET [149500]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63326.06|24008.11|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|UMR [2035]|UMR OPTIONS [203501]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63326.06|13960.87|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63326.06|23579.9|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63326.06|23028.62|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63326.06|13960.87|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63326.06|24218.36|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63326.06|20396.54|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63326.06|24218.36|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63326.06|10318.82|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63326.06|57637|72787.05|273.07|||| MS280|DRG||Acute Myocardial Infarction, Discharged Alive With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63326.06|24008.11|72787.05|273.07|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43417.07|13515.45|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43417.07|35617.94|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43417.07|2550|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|TRUSTMARK [2030]|STARMARK [203000]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43417.07|13199.47|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43417.07|1450|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|HEALTHNET [1495]|HEALTHNET [149500]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|UMR [2035]|UMR OPTIONS [203501]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43417.07|16647.49|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43417.07|8274.45|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MULTIPLAN [1680]|HMA [168003]|43417.07|502.82|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43417.07|41698.62|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43417.07|8274.45|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|||43417.07|13025.12|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43417.07|13314.5|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43417.07|11265.98|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43417.07|27104.1|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43417.07|24222.73|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MULTIPLAN [1680]|IHC HS [168011]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43417.07|6005.27|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|CHAMPVA [1240]|CHAMP VA [124000]|43417.07|29790.53|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43417.07|15200.85|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|CORESOURCE [1315]|CORESOURCE [131500]|43417.07|37528.76|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43417.07|12114.86|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43417.07|35617.94|41698.62|502.82|||| MS281|DRG||Acute Myocardial Infarction, Discharged Alive With Cc|GEHA [1415]|GEHA [141500]|43417.07|37528.76|41698.62|502.82|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|36764.10|192.03|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36764.10|26968.53|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36764.10|725|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36764.10|850|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36764.10|10273.81|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36764.10|9228.41|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36764.10|9228.41|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36764.10|6106.32|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36764.10|9228.41|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|GEHA [1415]|GEHA [141500]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|36764.10|21475.56|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|||36764.10|11029.23|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36764.10|27232.91|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36764.10|24337.85|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36764.10|8581.78|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36764.10|26968.53|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36764.10|12301.85|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36764.10|41896.79|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36764.10|10256.27|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36764.10|10519.75|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36764.10|6106.32|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36764.10|12301.85|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36764.10|4721.33|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36764.10|37707.12|41896.79|192.03|||| MS282|DRG||Acute Myocardial Infarction, Discharged Alive Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36764.10|4721.33|41896.79|192.03|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81985.81|13528.05|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81985.81|26404.6|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81985.81|27036.7|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81985.81|83574.94|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81985.81|1700|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81985.81|1450|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|AETNA [1015]|AETNA ACO WILCO [101532]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|TRUSTMARK [2030]|STARMARK [203000]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MULTIPLAN [1680]|IHC HS [168011]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MULTIPLAN [1680]|HMA [168003]|81985.81|317.71|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81985.81|13528.05|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|UMR [2035]|UMR OPTIONS [203501]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|HEALTHNET [1495]|HEALTHNET [149500]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81985.81|23757.34|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81985.81|58452.35|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81985.81|20930.51|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81985.81|19136.99|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81985.81|37994.03|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81985.81|33954.99|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|||81985.81|24595.74|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81985.81|19136.99|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|CHAMPVA [1240]|CHAMP VA [124000]|81985.81|141784.03|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81985.81|83574.94|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|CORESOURCE [1315]|CORESOURCE [131500]|81985.81|52607.12|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81985.81|20296.62|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81985.81|11800.36|141784.03|317.71|||| MS283|DRG||Acute Myocardial Infarction, Expired With McC|GEHA [1415]|GEHA [141500]|81985.81|52607.12|141784.03|317.71|||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|CORESOURCE [1315]|CORESOURCE [131500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|CHAMPVA [1240]|CHAMP VA [124000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|GEHA [1415]|GEHA [141500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|UMR [2035]|UMR OPTIONS [203501]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MULTIPLAN [1680]|HMA [168003]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|TRUSTMARK [2030]|STARMARK [203000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|HEALTHNET [1495]|HEALTHNET [149500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MULTIPLAN [1680]|IHC HS [168011]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|||9137.49|2741.25|2741.25|2741.25|||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|9137.49||||||| MS284|DRG||Acute Myocardial Infarction, Expired With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9137.49||||||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85575.21|17151.3|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85575.21|32630.71|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85575.21|31353.87|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85575.21|45226.01|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85575.21|32104.45|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85575.21|26092|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85575.21|3400|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85575.21|2175|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85575.21|26092|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|85575.21|28566.2|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|HEALTHNET [1495]|HEALTHNET [149500]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MULTIPLAN [1680]|IHC HS [168011]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85575.21|26092|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MULTIPLAN [1680]|HMA [168003]|85575.21|832.87|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85575.21|32630.71|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85575.21|8749.89|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|UMR [2035]|UMR OPTIONS [203501]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85575.21|30125.26|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85575.21|77925|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|TRUSTMARK [2030]|STARMARK [203000]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85575.21|26092|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85575.21|32630.71|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85575.21|25555.76|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85575.21|26092|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85575.21|50651.25|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85575.21|45266.63|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|||85575.21|25672.56|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85575.21|17151.3|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85575.21|13972.35|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85575.21|8749.89|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|CHAMPVA [1240]|CHAMP VA [124000]|85575.21|65660.68|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85575.21|26092|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85575.21|26092|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|GEHA [1415]|GEHA [141500]|85575.21|70132.51|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85575.21|45226.01|77925|832.87|||| MS286|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization With McC|CORESOURCE [1315]|CORESOURCE [131500]|85575.21|70132.51|77925|832.87|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51873.76|28333.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|GEHA [1415]|GEHA [141500]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|CHAMPVA [1240]|CHAMP VA [124000]|51873.76|39307.57|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|||51873.76|15562.13|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51873.76|29851.85|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51873.76|33402.82|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51873.76|8242.69|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51873.76|51388.95|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51873.76|15886|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|UMR [2035]|UMR OPTIONS [203501]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51873.76|8242.69|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|HEALTHNET [1495]|HEALTHNET [149500]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|TRUSTMARK [2030]|STARMARK [203000]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|51873.76|14978.6|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51873.76|1450|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51873.76|13400.09|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51873.76|1700|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51873.76|28333.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51873.76|9116.68|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MULTIPLAN [1680]|IHC HS [168011]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|CORESOURCE [1315]|CORESOURCE [131500]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51873.76|16675|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51873.76|16285.15|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51873.76|14409.77|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51873.76|9116.68|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51873.76|46250.05|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51873.76|17109.81|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51873.76|7359.44|51388.95|291.19|||| MS287|DRG||Circulatory Disorders Except Ami, With Cardiac Catheterization Without McC|MULTIPLAN [1680]|HMA [168003]|51873.76|291.19|51388.95|291.19|||| MS288|DRG||Acute And Subacute Endocarditis With McC|HEALTHNET [1495]|HEALTHNET [149500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MULTIPLAN [1680]|IHC HS [168011]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MULTIPLAN [1680]|HMA [168003]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|UMR [2035]|UMR OPTIONS [203501]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|TRUSTMARK [2030]|STARMARK [203000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|CHAMPVA [1240]|CHAMP VA [124000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|CORESOURCE [1315]|CORESOURCE [131500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|GEHA [1415]|GEHA [141500]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71643.09||||||| MS288|DRG||Acute And Subacute Endocarditis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71643.09|41617.48|41617.48|2550|||| MS288|DRG||Acute And Subacute Endocarditis With McC|||71643.09|21492.93|41617.48|2550|||| MS288|DRG||Acute And Subacute Endocarditis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71643.09|41617.48|41617.48|2550|||| MS288|DRG||Acute And Subacute Endocarditis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71643.09|21956.9|41617.48|2550|||| MS288|DRG||Acute And Subacute Endocarditis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71643.09|21956.9|41617.48|2550|||| MS288|DRG||Acute And Subacute Endocarditis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71643.09|2550|41617.48|2550|||| MS289|DRG||Acute And Subacute Endocarditis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|GEHA [1415]|GEHA [141500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|UMR [2035]|UMR OPTIONS [203501]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MULTIPLAN [1680]|HMA [168003]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|TRUSTMARK [2030]|STARMARK [203000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MULTIPLAN [1680]|IHC HS [168011]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21068.19||||||| MS289|DRG||Acute And Subacute Endocarditis With Cc|||21068.19|6320.46|6320.46|6320.46|||| MS289|DRG||Acute And Subacute Endocarditis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21068.19||||||| MS291|DRG||Heart Failure And Shock With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54464.25|19984.71|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54464.25|19984.71|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54464.25|19984.71|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54464.25|19443.05|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54464.25|33922.6|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54464.25|18988.48|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54464.25|17780.99|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54464.25|4250|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54464.25|2175|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54464.25|17780.99|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|AETNA [1015]|AETNA ACO WILCO [101532]|54464.25|17780.99|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|TRUSTMARK [2030]|STARMARK [203000]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|HEALTHNET [1495]|HEALTHNET [149500]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MULTIPLAN [1680]|IHC HS [168011]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MULTIPLAN [1680]|HMA [168003]|54464.25|320.48|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54464.25|10393.52|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54464.25|17780.99|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54464.25|19954.17|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54464.25|14698.74|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54464.25|47650.44|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54464.25|17780.99|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|UMR [2035]|UMR OPTIONS [203501]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54464.25|15651.65|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54464.25|17780.99|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54464.25|30972.79|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54464.25|27680.14|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|||54464.25|16339.27|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54464.25|12190.83|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54464.25|12190.83|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54464.25|9941.65|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|CHAMPVA [1240]|CHAMP VA [124000]|54464.25|39101.79|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54464.25|17780.99|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|GEHA [1415]|GEHA [141500]|54464.25|42885.39|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54464.25|33922.6|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54464.25|8545.78|47650.44|320.48|||| MS291|DRG||Heart Failure And Shock With McC|CORESOURCE [1315]|CORESOURCE [131500]|54464.25|42885.39|47650.44|320.48|||| MS292|DRG||Heart Failure And Shock With Cc|GEHA [1415]|GEHA [141500]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|CHAMPVA [1240]|CHAMP VA [124000]|41645.71|11430.05|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|||41645.71|12493.71|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41645.71|25056.12|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41645.71|38547.87|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41645.71|25635.62|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41645.71|12962.98|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|UMR [2035]|UMR OPTIONS [203501]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41645.71|6894.74|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MULTIPLAN [1680]|IHC HS [168011]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|HEALTHNET [1495]|HEALTHNET [149500]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41645.71|6325.83|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41645.71|10530.97|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MULTIPLAN [1680]|HMA [168003]|41645.71|71.05|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|CORESOURCE [1315]|CORESOURCE [131500]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41645.71|22392.45|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41645.71|2900|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41645.71|3400|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|TRUSTMARK [2030]|STARMARK [203000]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41645.71|25635.62|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41645.71|7932.88|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41645.71|12978.95|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41645.71|12675.51|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41645.71|7932.88|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41645.71|7362.74|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41645.71|7362.74|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41645.71|9326.03|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41645.71|34693.08|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41645.71|5775.32|38547.87|71.05|||| MS292|DRG||Heart Failure And Shock With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41645.71|7362.74|38547.87|71.05|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|33915.14||||||| MS293|DRG||Heart Failure And Shock Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33915.14|9462.7|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33915.14|5460.32|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33915.14|3625|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33915.14|4062.35|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33915.14|5460.32|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33915.14|9107.07|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33915.14|46045.86|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33915.14|1700|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33915.14|7621.14|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33915.14|14876.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33915.14|9241.47|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33915.14|29929.81|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33915.14|26748.05|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|||33915.14|10174.54|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33915.14|4268.28|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|33915.14|292.65|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33915.14|4062.35|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33915.14|7527.84|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33915.14|14876.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33915.14|41441.27|46045.86|292.65|||| MS293|DRG||Heart Failure And Shock Without Cc/McC|GEHA [1415]|GEHA [141500]|33915.14|41441.27|46045.86|292.65|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|GEHA [1415]|GEHA [141500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|CORESOURCE [1315]|CORESOURCE [131500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|CHAMPVA [1240]|CHAMP VA [124000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|UMR [2035]|UMR OPTIONS [203501]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|TRUSTMARK [2030]|STARMARK [203000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|AETNA [1015]|AETNA ACO WILCO [101532]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|HEALTHNET [1495]|HEALTHNET [149500]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MULTIPLAN [1680]|HMA [168003]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|||36988.16|11096.45|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MULTIPLAN [1680]|IHC HS [168011]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36988.16||||||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36988.16|10123.68|11096.45|10123.68|||| MS296|DRG||Cardiac Arrest, Unexplained With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36988.16|10123.68|11096.45|10123.68|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|GEHA [1415]|GEHA [141500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65234.51||||||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65234.51|3977.31|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|||65234.51|19570.35|19570.35|3977.31|||| MS298|DRG||Cardiac Arrest, Unexplained Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65234.51|3977.31|19570.35|3977.31|||| MS299|DRG||Peripheral Vascular Disorders With McC|GEHA [1415]|GEHA [141500]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|38899.15||||||| MS299|DRG||Peripheral Vascular Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38899.15|9766.26|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|||38899.15|11669.74|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38899.15|25072.68|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38899.15|38573.35|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38899.15|19079.42|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38899.15|9766.26|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MULTIPLAN [1680]|HMA [168003]|38899.15|76.77|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|38899.15|18855.2|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38899.15|16860.01|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38899.15|725|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38899.15|32357.36|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38899.15|22407.25|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38899.15|5100|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38899.15|32357.36|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38899.15|11380.91|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38899.15|4270.25|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38899.15|21686.16|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38899.15|11380.91|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38899.15|34716.03|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38899.15|9729.66|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38899.15|18130.4|38573.35|76.77|||| MS299|DRG||Peripheral Vascular Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38899.15|9729.66|38573.35|76.77|||| MS300|DRG||Peripheral Vascular Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|34530.84||||||| MS300|DRG||Peripheral Vascular Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34530.84|15111.9|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34530.84|7889.28|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34530.84|725|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|34530.84|13308.1|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34530.84|14758.59|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34530.84|6915.12|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34530.84|7889.28|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34530.84|13768.77|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34530.84|18570.2|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34530.84|1700|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34530.84|11950.99|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34530.84|21266.57|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34530.84|14831.4|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34530.84|12070.63|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34530.84|10787.44|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|||34530.84|10359.25|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34530.84|6689.49|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|34530.84|63|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34530.84|6915.12|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34530.84|21266.57|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|GEHA [1415]|GEHA [141500]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|34530.84|16713.18|21266.57|63|||| MS300|DRG||Peripheral Vascular Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34530.84|14831.4|21266.57|63|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31394.90||||||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31394.90||||||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31394.90||||||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31394.90||||||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31394.90|18237.29|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31394.90||||||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31394.90|8441.05|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31394.90|31394.9|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31394.90|5471.62|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31394.90|9803.35|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31394.90|91.35|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31394.90|20406.69|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31394.90||||||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|||31394.90|9418.47|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31394.90|9440.6|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31394.90|1450|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31394.90|28255.41|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31394.90|10766.25|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31394.90|10514.54|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31394.90|5471.62|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31394.90|9077.08|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31394.90|4826.98|31394.9|91.35|||| MS301|DRG||Peripheral Vascular Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31394.90|28255.41|31394.9|91.35|||| MS302|DRG||Atherosclerosis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|MULTIPLAN [1680]|HMA [168003]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|CHAMPVA [1240]|CHAMP VA [124000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|CORESOURCE [1315]|CORESOURCE [131500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56700.24|33550.24|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|UMR [2035]|UMR OPTIONS [203501]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56700.24|4250|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|GEHA [1415]|GEHA [141500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56700.24|5674.23|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|MULTIPLAN [1680]|IHC HS [168011]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|||56700.24|17010.07|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56700.24|5674.23|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56700.24|33550.24|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56700.24|7008.3|33550.24|4250|||| MS302|DRG||Atherosclerosis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|TRUSTMARK [2030]|STARMARK [203000]|56700.24||||||| MS302|DRG||Atherosclerosis With McC|HEALTHNET [1495]|HEALTHNET [149500]|56700.24||||||| MS303|DRG||Atherosclerosis Without McC|CHAMPVA [1240]|CHAMP VA [124000]|28184.20||||||| MS303|DRG||Atherosclerosis Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|GEHA [1415]|GEHA [141500]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28184.20|16357.25|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|CORESOURCE [1315]|CORESOURCE [131500]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28184.20|4681.81|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|||28184.20|8455.26|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28184.20|20517.37|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28184.20|7858.39|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28184.20|31565.18|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28184.20|8963.76|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|UMR [2035]|UMR OPTIONS [203501]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28184.20|4926.56|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28184.20|4681.81|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MULTIPLAN [1680]|IHC HS [168011]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MULTIPLAN [1680]|HMA [168003]|28184.20|508.47|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|HEALTHNET [1495]|HEALTHNET [149500]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|TRUSTMARK [2030]|STARMARK [203000]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28184.20|18336.21|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28184.20|725|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28184.20|850|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28184.20|16357.25|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28184.20|28408.66|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28184.20|9807.8|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28184.20|9578.5|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28184.20|4926.56|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28184.20|10033.94|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28184.20|10033.94|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28184.20|10033.94|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28184.20|4416.19|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28184.20|8450.51|31565.18|508.47|||| MS303|DRG||Atherosclerosis Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28184.20|28408.66|31565.18|508.47|||| MS304|DRG||Hypertension With McC|CHAMPVA [1240]|CHAMP VA [124000]|59730.84||||||| MS304|DRG||Hypertension With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59730.84|8087.92|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59730.84|15886.2|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59730.84|1450|40188.4|529.85|||| MS304|DRG||Hypertension With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|AETNA [1015]|AETNA ACO WILCO [101532]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|TRUSTMARK [2030]|STARMARK [203000]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|HEALTHNET [1495]|HEALTHNET [149500]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MULTIPLAN [1680]|IHC HS [168011]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MULTIPLAN [1680]|HMA [168003]|59730.84|529.85|40188.4|529.85|||| MS304|DRG||Hypertension With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59730.84|5610.47|40188.4|529.85|||| MS304|DRG||Hypertension With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59730.84|8087.92|40188.4|529.85|||| MS304|DRG||Hypertension With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|UMR [2035]|UMR OPTIONS [203501]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59730.84|1700|40188.4|529.85|||| MS304|DRG||Hypertension With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59730.84|14504.42|40188.4|529.85|||| MS304|DRG||Hypertension With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59730.84|14174.37|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59730.84|40188.4|40188.4|529.85|||| MS304|DRG||Hypertension With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59730.84|15514.79|40188.4|529.85|||| MS304|DRG||Hypertension With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59730.84|12694.15|40188.4|529.85|||| MS304|DRG||Hypertension With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59730.84|26122.46|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59730.84|23345.45|40188.4|529.85|||| MS304|DRG||Hypertension With McC|||59730.84|17919.25|40188.4|529.85|||| MS304|DRG||Hypertension With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59730.84|7021.35|40188.4|529.85|||| MS304|DRG||Hypertension With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59730.84|5610.47|40188.4|529.85|||| MS304|DRG||Hypertension With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59730.84|13650.64|40188.4|529.85|||| MS304|DRG||Hypertension With McC|CORESOURCE [1315]|CORESOURCE [131500]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59730.84|14504.42|40188.4|529.85|||| MS304|DRG||Hypertension With McC|GEHA [1415]|GEHA [141500]|59730.84|36169.57|40188.4|529.85|||| MS304|DRG||Hypertension With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59730.84|36169.57|40188.4|529.85|||| MS305|DRG||Hypertension Without McC|GEHA [1415]|GEHA [141500]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36405.60|22434.35|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|CORESOURCE [1315]|CORESOURCE [131500]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|CHAMPVA [1240]|CHAMP VA [124000]|36405.60|8994.75|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36405.60|5801.4|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|||36405.60|10921.68|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36405.60|21556.67|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36405.60|24120.92|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36405.60|8507.35|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36405.60|9350.43|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|UMR [2035]|UMR OPTIONS [203501]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36405.60|5064.64|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36405.60|5801.4|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MULTIPLAN [1680]|IHC HS [168011]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36405.60|37109.1|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MULTIPLAN [1680]|HMA [168003]|36405.60|570.75|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|HEALTHNET [1495]|HEALTHNET [149500]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|TRUSTMARK [2030]|STARMARK [203000]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36405.60|725|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36405.60|1700|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36405.60|22434.35|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36405.60|10708.25|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36405.60|10457.9|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36405.60|5064.64|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36405.60|33398.2|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36405.60|4802.13|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36405.60|10862.55|37109.1|570.75|||| MS305|DRG||Hypertension Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36405.60|33398.2|37109.1|570.75|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50674.29||||||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50674.29||||||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50674.29||||||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|50674.29||||||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50674.29||||||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MULTIPLAN [1680]|HMA [168003]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50674.29||||||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|||50674.29|15202.29|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50674.29|9557.51|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|GEHA [1415]|GEHA [141500]|50674.29|20422.74|20422.74|9557.51|||| MS306|DRG||Cardiac Congenital And Valvular Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50674.29|20422.74|20422.74|9557.51|||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|GEHA [1415]|GEHA [141500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|CHAMPVA [1240]|CHAMP VA [124000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|UMR [2035]|UMR OPTIONS [203501]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MULTIPLAN [1680]|IHC HS [168011]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MULTIPLAN [1680]|HMA [168003]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|HEALTHNET [1495]|HEALTHNET [149500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|TRUSTMARK [2030]|STARMARK [203000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|CORESOURCE [1315]|CORESOURCE [131500]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33653.00||||||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33653.00|19549.03|19549.03|1700|||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33653.00|7370.86|19549.03|1700|||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|||33653.00|10095.9|19549.03|1700|||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33653.00|7370.86|19549.03|1700|||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33653.00|1700|19549.03|1700|||| MS307|DRG||Cardiac Congenital And Valvular Disorders Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33653.00|19549.03|19549.03|1700|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|52822.52||||||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52822.52|17437.79|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52822.52|17636.98|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52822.52|17636.98|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52822.52|17636.98|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52822.52|17389.85|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52822.52|17437.79|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52822.52|2550|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52822.52|2175|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52822.52|17437.79|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|52822.52|15646.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52822.52|17437.79|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52822.52|8705.08|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MULTIPLAN [1680]|HMA [168003]|52822.52|68.69|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52822.52|9776.4|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52822.52|17437.79|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52822.52|24954.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52822.52|16068.52|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52822.52|36083.55|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52822.52|16983.29|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52822.52|13812.95|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52822.52|17437.79|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52822.52|23454.31|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52822.52|9776.4|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52822.52|20960.95|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|||52822.52|15846.76|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52822.52|7665.8|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52822.52|8705.08|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52822.52|17437.79|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52822.52|24954.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|GEHA [1415]|GEHA [141500]|52822.52|32475.2|36083.55|68.69|||| MS308|DRG||Cardiac Arrhythmia And Conduction Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52822.52|32475.2|36083.55|68.69|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|GEHA [1415]|GEHA [141500]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31410.60|14578.01|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31410.60|10239.69|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|31410.60|20259.61|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31410.60|5607.99|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|||31410.60|9423.18|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31410.60|17919.59|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31410.60|20051.16|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31410.60|8795.77|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31410.60|30847.93|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31410.60|10437.44|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31410.60|10239.69|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31410.60|6350.99|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31410.60|5607.99|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31410.60|10239.69|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|31410.60|477.2|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31410.60|10239.69|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31410.60|10239.69|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|31410.60|9925.5|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31410.60|725|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31410.60|850|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31410.60|10239.69|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31410.60|14578.01|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31410.60|27763.15|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31410.60|10866.3|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31410.60|10612.25|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31410.60|6350.99|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31410.60|11230.82|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31410.60|11230.82|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31410.60|9458.52|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31410.60|4869.85|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31410.60|10239.69|30847.93|477.2|||| MS309|DRG||Cardiac Arrhythmia And Conduction Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31410.60|27763.15|30847.93|477.2|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20677.71|6994.78|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20677.71|4435.6|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|20677.71|8146.62|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20677.71|8146.62|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|20677.71|8146.62|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20677.71|7907.5|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20677.71|8096.8|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20677.71|10696.95|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20677.71|6994.78|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20677.71|1700|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|20677.71|725|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20677.71|6994.78|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|20677.71|7309.9|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|20677.71|149.6|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|20677.71|6994.78|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|20677.71|3841.3|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20677.71|4435.6|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20677.71|6994.78|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20677.71|7605|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20677.71|24130.25|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20677.71|6504.66|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|20677.71|6994.78|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20677.71|15684.67|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20677.71|14017.25|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|||20677.71|6203.31|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20677.71|3682.86|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20677.71|3841.3|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|20677.71|17882.9|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|20677.71|6994.78|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|20677.71|10696.95|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|20677.71|21717.23|24130.25|149.6|||| MS310|DRG||Cardiac Arrhythmia And Conduction Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20677.71|21717.23|24130.25|149.6|||| MS311|DRG||Angina Pectoris|CHAMPVA [1240]|CHAMP VA [124000]|22650.01||||||| MS311|DRG||Angina Pectoris|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22650.01|13155.12|22650.01|240.8|||| MS311|DRG||Angina Pectoris|CORESOURCE [1315]|CORESOURCE [131500]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22650.01|5070.97|22650.01|240.8|||| MS311|DRG||Angina Pectoris|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|||22650.01|6795|22650.01|240.8|||| MS311|DRG||Angina Pectoris|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22650.01|14722.51|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22650.01|22650.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22650.01|9184.14|22650.01|240.8|||| MS311|DRG||Angina Pectoris|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|UMR [2035]|UMR OPTIONS [203501]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22650.01|4572.07|22650.01|240.8|||| MS311|DRG||Angina Pectoris|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22650.01|5070.97|22650.01|240.8|||| MS311|DRG||Angina Pectoris|FIRST HEALTH [1375]|QUALCHOICE [137513]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|FMH BENEFIT SERVICES [1390]|FMH [139000]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MULTIPLAN [1680]|IHC HS [168011]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MULTIPLAN [1680]|HMA [168003]|22650.01|240.8|22650.01|240.8|||| MS311|DRG||Angina Pectoris|HEALTHNET [1495]|HEALTHNET [149500]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|TRUSTMARK [2030]|STARMARK [203000]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22650.01|7966.55|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22650.01|13157.38|22650.01|240.8|||| MS311|DRG||Angina Pectoris|AETNA [1015]|AETNA ACO WILCO [101532]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22650.01|725|22650.01|240.8|||| MS311|DRG||Angina Pectoris|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22650.01|850|22650.01|240.8|||| MS311|DRG||Angina Pectoris|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|GEHA [1415]|GEHA [141500]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22650.01|13155.12|22650.01|240.8|||| MS311|DRG||Angina Pectoris|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22650.01|20385.01|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22650.01|10106.5|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22650.01|9870.22|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22650.01|4572.07|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22650.01|4544.21|22650.01|240.8|||| MS311|DRG||Angina Pectoris|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22650.01|10172.04|22650.01|240.8|||| MS311|DRG||Angina Pectoris|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22650.01|20385.01|22650.01|240.8|||| MS312|DRG||Syncope And Collapse|CHAMPVA [1240]|CHAMP VA [124000]|36056.36||||||| MS312|DRG||Syncope And Collapse|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36056.36|12139.4|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36056.36|21636.91|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36056.36|5455.02|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36056.36|1450|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|AETNA [1015]|AETNA ACO WILCO [101532]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|TRUSTMARK [2030]|STARMARK [203000]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|HEALTHNET [1495]|HEALTHNET [149500]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MULTIPLAN [1680]|IHC HS [168011]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MULTIPLAN [1680]|HMA [168003]|36056.36|65.59|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|FMH BENEFIT SERVICES [1390]|FMH [139000]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|FIRST HEALTH [1375]|QUALCHOICE [137513]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36056.36|3996.26|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36056.36|5994.07|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|UMR [2035]|UMR OPTIONS [203501]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36056.36|850|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36056.36|10768.68|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36056.36|25135.41|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36056.36|11855.59|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36056.36|9497.06|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36056.36|16338.02|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36056.36|5994.07|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36056.36|14601.15|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|||36056.36|10816.91|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36056.36|5415.5|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36056.36|3996.26|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36056.36|10212.65|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|CORESOURCE [1315]|CORESOURCE [131500]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36056.36|21636.91|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|GEHA [1415]|GEHA [141500]|36056.36|22621.87|25135.41|65.59|||| MS312|DRG||Syncope And Collapse|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36056.36|22621.87|25135.41|65.59|||| MS313|DRG||Chest Pain|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|GEHA [1415]|GEHA [141500]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26763.78|13662.4|27982.6|563.36|||| MS313|DRG||Chest Pain|CORESOURCE [1315]|CORESOURCE [131500]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|CHAMPVA [1240]|CHAMP VA [124000]|26763.78|22300.89|27982.6|563.36|||| MS313|DRG||Chest Pain|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26763.78|4356.67|27982.6|563.36|||| MS313|DRG||Chest Pain|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|||26763.78|8029.13|27982.6|563.36|||| MS313|DRG||Chest Pain|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26763.78|16255.09|27982.6|563.36|||| MS313|DRG||Chest Pain|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26763.78|18188.69|27982.6|563.36|||| MS313|DRG||Chest Pain|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26763.78|8318.94|27982.6|563.36|||| MS313|DRG||Chest Pain|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26763.78|9496.45|27982.6|563.36|||| MS313|DRG||Chest Pain|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|UMR [2035]|UMR OPTIONS [203501]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26763.78|4956.44|27982.6|563.36|||| MS313|DRG||Chest Pain|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26763.78|4356.67|27982.6|563.36|||| MS313|DRG||Chest Pain|FIRST HEALTH [1375]|QUALCHOICE [137513]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|FMH BENEFIT SERVICES [1390]|FMH [139000]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|MULTIPLAN [1680]|IHC HS [168011]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26763.78|27982.6|27982.6|563.36|||| MS313|DRG||Chest Pain|MULTIPLAN [1680]|HMA [168003]|26763.78|563.36|27982.6|563.36|||| MS313|DRG||Chest Pain|HEALTHNET [1495]|HEALTHNET [149500]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|TRUSTMARK [2030]|STARMARK [203000]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|AETNA [1015]|AETNA ACO WILCO [101532]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26763.78|725|27982.6|563.36|||| MS313|DRG||Chest Pain|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26763.78|850|27982.6|563.36|||| MS313|DRG||Chest Pain|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26763.78|13662.4|27982.6|563.36|||| MS313|DRG||Chest Pain|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26763.78|25184.34|27982.6|563.36|||| MS313|DRG||Chest Pain|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26763.78|10451.6|27982.6|563.36|||| MS313|DRG||Chest Pain|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26763.78|10207.25|27982.6|563.36|||| MS313|DRG||Chest Pain|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26763.78|4956.44|27982.6|563.36|||| MS313|DRG||Chest Pain|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26763.78|4692.12|27982.6|563.36|||| MS313|DRG||Chest Pain|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26763.78|8945.76|27982.6|563.36|||| MS313|DRG||Chest Pain|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26763.78|25184.34|27982.6|563.36|||| MS314|DRG||Other Circulatory System Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75581.75|57325.97|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75581.75|29503.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75581.75|30209.3|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75581.75|46503.6|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75581.75|4250|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75581.75|5075|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|75581.75|1054.12|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75581.75|9516.94|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75581.75|57325.97|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75581.75|26474.86|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75581.75|110242.25|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75581.75|23603.09|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75581.75|71657.46|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75581.75|64039.72|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|||75581.75|22674.52|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75581.75|13160.11|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75581.75|9516.94|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|75581.75|51270.57|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75581.75|30137.45|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75581.75|46503.6|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|GEHA [1415]|GEHA [141500]|75581.75|99218.03|110242.25|1054.12|||| MS314|DRG||Other Circulatory System Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75581.75|99218.03|110242.25|1054.12|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|CHAMPVA [1240]|CHAMP VA [124000]|32928.58||||||| MS315|DRG||Other Circulatory System Diagnoses With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32928.58|18460.74|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|CORESOURCE [1315]|CORESOURCE [131500]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32928.58|6990.63|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|||32928.58|9878.57|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32928.58|18234.06|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32928.58|28052.41|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32928.58|13057.62|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|UMR [2035]|UMR OPTIONS [203501]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32928.58|7762.5|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32928.58|6990.63|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MULTIPLAN [1680]|IHC HS [168011]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MULTIPLAN [1680]|HMA [168003]|32928.58|375.53|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|HEALTHNET [1495]|HEALTHNET [149500]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32928.58|11285.75|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|TRUSTMARK [2030]|STARMARK [203000]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32928.58|16295.65|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32928.58|1450|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32928.58|850|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32928.58|18460.74|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32928.58|14140.4|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|GEHA [1415]|GEHA [141500]|32928.58|25247.17|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32928.58|13809.81|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32928.58|7762.5|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32928.58|12136.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32928.58|12136.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32928.58|12136.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32928.58|6273.12|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32928.58|14410.14|28052.41|375.53|||| MS315|DRG||Other Circulatory System Diagnoses With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32928.58|25247.17|28052.41|375.53|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22814.98|5014.58|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22814.98|10613.67|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22814.98|10867.75|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22814.98|13024.06|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22814.98|1700|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22814.98|725|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|22814.98|268.63|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22814.98|6736.55|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22814.98|5014.58|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22814.98|10006.15|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22814.98|22814.98|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22814.98|8631.79|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22814.98|14829.74|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22814.98|13253.22|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|||22814.98|6844.49|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22814.98|4870.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22814.98|6736.55|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|22814.98|32653.19|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22814.98|11021.44|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22814.98|13024.06|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|GEHA [1415]|GEHA [141500]|22814.98|20533.48|32653.19|268.63|||| MS316|DRG||Other Circulatory System Diagnoses Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22814.98|20533.48|32653.19|268.63|||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|GEHA [1415]|GEHA [141500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MULTIPLAN [1680]|HMA [168003]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|269650.65||||||| MS319|DRG||Other Endovascular Cardiac Valve Procedures With McC|||269650.65|80895.19|80895.19|80895.19|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|180328.55||||||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|180328.55|76059.37|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|180328.55|76153.61|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|180328.55|77976.65|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|180328.55|72635.42|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|180328.55|5950|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MULTIPLAN [1680]|HMA [168003]|180328.55|2958.09|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|180328.55|21484.33|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|180328.55|76059.37|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|180328.55|4350|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|180328.55|61486.26|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|180328.55|146268.01|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|180328.55|61295.92|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|180328.55|95074.2|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|||180328.55|54098.56|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|180328.55|84967.09|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|180328.55|33632.82|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|180328.55|21484.33|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|180328.55|78265.29|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|180328.55|72635.42|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|GEHA [1415]|GEHA [141500]|180328.55|131641.21|146268.01|2958.09|||| MS326|DRG||Stomach, Esophageal And Duodenal Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|180328.55|131641.21|146268.01|2958.09|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|95134.71||||||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|GEHA [1415]|GEHA [141500]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95134.71|66005.8|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95134.71|18305.93|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95134.71|39631.2|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95134.71|44345.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95134.71|29922.83|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95134.71|68223.82|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95134.71|28611.02|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95134.71|21424.59|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95134.71|18305.93|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|95134.71|1536.2|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|||95134.71|28540.41|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95134.71|1450|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95134.71|5950|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95134.71|66005.8|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95134.71|61401.44|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95134.71|37839.2|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95134.71|36954.55|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95134.71|21424.59|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95134.71|32177.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95134.71|16430.23|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95134.71|32267.48|68223.82|1450|||| MS327|DRG||Stomach, Esophageal And Duodenal Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95134.71|61401.44|68223.82|1450|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84012.47|12071.32|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84012.47|23585.15|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84012.47|43658.36|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84012.47|1700|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84012.47|725|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|84012.47|554.8|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84012.47|10208.71|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84012.47|12071.32|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84012.47|20339.49|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84012.47|92158.16|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84012.47|18317.25|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84012.47|24149.75|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84012.47|59902.81|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|||84012.47|25203.74|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84012.47|53534.68|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84012.47|10563.04|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84012.47|10208.71|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|84012.47|63009.36|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84012.47|19697.44|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84012.47|43658.36|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|84012.47|82942.35|92158.16|554.8|||| MS328|DRG||Stomach, Esophageal And Duodenal Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84012.47|82942.35|92158.16|554.8|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|GEHA [1415]|GEHA [141500]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|198389.71|129506.51|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|198389.71|167562.08|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|198389.71|25125.25|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|198389.71|90515.36|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|||198389.71|59516.91|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|198389.71|101282.46|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|198389.71|57070.74|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|198389.71|29842.99|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|198389.71|66427.82|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|198389.71|81025.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|198389.71|25125.25|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MULTIPLAN [1680]|HMA [168003]|198389.71|1193.78|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|198389.71|155819.16|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|198389.71|6525|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|198389.71|8500|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|198389.71|129506.51|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|198389.71|140237.24|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|198389.71|70329.35|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|198389.71|68685.1|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|198389.71|81025.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|198389.71|72870.4|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|198389.71|72870.4|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|198389.71|72870.4|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|198389.71|30355.26|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|198389.71|61370.96|167562.08|1193.78|||| MS329|DRG||Major Small And Large Bowel Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|198389.71|140237.24|167562.08|1193.78|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127468.59|69479.29|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127468.59|35954.78|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127468.59|36815.5|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127468.59|72146.57|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127468.59|4250|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127468.59|2900|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|127468.59|1059.91|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127468.59|16562.76|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127468.59|69479.29|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127468.59|33379.53|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127468.59|133614.01|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127468.59|29386.68|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127468.59|31600.94|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127468.59|86849.11|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|||127468.59|38240.58|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127468.59|77616.39|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127468.59|15991.48|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127468.59|16562.76|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|127468.59|167878.6|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127468.59|37522.2|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127468.59|72146.57|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|GEHA [1415]|GEHA [141500]|127468.59|120252.62|167878.6|1059.91|||| MS330|DRG||Major Small And Large Bowel Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127468.59|120252.62|167878.6|1059.91|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|91587.54||||||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|91587.54|55211.29|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|91587.54|10759.43|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|91587.54|47576.32|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|||91587.54|27476.26|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|91587.54|53235.7|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|91587.54|12004.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|91587.54|81901.09|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|91587.54|22656.82|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|91587.54|13388.35|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|91587.54|10759.43|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|91587.54|632.09|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|91587.54|19645.4|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|91587.54|1450|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|91587.54|850|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|91587.54|10840.21|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|91587.54|55211.29|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|91587.54|73710.98|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|91587.54|24796.45|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|91587.54|24216.73|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|91587.54|13388.35|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|91587.54|21125.66|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|91587.54|11567.15|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|91587.54|25084.1|81901.09|632.09|||| MS331|DRG||Major Small And Large Bowel Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|91587.54|73710.98|81901.09|632.09|||| MS333|DRG||Rectal Resection With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|TRUSTMARK [2030]|STARMARK [203000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MULTIPLAN [1680]|IHC HS [168011]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MULTIPLAN [1680]|HMA [168003]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|HEALTHNET [1495]|HEALTHNET [149500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|UMR [2035]|UMR OPTIONS [203501]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|CHAMPVA [1240]|CHAMP VA [124000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|CORESOURCE [1315]|CORESOURCE [131500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|GEHA [1415]|GEHA [141500]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137632.64||||||| MS333|DRG||Rectal Resection With Cc|||137632.64|41289.79|41289.79|41289.79|||| MS334|DRG||Rectal Resection Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|GEHA [1415]|GEHA [141500]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|141099.63|81964.78|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|||141099.63|42329.89|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|141099.63|17913.69|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|141099.63|91714.75|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|141099.63|141099.63|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|141099.63|17534.09|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|141099.63|73371.81|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|141099.63|509.43|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|141099.63|1450|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|141099.63||||||| MS334|DRG||Rectal Resection Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|141099.63|126989.66|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|141099.63|23333.4|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|141099.63|22787.88|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|141099.63|73371.81|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|141099.63|22872.98|141099.63|509.43|||| MS334|DRG||Rectal Resection Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|141099.63|126989.66|141099.63|509.43|||| MS335|DRG||Peritoneal Adhesiolysis With McC|CHAMPVA [1240]|CHAMP VA [124000]|160672.06||||||| MS335|DRG||Peritoneal Adhesiolysis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|160672.06|62743.1|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|160672.06|55091.95|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|160672.06|56410.8|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|160672.06|181470.61|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|160672.06|6800|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|TRUSTMARK [2030]|STARMARK [203000]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|HEALTHNET [1495]|HEALTHNET [149500]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MULTIPLAN [1680]|IHC HS [168011]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MULTIPLAN [1680]|HMA [168003]|160672.06|2661.38|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|160672.06|20906.58|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|160672.06|62743.1|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|UMR [2035]|UMR OPTIONS [203501]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|160672.06|5800|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|160672.06|55348.18|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|160672.06|120659.8|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|160672.06|47044.51|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|160672.06|78428.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|||160672.06|48201.62|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|160672.06|70091.29|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|160672.06|24389.88|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|160672.06|20906.58|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|160672.06|60068.48|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|CORESOURCE [1315]|CORESOURCE [131500]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|160672.06|181470.61|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|GEHA [1415]|GEHA [141500]|160672.06|108593.83|181470.61|2661.38|||| MS335|DRG||Peritoneal Adhesiolysis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|160672.06|108593.83|181470.61|2661.38|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|122263.58||||||| MS336|DRG||Peritoneal Adhesiolysis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|122263.58|89207.21|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|122263.58|15411.15|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|122263.58|54203.25|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|122263.58|60650.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|122263.58|93309.11|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|122263.58|31632.74|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|UMR [2035]|UMR OPTIONS [203501]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|122263.58|19007.74|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|122263.58|15411.15|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MULTIPLAN [1680]|IHC HS [168011]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MULTIPLAN [1680]|HMA [168003]|122263.58|333.03|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|122263.58|26355.91|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|TRUSTMARK [2030]|STARMARK [203000]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|||122263.58|36679.07|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|122263.58|3625|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|122263.58|5100|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|GEHA [1415]|GEHA [141500]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|122263.58|89207.21|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|122263.58|83978.19|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|122263.58|33102.05|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|122263.58|32328.15|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|122263.58|19007.74|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|122263.58|14399.92|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|122263.58|33652.37|93309.11|333.03|||| MS336|DRG||Peritoneal Adhesiolysis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|122263.58|83978.19|93309.11|333.03|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|114304.65||||||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114304.65|23672.7|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114304.65|74722.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|114304.65|2175|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|114304.65|513.18|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|114304.65|9046.93|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114304.65|52489.39|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114304.65|4250|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114304.65|21878.06|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114304.65|100941.13|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114304.65|23119.25|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114304.65|19069.71|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114304.65|65611.74|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114304.65|52489.39|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|||114304.65|34291.39|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114304.65|58636.71|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114304.65|10358.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114304.65|9046.93|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|114304.65|24349.04|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|114304.65|74722.57|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|GEHA [1415]|GEHA [141500]|114304.65|90847.03|100941.13|513.18|||| MS337|DRG||Peritoneal Adhesiolysis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114304.65|90847.03|100941.13|513.18|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|GEHA [1415]|GEHA [141500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|CORESOURCE [1315]|CORESOURCE [131500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|CHAMPVA [1240]|CHAMP VA [124000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|UMR [2035]|UMR OPTIONS [203501]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MULTIPLAN [1680]|IHC HS [168011]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MULTIPLAN [1680]|HMA [168003]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|HEALTHNET [1495]|HEALTHNET [149500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|TRUSTMARK [2030]|STARMARK [203000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|107075.22||||||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|||107075.22|32122.57|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|107075.22|19116.81|32122.57|19116.81|||| MS338|DRG||Appendectomy With Complicated Principal Diagnosis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|107075.22|19116.81|32122.57|19116.81|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|76640.59||||||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76640.59|14002.05|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76640.59|24002.9|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76640.59|24577.5|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76640.59|46294.95|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76640.59|2550|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|76640.59|1450|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|TRUSTMARK [2030]|STARMARK [203000]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MULTIPLAN [1680]|IHC HS [168011]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MULTIPLAN [1680]|HMA [168003]|76640.59|463.65|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|76640.59|10791.85|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76640.59|14002.05|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|UMR [2035]|UMR OPTIONS [203501]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76640.59|23052.95|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76640.59|62813.65|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76640.59|19958.24|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76640.59|40828.88|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|||76640.59|22992.18|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76640.59|36488.47|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76640.59|10874.16|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76640.59|10791.85|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|76640.59|21462.08|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|76640.59|46294.95|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|GEHA [1415]|GEHA [141500]|76640.59|56532.28|62813.65|463.65|||| MS339|DRG||Appendectomy With Complicated Principal Diagnosis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76640.59|56532.28|62813.65|463.65|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65158.04|42083.39|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65158.04|9513.17|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65158.04|35630.57|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|||65158.04|19547.41|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65158.04|39868.93|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65158.04|14392.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65158.04|61336.81|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65158.04|16221.3|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65158.04|9800.63|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65158.04|9513.17|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|GEHA [1415]|GEHA [141500]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|65158.04|352.44|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65158.04|1450|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65158.04||||||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65158.04|3400|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65158.04|42083.39|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65158.04|55203.13|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65158.04|17811.8|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65158.04|17395.37|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65158.04|9800.63|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65158.04|15476.56|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65158.04|15476.56|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65158.04|15476.56|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65158.04|15504.2|61336.81|352.44|||| MS340|DRG||Appendectomy With Complicated Principal Diagnosis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65158.04|55203.13|61336.81|352.44|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|UMR [2035]|UMR OPTIONS [203501]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85066.44|33637.76|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85066.44|99819.32|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85066.44|29750.7|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85066.44|64882.56|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|||85066.44|25519.93|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85066.44|57985.05|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85066.44|18461.07|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85066.44|7631.36|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|CORESOURCE [1315]|CORESOURCE [131500]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85066.44|42273.66|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|GEHA [1415]|GEHA [141500]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85066.44|33584.9|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85066.44|5075|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MULTIPLAN [1680]|HMA [168003]|85066.44|2301.86|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85066.44|32799.71|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|CHAMPVA [1240]|CHAMP VA [124000]|85066.44||||||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85066.44|14606.87|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|HEALTHNET [1495]|HEALTHNET [149500]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85066.44|18461.07|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85066.44|7631.36|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|85066.44|37986.99|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|TRUSTMARK [2030]|STARMARK [203000]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85066.44|1700|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|MULTIPLAN [1680]|IHC HS [168011]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85066.44|89837.39|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85066.44|42273.66|99819.32|1700|||| MS341|DRG||Appendectomy Without Complicated Principal Diagnosis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85066.44|37986.99|99819.32|1700|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64903.91|40736.23|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|UMR [2035]|UMR OPTIONS [203501]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|TRUSTMARK [2030]|STARMARK [203000]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64903.91|20294.13|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64903.91|62671.11|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64903.91|18727.79|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MULTIPLAN [1680]|HMA [168003]|64903.91|743.45|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64903.91|6130.37|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64903.91|10587.94|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64903.91|20779.95|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64903.91|10587.94|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MULTIPLAN [1680]|IHC HS [168011]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64903.91|35191.52|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64903.91|6130.37|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|64903.91|41571.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|||64903.91|19471.17|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64903.91|35191.52|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64903.91|9118.78|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64903.91|20138.91|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64903.91|725|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64903.91|36405.65|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64903.91|1700|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64903.91|20120.46|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|GEHA [1415]|GEHA [141500]|64903.91|56404|62671.11|725|||| MS342|DRG||Appendectomy Without Complicated Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64903.91|20138.91|62671.11|725|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58923.06|14273.06|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58923.06|34042.79|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|GEHA [1415]|GEHA [141500]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58923.06|38092.32|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58923.06|4746.75|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58923.06|14839.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58923.06|13393.11|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58923.06|32561.21|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58923.06|58603.55|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58923.06|15723.86|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58923.06|16086.3|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58923.06|7593.73|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58923.06|32561.21|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58923.06|14402.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58923.06|725|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58923.06|15710.21|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|||58923.06|17676.92|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|58923.06|45249.38|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58923.06|4746.75|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58923.06|7593.73|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|58923.06|357|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58923.06|850|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58923.06|8079.67|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58923.06|14918.27|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58923.06|52743.2|58603.55|357|||| MS343|DRG||Appendectomy Without Complicated Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58923.06|8079.67|58603.55|357|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138703.76||||||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138703.76||||||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138703.76||||||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|138703.76||||||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|GEHA [1415]|GEHA [141500]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138703.76||||||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138703.76|72125.96|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138703.76|90157.44|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138703.76|37217.86|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138703.76|5075|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138703.76|138703.76|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138703.76|40613.05|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|||138703.76|41611.13|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138703.76|44476.31|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138703.76|80573.02|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138703.76||||||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138703.76|72125.96|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138703.76|34833.01|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MULTIPLAN [1680]|HMA [168003]|138703.76|6424.07|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138703.76|39663.54|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138703.76|41700.67|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138703.76|124833.38|138703.76|5075|||| MS344|DRG||Minor Small And Large Bowel Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138703.76|124833.38|138703.76|5075|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|||68014.82|20404.45|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68014.82|24781.43|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|68014.82|57402.75|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|GEHA [1415]|GEHA [141500]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68014.82|27729.26|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68014.82|9666.32|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68014.82|41113.17|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68014.82|22876.65|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68014.82|22341.81|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68014.82|13813.9|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68014.82|3400|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68014.82|1450|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|68014.82|293.9|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68014.82|9666.32|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68014.82|13813.9|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68014.82|18995.28|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68014.82|41113.17|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68014.82|42660.38|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68014.82|38394.35|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68014.82|17229.95|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68014.82|21108.78|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68014.82|9934.57|57402.75|293.9|||| MS345|DRG||Minor Small And Large Bowel Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68014.82|38394.35|57402.75|293.9|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|61792.14||||||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61792.14|32710.12|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|||61792.14|18537.64|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61792.14|9682.73|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61792.14|14881.46|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61792.14|8423.91|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61792.14|14917.8|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61792.14|56309.36|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61792.14|8423.91|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61792.14|36601.09|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61792.14|34670.58|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|61792.14|581.09|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61792.14|18487.5|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61792.14|9682.73|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61792.14|1700|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61792.14|34670.58|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61792.14|18055.28|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61792.14|50678.42|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61792.14|1450|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61792.14|9161.57|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61792.14|16041.84|56309.36|581.09|||| MS346|DRG||Minor Small And Large Bowel Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|61792.14|50678.42|56309.36|581.09|||| MS347|DRG||Anal And Stomal Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66430.46|42160.44|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66430.46|34858.72|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66430.46|725|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|MULTIPLAN [1680]|HMA [168003]|66430.46|741.8|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|||66430.46|19929.14|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66430.46|35693.2|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|GEHA [1415]|GEHA [141500]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66430.46|47175.57|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66430.46|32971.64|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66430.46|30661.33|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66430.46|72577.79|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66430.46||||||| MS347|DRG||Anal And Stomal Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66430.46|21177.5|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66430.46|35552.19|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|66430.46|65320.02|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66430.46|21177.5|72577.79|725|||| MS347|DRG||Anal And Stomal Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66430.46|65320.02|72577.79|725|||| MS348|DRG||Anal And Stomal Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58985.51|38340.58|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|58985.51|27783.75|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58985.51|16391.31|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58985.51|21798.18|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|||58985.51|17695.65|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58985.51|34264.69|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|GEHA [1415]|GEHA [141500]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58985.51|2900|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58985.51|16390.16|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58985.51|19094.3|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|58985.51|166.6|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58985.51|11163.69|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58985.51|11163.69|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58985.51|21798.18|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58985.51|16391.31|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58985.51|19009.73|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58985.51|19464.8|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58985.51|53086.96|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58985.51|58985.51|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58985.51|20927.67|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58985.51|8555.12|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58985.51|850|58985.51|166.6|||| MS348|DRG||Anal And Stomal Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58985.51|20927.67|58985.51|166.6|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55120.62|13867.87|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55120.62|55120.62|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55120.62|14199.85|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55120.62|1450|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|55120.62|553.99|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55120.62|7330.49|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55120.62|32019.58|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55120.62|35828.4|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55120.62|13720.1|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55120.62|11407.87|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55120.62|7330.49|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|||55120.62|16536.19|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55120.62|14566.06|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55120.62|49608.56|55120.62|553.99|||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55120.62||||||| MS349|DRG||Anal And Stomal Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55120.62|49608.56|55120.62|553.99|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|114602.72|74712.77|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|114602.72|70865.71|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|114602.72|66770.22|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|GEHA [1415]|GEHA [141500]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|114602.72|1450|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|114602.72|114942.72|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|114602.72|59770.21|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|114602.72|8560.12|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|||114602.72|34380.82|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|114602.72|33268.66|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|114602.72|28369.06|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|114602.72|35559.8|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MULTIPLAN [1680]|HMA [168003]|114602.72|941.44|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|114602.72|70865.71|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|114602.72|34728.44|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|114602.72|59770.21|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|114602.72||||||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|114602.72|103448.45|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|114602.72|3400|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|114602.72|26579.68|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|114602.72|8560.12|114942.72|941.44|||| MS350|DRG||Inguinal And Femoral Hernia Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|114602.72|103448.45|114942.72|941.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64617.57|21105.55|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64617.57|11324.38|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64617.57|21610.8|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64617.57|51193.09|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64617.57|1450|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64617.57|5824.93|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64617.57|11324.38|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|64617.57|216.44|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64617.57|20133.98|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64617.57|16960.03|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64617.57|37619.61|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64617.57|37619.61|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64617.57|9406.46|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|GEHA [1415]|GEHA [141500]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|64617.57||||||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64617.57|16296.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64617.57|5824.93|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64617.57|1700|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|||64617.57|19385.27|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64617.57|33275.5|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|64617.57|46073.78|51193.09|216.44|||| MS351|DRG||Inguinal And Femoral Hernia Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64617.57|29738.06|51193.09|216.44|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|134933.14|7067.33|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|||134933.14|40479.94|40479.94|7067.33|||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|134933.14||||||| MS352|DRG||Inguinal And Femoral Hernia Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|134933.14||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111584.36|130123.84|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111584.36|289164.09|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|CHAMPVA [1240]|CHAMP VA [124000]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111584.36|130123.84|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111584.36|167975.41|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|AETNA [1015]|AETNA ACO WILCO [101532]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|TRUSTMARK [2030]|STARMARK [203000]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|HEALTHNET [1495]|HEALTHNET [149500]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MULTIPLAN [1680]|IHC HS [168011]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MULTIPLAN [1680]|HMA [168003]|111584.36|8803.34|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111584.36|150365.33|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|UMR [2035]|UMR OPTIONS [203501]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111584.36|7250|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111584.36|187956.66|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111584.36|144582.05|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111584.36|34505.05|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|||111584.36|33475.31|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111584.36|150365.33|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|CORESOURCE [1315]|CORESOURCE [131500]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|GEHA [1415]|GEHA [141500]|111584.36|260247.68|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111584.36||||||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111584.36|44057.55|289164.09|7250|||| MS353|DRG||Hernia Procedures Except Inguinal And Femoral With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111584.36|260247.68|289164.09|7250|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|CHAMPVA [1240]|CHAMP VA [124000]|104500.56||||||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104500.56|29769.67|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|GEHA [1415]|GEHA [141500]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|CORESOURCE [1315]|CORESOURCE [131500]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104500.56|5587.42|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104500.56|23305.78|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|||104500.56|31350.17|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|UMR [2035]|UMR OPTIONS [203501]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104500.56|60704.37|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|HEALTHNET [1495]|HEALTHNET [149500]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MULTIPLAN [1680]|IHC HS [168011]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MULTIPLAN [1680]|HMA [168003]|104500.56|389.06|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104500.56|54340.29|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|TRUSTMARK [2030]|STARMARK [203000]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104500.56|5587.42|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104500.56|67925.37|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104500.56|20028.02|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104500.56|25853.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104500.56|2175|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104500.56|850|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104500.56|54340.29|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104500.56|94050.5|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104500.56|25249.06|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104500.56|104500.56|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104500.56|29769.67|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104500.56|11293.26|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104500.56|25572.65|104500.56|389.06|||| MS354|DRG||Hernia Procedures Except Inguinal And Femoral With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104500.56|94050.5|104500.56|389.06|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82961.40||||||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82961.40||||||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82961.40||||||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82961.40||||||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82961.40|10110.71|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82961.40|19247.63|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82961.40|17854.51|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|82961.40|6028.05|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82961.40|10110.71|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82961.40|1450|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82961.40|46612.45|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82961.40|80241.8|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82961.40|52157.17|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|||82961.40|24888.42|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82961.40|19708.4|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|GEHA [1415]|GEHA [141500]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|82961.40||||||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82961.40||||||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82961.40|8659.52|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82961.40|15961.01|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82961.40|20075.61|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82961.40|72217.62|80241.8|1450|||| MS355|DRG||Hernia Procedures Except Inguinal And Femoral Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82961.40|20075.61|80241.8|1450|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156105.08|55370.05|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|156105.08|483.47|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|156105.08|26066.57|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156105.08|55370.05|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156105.08|62225.3|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156105.08|2175|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156105.08|2550|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156105.08|32018.87|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156105.08|60770.52|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156105.08|106480.86|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156105.08|51458.47|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|156105.08||||||| MS356|DRG||Other Digestive System O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|156105.08|32018.87|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156105.08|26066.57|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|156105.08|32290.45|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156105.08|61854.73|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|||156105.08|46831.52|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156105.08|69212.56|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|156105.08|51923.14|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156105.08|95832.78|106480.86|483.47|||| MS356|DRG||Other Digestive System O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156105.08|47417.84|106480.86|483.47|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|123587.96||||||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123587.96|57342.43|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123587.96|31914.65|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123587.96|71776.68|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123587.96|8500|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123587.96|4350|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|123587.96|4562.78|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123587.96|16915.9|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123587.96|57342.43|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123587.96|28392|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123587.96|110273.91|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123587.96|32678.65|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123587.96|26172.15|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123587.96|71678.04|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|||123587.96|37076.39|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123587.96|71776.68|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123587.96|28144.2|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123587.96|16915.9|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123587.96|14218.46|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123587.96|99246.51|110273.91|4350|||| MS357|DRG||Other Digestive System O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123587.96|64058.14|110273.91|4350|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82902.54|48121.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82902.54|40680.96|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|||82902.54|24870.76|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82902.54|45520.09|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82902.54|15952.87|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82902.54|19042.92|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82902.54|11092.63|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82902.54|8246.27|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82902.54|70030.91|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|82902.54|474.86|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82902.54|8246.27|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82902.54|18961.58|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82902.54||||||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82902.54|11092.63|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82902.54|19415.5|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82902.54|63027.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82902.54|17468.6|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82902.54|48121.82|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82902.54|2550|70030.91|474.86|||| MS358|DRG||Other Digestive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82902.54|725|70030.91|474.86|||| MS368|DRG||Major Esophageal Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MULTIPLAN [1680]|HMA [168003]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|GEHA [1415]|GEHA [141500]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111332.93||||||| MS368|DRG||Major Esophageal Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111332.93|9291.61|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111332.93|38749.54|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111332.93|9291.61|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|||111332.93|33399.88|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111332.93|2550|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111332.93|12283.24|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111332.93|38749.54|38749.54|2550|||| MS368|DRG||Major Esophageal Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111332.93|12283.24|38749.54|2550|||| MS369|DRG||Major Esophageal Disorders With Cc|GEHA [1415]|GEHA [141500]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35933.12||||||| MS369|DRG||Major Esophageal Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|35933.12||||||| MS369|DRG||Major Esophageal Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35933.12||||||| MS369|DRG||Major Esophageal Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35933.12||||||| MS369|DRG||Major Esophageal Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35933.12||||||| MS369|DRG||Major Esophageal Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35933.12|19355.84|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|||35933.12|10779.94|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35933.12|21658.28|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35933.12|33320.42|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35933.12|8642.67|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|35933.12|274.36|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35933.12|14707.06|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35933.12|1450|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35933.12|15248.56|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35933.12||||||| MS369|DRG||Major Esophageal Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35933.12|7866.68|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35933.12|12363.85|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35933.12|8642.67|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35933.12|15613.6|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35933.12|29988.38|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35933.12|13295.46|33320.42|274.36|||| MS369|DRG||Major Esophageal Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35933.12|7866.68|33320.42|274.36|||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|||20247.46|6074.24|6074.24|6074.24|||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20247.46||||||| MS370|DRG||Major Esophageal Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20247.46||||||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|||77325.51|23197.65|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|CHAMPVA [1240]|CHAMP VA [124000]|77325.51|26300.31|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|GEHA [1415]|GEHA [141500]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77325.51|57592.78|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|CORESOURCE [1315]|CORESOURCE [131500]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77325.51|8884.48|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77325.51|42686.28|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77325.51|47763.94|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77325.51|20067.57|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77325.51|11147.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77325.51|73482.98|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77325.51|23313.89|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77325.51|13680|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77325.51|8884.48|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MULTIPLAN [1680]|IHC HS [168011]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MULTIPLAN [1680]|HMA [168003]|77325.51|568.89|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|HEALTHNET [1495]|HEALTHNET [149500]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|UMR [2035]|UMR OPTIONS [203501]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|TRUSTMARK [2030]|STARMARK [203000]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|AETNA [1015]|AETNA ACO WILCO [101532]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77325.51|8700|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77325.51|7650|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77325.51|9560.76|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77325.51|21974.24|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77325.51|8052|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77325.51|6631.08|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77325.51|10953.32|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77325.51|13680|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77325.51|25060.35|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77325.51|11484|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77325.51|66134.68|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77325.51|57592.78|73482.98|568.89|||| MS371|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77325.51|10953.32|73482.98|568.89|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54686.32|9159.47|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54686.32|6606.82|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54686.32|14900.2|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54686.32|4350|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|TRUSTMARK [2030]|STARMARK [203000]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MULTIPLAN [1680]|IHC HS [168011]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54686.32|6709.49|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54686.32|9159.47|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|UMR [2035]|UMR OPTIONS [203501]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|HEALTHNET [1495]|HEALTHNET [149500]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54686.32|14317.68|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MULTIPLAN [1680]|HMA [168003]|54686.32|372.8|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54686.32|54686.32|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54686.32|2550|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54686.32|31509.29|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54686.32|11891.68|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54686.32|35546.11|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54686.32|14551.84|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54686.32|6709.49|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|CORESOURCE [1315]|CORESOURCE [131500]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54686.32|11349.88|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|CHAMPVA [1240]|CHAMP VA [124000]|54686.32|49473.24|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54686.32|31509.29|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54686.32|6598.77|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54686.32|49217.69|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54686.32|31767.29|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|||54686.32|16405.9|54686.32|372.8|||| MS372|DRG||Major Gastrointestinal Disorders And Peritoneal Infections With Cc|GEHA [1415]|GEHA [141500]|54686.32|49217.69|54686.32|372.8|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|GEHA [1415]|GEHA [141500]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|40684.52|11149.72|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40684.52|4873.61|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|40684.52||||||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40684.52|23633.65|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|||40684.52|12205.36|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40684.52|8627.13|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40684.52|6470.5|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|40684.52|4873.61|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|40684.52|283.5|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40684.52|10304.94|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40684.52|26444.94|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40684.52|40684.52|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|40684.52|1450|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40684.52|1700|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40684.52|11149.72|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40684.52|10780.75|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40684.52|10528.7|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40684.52|6470.5|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40684.52|9277.18|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40684.52|36616.06|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40684.52|4833.2|40684.52|283.5|||| MS373|DRG||Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40684.52|4833.2|40684.52|283.5|||| MS374|DRG||Digestive Malignancy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|TRUSTMARK [2030]|STARMARK [203000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|MULTIPLAN [1680]|IHC HS [168011]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|UMR [2035]|UMR OPTIONS [203501]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|HEALTHNET [1495]|HEALTHNET [149500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|CHAMPVA [1240]|CHAMP VA [124000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|CORESOURCE [1315]|CORESOURCE [131500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|GEHA [1415]|GEHA [141500]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|||79359.82|23807.95|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79359.82|13063.8|23807.95|13063.8|||| MS374|DRG||Digestive Malignancy With McC|MULTIPLAN [1680]|HMA [168003]|79359.82||||||| MS374|DRG||Digestive Malignancy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79359.82|13063.8|23807.95|13063.8|||| MS375|DRG||Digestive Malignancy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|56611.76|72596.63|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56611.76||||||| MS375|DRG||Digestive Malignancy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56611.76||||||| MS375|DRG||Digestive Malignancy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56611.76||||||| MS375|DRG||Digestive Malignancy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56611.76||||||| MS375|DRG||Digestive Malignancy With Cc|GEHA [1415]|GEHA [141500]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56611.76|58332.2|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56611.76|65271.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56611.76|16693.14|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56611.76|52216.81|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|UMR [2035]|UMR OPTIONS [203501]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MULTIPLAN [1680]|IHC HS [168011]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MULTIPLAN [1680]|HMA [168003]|56611.76|641.49|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56611.76|100416.94|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|TRUSTMARK [2030]|STARMARK [203000]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|||56611.76|16983.53|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56611.76|2175|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56611.76|7800.6|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56611.76||||||| MS375|DRG||Digestive Malignancy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56611.76|52216.81|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56611.76|17062.59|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56611.76|17471.05|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56611.76|90375.25|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56611.76|13245.03|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56611.76|14040.9|100416.94|641.49|||| MS375|DRG||Digestive Malignancy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56611.76|7800.6|100416.94|641.49|||| MS376|DRG||Digestive Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31478.06|12676.93|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31478.06|725|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31478.06|176.75|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31478.06|12980.4|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31478.06|7284.46|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31478.06|7284.46|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31478.06|12710.15|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31478.06||||||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31478.06|14868.99|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31478.06|18285.61|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|||31478.06|9443.42|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31478.06|20460.74|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31478.06|28330.25|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31478.06|11645.12|31478.06|176.75|||| MS376|DRG||Digestive Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31478.06|31478.06|31478.06|176.75|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|73637.32|11240.46|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|GEHA [1415]|GEHA [141500]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|73637.32|37056.84|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|CORESOURCE [1315]|CORESOURCE [131500]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|CHAMPVA [1240]|CHAMP VA [124000]|73637.32|46346.99|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|73637.32|43157.45|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|||73637.32|22091.2|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|73637.32|20583.94|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|73637.32|23173.28|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|73637.32|14353.31|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MULTIPLAN [1680]|IHC HS [168011]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MULTIPLAN [1680]|HMA [168003]|73637.32|1326.43|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|HEALTHNET [1495]|HEALTHNET [149500]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|UMR [2035]|UMR OPTIONS [203501]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|TRUSTMARK [2030]|STARMARK [203000]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|AETNA [1015]|AETNA ACO WILCO [101532]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|73637.32|48291.18|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|73637.32|74294.12|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|73637.32|2175|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|73637.32|2550|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|73637.32|11240.46|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|73637.32|37056.84|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|73637.32|25474.22|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|73637.32|66864.71|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|73637.32|14353.31|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|73637.32|23525.92|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|73637.32|26084.05|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|73637.32|11392.08|74294.12|1326.43|||| MS377|DRG||Gastrointestinal Hemorrhage With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|73637.32|66864.71|74294.12|1326.43|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46946.06|12357.48|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46946.06|14064.71|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46946.06|14401.4|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46946.06|26655.54|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46946.06|2550|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46946.06|1450|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|HEALTHNET [1495]|HEALTHNET [149500]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MULTIPLAN [1680]|HMA [168003]|46946.06|164.68|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46946.06|6654.69|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46946.06|8091.96|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|UMR [2035]|UMR OPTIONS [203501]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46946.06|11005.82|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|TRUSTMARK [2030]|STARMARK [203000]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46946.06|13118.46|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46946.06|43772.86|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46946.06|6384.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46946.06|11491.6|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46946.06|28452.36|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46946.06|25427.68|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46946.06|8091.96|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|CHAMPVA [1240]|CHAMP VA [124000]|46946.06|33337.5|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|GEHA [1415]|GEHA [141500]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46946.06|26655.54|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|CORESOURCE [1315]|CORESOURCE [131500]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46946.06|6654.69|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46946.06|14672.98|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|MULTIPLAN [1680]|IHC HS [168011]|46946.06|39395.58|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46946.06|6398.73|43772.86|164.68|||| MS378|DRG||Gastrointestinal Hemorrhage With Cc|||46946.06|14083.82|43772.86|164.68|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29374.33|17085.55|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29374.33|4871.08|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|||29374.33|8812.3|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29374.33|14651.26|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29374.33|7509.49|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29374.33|22540.41|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29374.33|8714.99|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29374.33|4871.08|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29374.33|5471.62|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|29374.33|209.3|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29374.33|13093.73|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29374.33|725|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29374.33|850|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29374.33|9021.97|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29374.33|5471.62|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|29374.33|10193.23|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|GEHA [1415]|GEHA [141500]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29374.33|4171.98|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29374.33|8137.24|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29374.33|9237.95|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29374.33|20286.37|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29374.33|17085.55|22540.41|209.3|||| MS379|DRG||Gastrointestinal Hemorrhage Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29374.33|4171.98|22540.41|209.3|||| MS380|DRG||Complicated Peptic Ulcer With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67248.64|15556.49|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67248.64|26666.58|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67248.64|27304.95|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67248.64|46125.6|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67248.64|3400|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67248.64|2900|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|AETNA [1015]|AETNA ACO WILCO [101532]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|HEALTHNET [1495]|HEALTHNET [149500]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MULTIPLAN [1680]|HMA [168003]|67248.64|926.39|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67248.64|10130.52|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|UMR [2035]|UMR OPTIONS [203501]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67248.64|15556.49|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|TRUSTMARK [2030]|STARMARK [203000]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67248.64|25644.74|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67248.64|85373.29|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67248.64|21952.79|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MULTIPLAN [1680]|IHC HS [168011]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|CORESOURCE [1315]|CORESOURCE [131500]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|GEHA [1415]|GEHA [141500]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|CHAMPVA [1240]|CHAMP VA [124000]|67248.64||||||| MS380|DRG||Complicated Peptic Ulcer With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67248.64|28030.27|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67248.64|10130.52|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67248.64|46125.6|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67248.64|11915.34|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67248.64|76835.96|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|||67248.64|20174.59|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67248.64|55492.64|85373.29|926.39|||| MS380|DRG||Complicated Peptic Ulcer With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67248.64|49593.36|85373.29|926.39|||| MS381|DRG||Complicated Peptic Ulcer With Cc|CHAMPVA [1240]|CHAMP VA [124000]|42762.09||||||| MS381|DRG||Complicated Peptic Ulcer With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|GEHA [1415]|GEHA [141500]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|CORESOURCE [1315]|CORESOURCE [131500]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42762.09|27304.33|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|||42762.09|12828.63|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42762.09|30552.27|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42762.09|12522.02|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42762.09|47003.48|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42762.09|14575.91|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42762.09|8781.56|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42762.09|6927.01|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|UMR [2035]|UMR OPTIONS [203501]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MULTIPLAN [1680]|IHC HS [168011]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MULTIPLAN [1680]|HMA [168003]|42762.09|871.5|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|HEALTHNET [1495]|HEALTHNET [149500]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|TRUSTMARK [2030]|STARMARK [203000]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42762.09|2900|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42762.09|1700|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42762.09|6927.01|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42762.09|22275.91|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42762.09|22275.91|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42762.09|42303.13|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42762.09|15365.65|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42762.09|15006.41|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42762.09|8781.56|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42762.09|6798.25|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42762.09|13711.77|47003.48|871.5|||| MS381|DRG||Complicated Peptic Ulcer With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42762.09|42303.13|47003.48|871.5|||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|GEHA [1415]|GEHA [141500]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33562.52||||||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33562.52|19496.47|19496.47|2550|||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33562.52|2550|19496.47|2550|||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33562.52|4353.43|19496.47|2550|||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|||33562.52|10068.76|19496.47|2550|||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33562.52|4353.43|19496.47|2550|||| MS382|DRG||Complicated Peptic Ulcer Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33562.52|19496.47|19496.47|2550|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|CORESOURCE [1315]|CORESOURCE [131500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|CHAMPVA [1240]|CHAMP VA [124000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|UMR [2035]|UMR OPTIONS [203501]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MULTIPLAN [1680]|IHC HS [168011]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|HEALTHNET [1495]|HEALTHNET [149500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|TRUSTMARK [2030]|STARMARK [203000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MULTIPLAN [1680]|HMA [168003]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|AETNA [1015]|AETNA ACO WILCO [101532]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59977.25|43931.45|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59977.25|5678.03|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|||59977.25|17993.17|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|GEHA [1415]|GEHA [141500]|59977.25||||||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59977.25|5678.03|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59977.25|4250|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59977.25|43931.45|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59977.25|9425.4|43931.45|4250|||| MS383|DRG||Uncomplicated Peptic Ulcer With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59977.25|9425.4|43931.45|4250|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|TRUSTMARK [2030]|STARMARK [203000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|HEALTHNET [1495]|HEALTHNET [149500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MULTIPLAN [1680]|IHC HS [168011]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MULTIPLAN [1680]|HMA [168003]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|UMR [2035]|UMR OPTIONS [203501]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|CHAMPVA [1240]|CHAMP VA [124000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|CORESOURCE [1315]|CORESOURCE [131500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|GEHA [1415]|GEHA [141500]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33476.44|13093.53|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33476.44|850|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33476.44||||||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33476.44|4384.8|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|||33476.44|10042.93|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33476.44|5788.95|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33476.44|4384.8|13093.53|850|||| MS384|DRG||Uncomplicated Peptic Ulcer Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33476.44|13093.53|13093.53|850|||| MS385|DRG||Inflammatory Bowel Disease With McC|CHAMPVA [1240]|CHAMP VA [124000]|55663.55||||||| MS385|DRG||Inflammatory Bowel Disease With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|GEHA [1415]|GEHA [141500]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|CORESOURCE [1315]|CORESOURCE [131500]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55663.55|25883.57|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|||55663.55|16699.06|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55663.55|44557.71|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55663.55|44557.71|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55663.55|44557.71|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|UMR [2035]|UMR OPTIONS [203501]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55663.55|44557.71|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55663.55|8639.42|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MULTIPLAN [1680]|IHC HS [168011]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MULTIPLAN [1680]|HMA [168003]|55663.55|728.55|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|HEALTHNET [1495]|HEALTHNET [149500]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|TRUSTMARK [2030]|STARMARK [203000]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|AETNA [1015]|AETNA ACO WILCO [101532]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55663.55|28962.51|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55663.55|2900|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55663.55|1700|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55663.55|8639.42|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55663.55|18103.55|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55663.55|18103.55|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55663.55|40101.93|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55663.55|44557.71|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55663.55|44557.71|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55663.55|44557.71|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55663.55|10274.7|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55663.55|28854.46|44557.71|728.55|||| MS385|DRG||Inflammatory Bowel Disease With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55663.55|40101.93|44557.71|728.55|||| MS386|DRG||Inflammatory Bowel Disease With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52395.05|8107.3|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52395.05|14068.95|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52395.05|14405.75|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52395.05|30436.3|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52395.05|4250|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|TRUSTMARK [2030]|STARMARK [203000]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|HEALTHNET [1495]|HEALTHNET [149500]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MULTIPLAN [1680]|IHC HS [168011]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MULTIPLAN [1680]|HMA [168003]|52395.05|398.46|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52395.05|5719.05|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52395.05|8107.3|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|UMR [2035]|UMR OPTIONS [203501]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52395.05|2900|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52395.05|13004.89|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52395.05|49636.35|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52395.05|11457.88|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52395.05|32263.63|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|||52395.05|15718.51|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52395.05|28833.78|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52395.05|6386.85|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52395.05|5719.05|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|CHAMPVA [1240]|CHAMP VA [124000]|52395.05|49209.09|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52395.05|14629.91|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|CORESOURCE [1315]|CORESOURCE [131500]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52395.05|30436.3|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|GEHA [1415]|GEHA [141500]|52395.05|44672.72|49636.35|398.46|||| MS386|DRG||Inflammatory Bowel Disease With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52395.05|44672.72|49636.35|398.46|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|37613.39||||||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|GEHA [1415]|GEHA [141500]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37613.39|26029.18|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37613.39|4114.23|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|||37613.39|11284.02|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37613.39|22609.67|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37613.39|8149.14|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37613.39|34784.11|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37613.39|6015.07|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37613.39|4114.23|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37613.39|9934.5|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|37613.39|181.19|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37613.39|20206.09|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37613.39|725|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37613.39|3400|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37613.39|26029.18|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37613.39|31305.69|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37613.39|10345.75|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37613.39|10103.87|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37613.39|6015.07|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37613.39|4608|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37613.39|25953.3|34784.11|181.19|||| MS387|DRG||Inflammatory Bowel Disease Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37613.39|31305.69|34784.11|181.19|||| MS388|DRG||Gastrointestinal Obstruction With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55439.11|13000.75|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55439.11|21408.6|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55439.11|21921.1|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55439.11|25101.51|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55439.11|1700|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55439.11|2175|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|AETNA [1015]|AETNA ACO WILCO [101532]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|HEALTHNET [1495]|HEALTHNET [149500]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MULTIPLAN [1680]|HMA [168003]|55439.11|239.75|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MULTIPLAN [1680]|IHC HS [168011]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|TRUSTMARK [2030]|STARMARK [203000]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55439.11|7067.73|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55439.11|13000.75|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|UMR [2035]|UMR OPTIONS [203501]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55439.11|20603.13|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55439.11|44800.79|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55439.11|17736.91|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55439.11|29120.51|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|||55439.11|16631.73|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55439.11|26024.79|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|CHAMPVA [1240]|CHAMP VA [124000]|55439.11||||||| MS388|DRG||Gastrointestinal Obstruction With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55439.11|9607.85|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55439.11|7067.73|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55439.11|19073.37|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|CORESOURCE [1315]|CORESOURCE [131500]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55439.11|25101.51|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|GEHA [1415]|GEHA [141500]|55439.11|40320.71|44800.79|239.75|||| MS388|DRG||Gastrointestinal Obstruction With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55439.11|40320.71|44800.79|239.75|||| MS389|DRG||Gastrointestinal Obstruction With Cc|CHAMPVA [1240]|CHAMP VA [124000]|34181.69||||||| MS389|DRG||Gastrointestinal Obstruction With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|GEHA [1415]|GEHA [141500]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|CORESOURCE [1315]|CORESOURCE [131500]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34181.69|4700.9|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34181.69|18940.2|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|||34181.69|10254.51|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34181.69|9765.71|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34181.69|32604.92|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34181.69|11540.67|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34181.69|9222.42|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34181.69|7038.98|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34181.69|4700.9|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|UMR [2035]|UMR OPTIONS [203501]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MULTIPLAN [1680]|IHC HS [168011]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MULTIPLAN [1680]|HMA [168003]|34181.69|462.35|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|HEALTHNET [1495]|HEALTHNET [149500]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34181.69|21193.2|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|TRUSTMARK [2030]|STARMARK [203000]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34181.69|1450|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34181.69|2550|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34181.69|21639.51|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34181.69|21639.51|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34181.69|29344.43|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34181.69|11916.1|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34181.69|11637.51|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34181.69|7038.98|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34181.69|12469.28|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34181.69|12469.28|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34181.69|5361.87|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34181.69|5319.81|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34181.69|10501.55|32604.92|462.35|||| MS389|DRG||Gastrointestinal Obstruction With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34181.69|29344.43|32604.92|462.35|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31916.81|4872.46|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31916.81|8250.2|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31916.81|8447.7|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31916.81|17700.18|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31916.81|1700|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31916.81|133|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31916.81|3344.9|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31916.81|4872.46|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31916.81|1450|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31916.81|8066.03|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31916.81|27663.66|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31916.81|6740.75|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31916.81|17981.38|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|||31916.81|9575.04|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31916.81|16069.82|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31916.81|4638.01|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31916.81|3344.9|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31916.81|23829.68|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31916.81|8606.88|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31916.81|17700.18|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|GEHA [1415]|GEHA [141500]|31916.81|24897.29|27663.66|133|||| MS390|DRG||Gastrointestinal Obstruction Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31916.81|24897.29|27663.66|133|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52487.59|27553.05|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52487.59|4472.63|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52487.59|32024.57|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|||52487.59|15746.28|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52487.59|35833.99|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52487.59|14363.05|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52487.59|55129.22|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52487.59|9670.62|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52487.59|4472.63|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MULTIPLAN [1680]|HMA [168003]|52487.59|685.77|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52487.59|16697.2|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52487.59|2175|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52487.59|1700|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|52487.59|23501.46|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52487.59|27553.05|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|GEHA [1415]|GEHA [141500]|52487.59|49616.3|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52487.59|18043.8|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52487.59|17621.95|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52487.59|9670.62|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52487.59|18239.37|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52487.59|18239.37|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52487.59|7946.08|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52487.59|15445.29|55129.22|685.77|||| MS391|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52487.59|49616.3|55129.22|685.77|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35764.63|9523.56|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35764.63|11083.8|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35764.63|5074.35|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35764.63|2550|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35764.63|2175|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|TRUSTMARK [2030]|STARMARK [203000]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|HEALTHNET [1495]|HEALTHNET [149500]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MULTIPLAN [1680]|IHC HS [168011]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MULTIPLAN [1680]|HMA [168003]|35764.63|1225.23|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35764.63|4740|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35764.63|5965.81|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|UMR [2035]|UMR OPTIONS [203501]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35764.63|10265.74|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35764.63|20450.3|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35764.63|34562.14|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35764.63|5014.63|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35764.63|8856.25|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35764.63|11308.04|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35764.63|22465.39|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35764.63|10824.67|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35764.63|5965.81|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|||35764.63|10729.39|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35764.63|20077.14|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35764.63|4963.07|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35764.63|3704.19|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|CHAMPVA [1240]|CHAMP VA [124000]|35764.63|23029.25|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35764.63|8508.32|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|CORESOURCE [1315]|CORESOURCE [131500]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35764.63|20450.3|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|GEHA [1415]|GEHA [141500]|35764.63|31105.92|34562.14|1225.23|||| MS392|DRG||Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35764.63|31105.92|34562.14|1225.23|||| MS393|DRG||Other Digestive System Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|GEHA [1415]|GEHA [141500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65558.39|29945.19|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|65558.39|39990.71|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|||65558.39|19667.52|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65558.39|6456.95|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65558.39|6456.95|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65558.39|3400|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65558.39|29945.19|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65558.39|10489.08|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65558.39|20316.5|39990.71|3400|||| MS393|DRG||Other Digestive System Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65558.39|20316.5|39990.71|3400|||| MS394|DRG||Other Digestive System Diagnoses With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44237.57|6275.65|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44237.57|7629.26|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44237.57|13291.51|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44237.57|13609.7|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44237.57|28301.03|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44237.57|6045.65|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44237.57|5950|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|TRUSTMARK [2030]|STARMARK [203000]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|HEALTHNET [1495]|HEALTHNET [149500]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MULTIPLAN [1680]|IHC HS [168011]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MULTIPLAN [1680]|HMA [168003]|44237.57|245.9|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44237.57|5366.69|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44237.57|7629.26|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|UMR [2035]|UMR OPTIONS [203501]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44237.57|2900|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44237.57|12750.71|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44237.57|38285.98|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44237.57|6045.65|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44237.57|10910.1|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44237.57|24885.89|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|||44237.57|13271.27|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44237.57|22240.33|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44237.57|6081.55|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44237.57|5366.69|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|CHAMPVA [1240]|CHAMP VA [124000]|44237.57|22919.13|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44237.57|13930.49|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|CORESOURCE [1315]|CORESOURCE [131500]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44237.57|28301.03|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|GEHA [1415]|GEHA [141500]|44237.57|34457.38|38285.98|245.9|||| MS394|DRG||Other Digestive System Diagnoses With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44237.57|34457.38|38285.98|245.9|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31230.09|15733.81|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31230.09|4679.98|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|||31230.09|9369.03|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31230.09|17255.1|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31230.09|7610.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31230.09|26546.3|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31230.09|5308.51|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31230.09|4679.98|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31230.09|9120.59|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31230.09|493.75|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31230.09|15420.76|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31230.09|1450|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31230.09|850|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31230.09|12262.19|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31230.09|15733.81|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|GEHA [1415]|GEHA [141500]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31230.09|23891.67|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31230.09|9420.65|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31230.09|9200.4|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31230.09|5308.51|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31230.09|4250.27|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31230.09|9717.64|26546.3|493.75|||| MS395|DRG||Other Digestive System Diagnoses Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31230.09|23891.67|26546.3|493.75|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|174381.17|83516|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|174381.17|81149.61|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|174381.17|83092.25|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|174381.17|1385038.07|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|174381.17|53550|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|174381.17|7250|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MULTIPLAN [1680]|HMA [168003]|174381.17|2088|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|174381.17|56465.52|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|174381.17|83516|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|174381.17|71485.65|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|174381.17|160607.69|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|174381.17|63118.34|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|174381.17|104395|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|||174381.17|52314.35|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|174381.17|93296.99|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|174381.17||||||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|174381.17|26452.08|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|174381.17|56465.52|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|174381.17|80592.24|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|174381.17|1385038.07|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|GEHA [1415]|GEHA [141500]|174381.17|144546.93|1385038.07|2088|||| MS405|DRG||Pancreas, Liver And Shunt Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|174381.17|144546.93|1385038.07|2088|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|GEHA [1415]|GEHA [141500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|108757.42|63091.52|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108757.42|15620.28|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|108757.42||||||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|||108757.42|32627.23|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|108757.42|15620.28|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108757.42|1700|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108757.42|63091.52|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108757.42|18092.01|63091.52|1700|||| MS406|DRG||Pancreas, Liver And Shunt Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108757.42|18092.01|63091.52|1700|||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|58550.54||||||| MS407|DRG||Pancreas, Liver And Shunt Procedures Without Cc/McC|||58550.54|17565.16|17565.16|17565.16|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|CORESOURCE [1315]|CORESOURCE [131500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|CHAMPVA [1240]|CHAMP VA [124000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|UMR [2035]|UMR OPTIONS [203501]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MULTIPLAN [1680]|IHC HS [168011]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MULTIPLAN [1680]|HMA [168003]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|HEALTHNET [1495]|HEALTHNET [149500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|TRUSTMARK [2030]|STARMARK [203000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|AETNA [1015]|AETNA ACO WILCO [101532]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|||142488.31|42746.49|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|GEHA [1415]|GEHA [141500]|142488.31||||||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142488.31|23514.25|42746.49|23514.25|||| MS408|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142488.31|23514.25|42746.49|23514.25|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|TRUSTMARK [2030]|STARMARK [203000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MULTIPLAN [1680]|IHC HS [168011]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MULTIPLAN [1680]|HMA [168003]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|UMR [2035]|UMR OPTIONS [203501]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|HEALTHNET [1495]|HEALTHNET [149500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|CHAMPVA [1240]|CHAMP VA [124000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|CORESOURCE [1315]|CORESOURCE [131500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|GEHA [1415]|GEHA [141500]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138167.86||||||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|||138167.86|41450.36|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138167.86|13352.15|41450.36|13352.15|||| MS409|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138167.86|13352.15|41450.36|13352.15|||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|GEHA [1415]|GEHA [141500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82519.15||||||| MS410|DRG||Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/McC|||82519.15|24755.74|24755.74|24755.74|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|TRUSTMARK [2030]|STARMARK [203000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|HEALTHNET [1495]|HEALTHNET [149500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MULTIPLAN [1680]|IHC HS [168011]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MULTIPLAN [1680]|HMA [168003]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|UMR [2035]|UMR OPTIONS [203501]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|CHAMPVA [1240]|CHAMP VA [124000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|CORESOURCE [1315]|CORESOURCE [131500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|GEHA [1415]|GEHA [141500]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|184042.84||||||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|||184042.84|55212.85|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|184042.84|14355.19|55212.85|14355.19|||| MS412|DRG||Cholecystectomy With C.D.E. With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|184042.84|14355.19|55212.85|14355.19|||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|GEHA [1415]|GEHA [141500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|CORESOURCE [1315]|CORESOURCE [131500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|UMR [2035]|UMR OPTIONS [203501]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MULTIPLAN [1680]|IHC HS [168011]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MULTIPLAN [1680]|HMA [168003]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|HEALTHNET [1495]|HEALTHNET [149500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|TRUSTMARK [2030]|STARMARK [203000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|AETNA [1015]|AETNA ACO WILCO [101532]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|CHAMPVA [1240]|CHAMP VA [124000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|148574.89||||||| MS414|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With McC|||148574.89|44572.47|44572.47|44572.47|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|TRUSTMARK [2030]|STARMARK [203000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|HEALTHNET [1495]|HEALTHNET [149500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MULTIPLAN [1680]|IHC HS [168011]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MULTIPLAN [1680]|HMA [168003]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|CHAMPVA [1240]|CHAMP VA [124000]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|UMR [2035]|UMR OPTIONS [203501]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119271.85||||||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|||119271.85|35781.55|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|CORESOURCE [1315]|CORESOURCE [131500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|GEHA [1415]|GEHA [141500]|119271.85|43797.11|43797.11|35781.55|||| MS415|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119271.85|43797.11|43797.11|35781.55|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|139674.85||||||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|139674.85||||||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|139674.85||||||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|139674.85||||||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|139674.85||||||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|GEHA [1415]|GEHA [141500]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|139674.85|81003.52|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|||139674.85|41902.45|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|139674.85|90639.15|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|139674.85|15703.99|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|139674.85|139444.85|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|139674.85|18959.1|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|139674.85|72511.32|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|139674.85|1949.49|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|139674.85|3625|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|139674.85||||||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|139674.85|125500.36|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|139674.85|20621.9|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|139674.85|20139.77|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|139674.85|72511.32|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|139674.85|9051.03|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|139674.85|17117.27|139444.85|1949.49|||| MS416|DRG||Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|139674.85|125500.36|139444.85|1949.49|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|108683.92|35698.15|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108683.92|56785.3|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108683.92|35698.15|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108683.92|34319.18|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108683.92|35140.75|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108683.92|53586.09|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108683.92|3400|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|TRUSTMARK [2030]|STARMARK [203000]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|HEALTHNET [1495]|HEALTHNET [149500]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MULTIPLAN [1680]|IHC HS [168011]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MULTIPLAN [1680]|HMA [168003]|108683.92|606.93|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|108683.92|10035.94|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108683.92|56785.3|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|AETNA [1015]|AETNA ACO WILCO [101532]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|UMR [2035]|UMR OPTIONS [203501]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|108683.92|2175|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108683.92|32329.02|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108683.92|109202.5|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108683.92|28036.44|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|108683.92|35698.15|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108683.92|70981.63|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|||108683.92|32605.18|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108683.92|63435.74|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108683.92|15273.7|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108683.92|10035.94|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|CHAMPVA [1240]|CHAMP VA [124000]|108683.92|95254.03|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|108683.92|30048.96|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|CORESOURCE [1315]|CORESOURCE [131500]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|108683.92|53586.09|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|GEHA [1415]|GEHA [141500]|108683.92|98282.26|109202.5|606.93|||| MS417|DRG||Laparoscopic Cholecystectomy Without C.D.E. With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108683.92|98282.26|109202.5|606.93|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|87695.38|47618.97|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|CORESOURCE [1315]|CORESOURCE [131500]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87695.38|7671.45|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87695.38|44772.06|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|||87695.38|26308.61|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87695.38|50097.84|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87695.38|19409.31|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87695.38|77073.6|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|UMR [2035]|UMR OPTIONS [203501]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87695.38|13404.5|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|87695.38|7671.45|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87695.38|22527.02|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MULTIPLAN [1680]|IHC HS [168011]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MULTIPLAN [1680]|HMA [168003]|87695.38|852.35|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|HEALTHNET [1495]|HEALTHNET [149500]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|TRUSTMARK [2030]|STARMARK [203000]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|87695.38|2175|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87695.38|2550|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|CHAMPVA [1240]|CHAMP VA [124000]|87695.38|54276.03|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87695.38|47618.97|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|GEHA [1415]|GEHA [141500]|87695.38|69366.24|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87695.38|24477.45|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87695.38|23905.18|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87695.38|13404.5|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|87695.38|24782.65|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87695.38|24782.65|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|87695.38|20871.78|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87695.38|10703.49|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87695.38|24139.96|77073.6|852.35|||| MS418|DRG||Laparoscopic Cholecystectomy Without C.D.E. With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87695.38|69366.24|77073.6|852.35|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|78788.56|18895.29|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78788.56|19070.4|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78788.56|2550|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|78788.56|2175|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|78788.56|806.65|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|78788.56|6831.99|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78788.56|9945.17|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78788.56|14424.04|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78788.56|17646.3|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78788.56|43544.68|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78788.56|70598.28|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78788.56|15198.08|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78788.56|45888.89|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78788.56|18624.55|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78788.56|9945.17|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|||78788.56|23636.57|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78788.56|41010.53|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78788.56|9424.2|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78788.56|6831.99|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|78788.56|50225.01|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|78788.56|16343.25|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|78788.56|43544.68|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|GEHA [1415]|GEHA [141500]|78788.56|63538.46|70598.28|806.65|||| MS419|DRG||Laparoscopic Cholecystectomy Without C.D.E. Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78788.56|63538.46|70598.28|806.65|||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|GEHA [1415]|GEHA [141500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MULTIPLAN [1680]|HMA [168003]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|201980.68||||||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|201980.68|117330.56|117330.56|2550|||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|201980.68|24608.26|117330.56|2550|||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|||201980.68|60594.2|117330.56|2550|||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|201980.68|24608.26|117330.56|2550|||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|201980.68|2550|117330.56|2550|||| MS420|DRG||Hepatobiliary Diagnostic Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|201980.68|117330.56|117330.56|2550|||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|GEHA [1415]|GEHA [141500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|||149325.21|44797.56|44797.56|44797.56|||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149325.21||||||| MS421|DRG||Hepatobiliary Diagnostic Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149325.21||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|||130530.62|39159.19|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|130530.62|26183.41|39159.19|26183.41|||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|130530.62||||||| MS423|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130530.62||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|||146232.95|43869.88|43869.88|43869.88|||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146232.95||||||| MS424|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146232.95||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161537.99|105121.25|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161537.99|161724.99|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161537.99|16997.25|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161537.99|84096.99|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161537.99|93946.06|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161537.99|21669.86|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161537.99|84096.99|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161537.99|22377.85|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161537.99|21854.67|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|161537.99|3625|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|161537.99|145552.49|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161537.99||||||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|161537.99|593.25|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|||161537.99|48461.4|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161537.99|13047.89|161724.99|593.25|||| MS425|DRG||Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161537.99|145552.49|161724.99|593.25|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|UMR [2035]|UMR OPTIONS [203501]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69855.63|21206.14|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69855.63|13939.47|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|GEHA [1415]|GEHA [141500]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69855.63|46574.2|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69855.63|52114.38|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|CORESOURCE [1315]|CORESOURCE [131500]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69855.63|45649.72|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|CHAMPVA [1240]|CHAMP VA [124000]|69855.63|45473.63|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|||69855.63|20956.69|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69855.63|24341.41|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69855.63|13493.33|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69855.63|80175.95|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69855.63|13939.47|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69855.63|45649.72|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69855.63|13493.33|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MULTIPLAN [1680]|IHC HS [168011]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69855.63|3400|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69855.63|2900|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69855.63|26652.42|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|TRUSTMARK [2030]|STARMARK [203000]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69855.63|27290.45|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MULTIPLAN [1680]|HMA [168003]|69855.63|856.83|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69855.63|22804.01|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|HEALTHNET [1495]|HEALTHNET [149500]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69855.63|72158.36|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69855.63|11909.12|80175.95|856.83|||| MS432|DRG||Cirrhosis And Alcoholic Hepatitis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69855.63|11909.12|80175.95|856.83|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51832.05|41011.9|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51832.05|26925.09|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|||51832.05|15549.61|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51832.05|6735.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51832.05|13809.33|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51832.05|6735.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51832.05|63095.22|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51832.05|12002.16|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|UMR [2035]|UMR OPTIONS [203501]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MULTIPLAN [1680]|IHC HS [168011]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51832.05|36652.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|TRUSTMARK [2030]|STARMARK [203000]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51832.05|7407.2|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51832.05|2550|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51832.05|14913.25|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51832.05|2900|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51832.05|26925.09|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51832.05|7407.2|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|51832.05||||||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|GEHA [1415]|GEHA [141500]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51832.05|14564.59|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51832.05|56785.7|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MULTIPLAN [1680]|HMA [168003]|51832.05|3654.6|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51832.05|12812.02|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51832.05|6604.36|63095.22|2550|||| MS433|DRG||Cirrhosis And Alcoholic Hepatitis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51832.05|6604.36|63095.22|2550|||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41351.86|30320.57|30320.57|1700|||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|GEHA [1415]|GEHA [141500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41351.86|4865.78|30320.57|1700|||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41351.86|4865.78|30320.57|1700|||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41351.86|1700|30320.57|1700|||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|||41351.86|12405.56|30320.57|1700|||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41351.86|30320.57|30320.57|1700|||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41351.86||||||| MS434|DRG||Cirrhosis And Alcoholic Hepatitis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41351.86||||||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|||102832.25|30849.67|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|GEHA [1415]|GEHA [141500]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|102832.25|54376.96|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|CHAMPVA [1240]|CHAMP VA [124000]|102832.25||||||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102832.25|59020.73|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102832.25|73775.92|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102832.25|19737.27|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|CORESOURCE [1315]|CORESOURCE [131500]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102832.25|22581.1|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|AETNA [1015]|AETNA ACO WILCO [101532]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102832.25|12080.32|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|UMR [2035]|UMR OPTIONS [203501]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MULTIPLAN [1680]|IHC HS [168011]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|HEALTHNET [1495]|HEALTHNET [149500]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102832.25|113501.41|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|102832.25|12080.32|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102832.25|65932.97|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MULTIPLAN [1680]|HMA [168003]|102832.25|3778.85|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102832.25|6800|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102832.25|54376.96|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102832.25|11105.57|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102832.25|59020.73|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102832.25|24821.4|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102832.25|25415.6|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|TRUSTMARK [2030]|STARMARK [203000]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|102832.25|21224.46|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102832.25|102151.28|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|102832.25|5075|113501.41|3778.85|||| MS435|DRG||Malignancy Of Hepatobiliary System Or Pancreas With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102832.25|102151.28|113501.41|3778.85|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35745.03|23234.27|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|GEHA [1415]|GEHA [141500]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35745.03|20764.28|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|||35745.03|10723.51|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35745.03|13091.89|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|CORESOURCE [1315]|CORESOURCE [131500]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35745.03|15350.61|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35745.03|35745.03|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35745.03||||||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35745.03||||||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|CHAMPVA [1240]|CHAMP VA [124000]|35745.03||||||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35745.03||||||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35745.03|9399.3|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35745.03|16242.9|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MULTIPLAN [1680]|IHC HS [168011]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35745.03|2900|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35745.03|15863.15|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|HEALTHNET [1495]|HEALTHNET [149500]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MULTIPLAN [1680]|HMA [168003]|35745.03|137.22|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35745.03|9399.3|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35745.03||||||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35745.03||||||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|TRUSTMARK [2030]|STARMARK [203000]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35745.03|14078.35|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35745.03|9504.23|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35745.03|32170.52|35745.03|137.22|||| MS436|DRG||Malignancy Of Hepatobiliary System Or Pancreas With Cc|UMR [2035]|UMR OPTIONS [203501]|35745.03|32170.52|35745.03|137.22|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|||31574.45|9472.33|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|GEHA [1415]|GEHA [141500]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31574.45||||||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31574.45|5701.51|9472.33|5701.51|||| MS437|DRG||Malignancy Of Hepatobiliary System Or Pancreas Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31574.45|5701.51|9472.33|5701.51|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74317.32|23146.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|CHAMPVA [1240]|CHAMP VA [124000]|74317.32||||||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74317.32|22605.2|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|HEALTHNET [1495]|HEALTHNET [149500]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|TRUSTMARK [2030]|STARMARK [203000]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MULTIPLAN [1680]|IHC HS [168011]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MULTIPLAN [1680]|HMA [168003]|74317.32|2306.4|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74317.32|10244.87|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74317.32|2550|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74317.32|13746.07|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74317.32|40524.7|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74317.32|5800|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|UMR [2035]|UMR OPTIONS [203501]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74317.32|22433.74|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74317.32|92531.5|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74317.32|60145.48|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74317.32|13746.07|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74317.32|10244.87|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74317.32|10133|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74317.32|24328.25|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|||74317.32|22295.2|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|CORESOURCE [1315]|CORESOURCE [131500]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74317.32|40524.7|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74317.32|19053.43|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|GEHA [1415]|GEHA [141500]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74317.32|83278.35|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74317.32|53751.57|92531.5|2306.4|||| MS438|DRG||Disorders Of Pancreas Except Malignancy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74317.32|83278.35|92531.5|2306.4|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|40092.18|9264.39|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|40092.18|22193.62|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|GEHA [1415]|GEHA [141500]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|40092.18|34525.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40092.18|7037.54|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MULTIPLAN [1680]|IHC HS [168011]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|||40092.18|12027.65|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40092.18|9852.94|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40092.18|38558.95|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40092.18|11817.83|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|UMR [2035]|UMR OPTIONS [203501]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40092.18|7324.83|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40092.18|25063.32|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|40092.18|10244.86|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40092.18|5498.58|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MULTIPLAN [1680]|HMA [168003]|40092.18|516.53|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40092.18|22398.9|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|TRUSTMARK [2030]|STARMARK [203000]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40092.18|3400|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|40092.18|725|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40092.18|22193.62|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40092.18|7324.83|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40092.18|12243.8|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|40092.18|10595.35|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40092.18|11957.55|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40092.18|5498.58|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40092.18|12580.66|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40092.18|34703.05|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40092.18|5460.24|38558.95|516.53|||| MS439|DRG||Disorders Of Pancreas Except Malignancy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|40092.18|12580.66|38558.95|516.53|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33550.01|18046.05|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33550.01|8785.55|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|33550.01||||||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33550.01|8580.15|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33550.01|5186.57|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33550.01|9001.41|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33550.01|9001.41|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33550.01|7698.88|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33550.01|5709.39|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33550.01|3400|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33550.01|18046.05|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|33550.01|299.43|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33550.01|1450|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33550.01|5186.57|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33550.01|8627.11|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33550.01|5709.39|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|||33550.01|10065|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33550.01|19030.46|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33550.01|21294.19|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33550.01|7159.43|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33550.01|32760.29|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33550.01|9141.47|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|33550.01|29484.26|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33550.01|3978.06|32760.29|299.43|||| MS440|DRG||Disorders Of Pancreas Except Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33550.01|29484.26|32760.29|299.43|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|CORESOURCE [1315]|CORESOURCE [131500]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|CHAMPVA [1240]|CHAMP VA [124000]|61869.99|49249.97|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|61869.99|10169.48|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|61869.99|36106.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|61869.99|42587.45|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|61869.99|65519.13|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|UMR [2035]|UMR OPTIONS [203501]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|61869.99|38060.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|61869.99|9306.4|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MULTIPLAN [1680]|IHC HS [168011]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|61869.99|15209.26|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|61869.99|24550.97|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MULTIPLAN [1680]|HMA [168003]|61869.99|515.24|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|61869.99|21521.32|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|HEALTHNET [1495]|HEALTHNET [149500]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|61869.99|2550|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|61869.99|26675.08|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|61869.99|27313.65|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|||61869.99|18561|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|61869.99|15209.26|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|GEHA [1415]|GEHA [141500]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|61869.99|11919.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|61869.99|11785.68|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|61869.99|2175|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|61869.99|27479.35|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|TRUSTMARK [2030]|STARMARK [203000]|61869.99|58967.22|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|61869.99|36106.06|65519.13|515.24|||| MS441|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|61869.99|27479.35|65519.13|515.24|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|43768.95|7482.3|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|43768.95|13508.2|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|43768.95|13192.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|43768.95||||||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|43768.95|3625|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|TRUSTMARK [2030]|STARMARK [203000]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|43768.95|3400|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MULTIPLAN [1680]|IHC HS [168011]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MULTIPLAN [1680]|HMA [168003]|43768.95|1208.65|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|43768.95|5818.94|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|43768.95|7482.3|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|43768.95|37704.78|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|UMR [2035]|UMR OPTIONS [203501]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|43768.95|12700.69|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|||43768.95|13130.68|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|43768.95|31864.78|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|43768.95|5818.94|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|43768.95|6002.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|43768.95|37704.78|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|43768.95|10855.44|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|GEHA [1415]|GEHA [141500]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|43768.95|35655.2|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|43768.95|11673.39|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|43768.95|54854.15|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|43768.95|49368.73|54854.15|1208.65|||| MS442|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|43768.95|11673.39|54854.15|1208.65|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|GEHA [1415]|GEHA [141500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31078.84|21627.1|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31078.84|7120.83|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|||31078.84|9323.65|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31078.84|7120.83|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31078.84|21627.1|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31078.84|1700|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31078.84||||||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31078.84|10102.24|21627.1|1700|||| MS443|DRG||Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31078.84||||||| MS444|DRG||Disorders Of The Biliary Tract With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77301.28|13091.19|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77301.28|23631.88|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77301.28|24197.6|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77301.28|30588.84|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77301.28|2175|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|TRUSTMARK [2030]|STARMARK [203000]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|AETNA [1015]|AETNA ACO WILCO [101532]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|HEALTHNET [1495]|HEALTHNET [149500]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77301.28|2550|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MULTIPLAN [1680]|HMA [168003]|77301.28|874.13|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MULTIPLAN [1680]|IHC HS [168011]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77301.28|6218.5|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77301.28|13091.19|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|UMR [2035]|UMR OPTIONS [203501]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77301.28|78680.34|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77301.28|51142.22|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77301.28|45705.4|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77301.28|10583.55|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|||77301.28|23190.38|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77301.28|11734.33|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77301.28|6218.5|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77301.28|21627.94|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|CHAMPVA [1240]|CHAMP VA [124000]|77301.28|37238.14|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77301.28|24147.08|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|CORESOURCE [1315]|CORESOURCE [131500]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77301.28|30588.84|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77301.28|18911.54|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|GEHA [1415]|GEHA [141500]|77301.28|70812.3|78680.34|874.13|||| MS444|DRG||Disorders Of The Biliary Tract With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77301.28|70812.3|78680.34|874.13|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|GEHA [1415]|GEHA [141500]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54827.14|15403.58|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|CORESOURCE [1315]|CORESOURCE [131500]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|CHAMPVA [1240]|CHAMP VA [124000]|54827.14|35648.25|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54827.14|4480.13|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|||54827.14|16448.14|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54827.14|23786.41|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54827.14|26615.88|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54827.14|12496.44|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54827.14|14305.51|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|UMR [2035]|UMR OPTIONS [203501]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54827.14|4480.13|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54827.14|8603.11|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54827.14|40947.51|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MULTIPLAN [1680]|IHC HS [168011]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MULTIPLAN [1680]|HMA [168003]|54827.14|574.26|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|HEALTHNET [1495]|HEALTHNET [149500]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54827.14|3625|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54827.14|15613.6|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54827.14|15248.56|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54827.14|8603.11|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54827.14|15955.99|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54827.14|15955.99|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54827.14|15955.99|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54827.14|6904.5|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54827.14|15403.58|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54827.14|1700|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|TRUSTMARK [2030]|STARMARK [203000]|54827.14|36852.77|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|54827.14|14141.03|40947.51|574.26|||| MS445|DRG||Disorders Of The Biliary Tract With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54827.14|36852.77|40947.51|574.26|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|46413.70||||||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46413.70|6111.97|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46413.70|11834.9|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46413.70|2175|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|46413.70|673|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46413.70|850|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46413.70|19810.12|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46413.70|3672.29|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46413.70|6111.97|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46413.70|11558.21|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46413.70|38399.54|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46413.70|5284.99|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46413.70|3672.29|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46413.70|34317.37|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|||46413.70|13924.11|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46413.70|19810.12|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|GEHA [1415]|GEHA [141500]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46413.70|10163.88|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46413.70|9451.7|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46413.70|59076.22|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46413.70|10702.43|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46413.70|53168.59|59076.22|673|||| MS446|DRG||Disorders Of The Biliary Tract Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46413.70|53168.59|59076.22|673|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|GEHA [1415]|GEHA [141500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|CORESOURCE [1315]|CORESOURCE [131500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|CHAMPVA [1240]|CHAMP VA [124000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MULTIPLAN [1680]|IHC HS [168011]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MULTIPLAN [1680]|HMA [168003]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|HEALTHNET [1495]|HEALTHNET [149500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|TRUSTMARK [2030]|STARMARK [203000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|UMR [2035]|UMR OPTIONS [203501]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|AETNA [1015]|AETNA ACO WILCO [101532]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|||156984.41|47095.32|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|156984.41|47483.28|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|156984.41|3400|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|156984.41|120661.66|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|156984.41|47483.28|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|156984.41|120661.66|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156984.41|57347.07|120661.66|3400|||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|156984.41||||||| MS453|DRG||Combined Anterior And Posterior Spinal Fusion With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|156984.41||||||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|231952.26|129404.89|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|231952.26|86355.19|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|231952.26|127982.39|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|231952.26|3625|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|HEALTHNET [1495]|HEALTHNET [149500]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MULTIPLAN [1680]|HMA [168003]|231952.26|21650.45|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|TRUSTMARK [2030]|STARMARK [203000]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MULTIPLAN [1680]|IHC HS [168011]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|231952.26|29464.4|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|231952.26|129404.89|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|UMR [2035]|UMR OPTIONS [203501]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|231952.26|88422.45|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|231952.26|87836.74|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|231952.26|248855.56|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|231952.26|1700|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|||231952.26|69585.68|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|231952.26|29464.4|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|CHAMPVA [1240]|CHAMP VA [124000]|231952.26|187043.24|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|CORESOURCE [1315]|CORESOURCE [131500]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|231952.26|144560.22|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|231952.26|127982.39|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|GEHA [1415]|GEHA [141500]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|231952.26|161756.11|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|231952.26|71233.75|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|231952.26|38109.83|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|231952.26|223970|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|231952.26|76601.15|248855.56|1700|||| MS454|DRG||Combined Anterior And Posterior Spinal Fusion With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|231952.26|223970|248855.56|1700|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|GEHA [1415]|GEHA [141500]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|190455.08|127565.18|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|190455.08|23599.95|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|190455.08|110635.36|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|190455.08|123795.81|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|190455.08|55978.68|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|190455.08|68657.26|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|190455.08|23599.95|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|190455.08|99036.64|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|190455.08|190455.08|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|||190455.08|57136.52|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|190455.08|30363.67|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|190455.08|1450|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|190455.08|120072.31|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|190455.08|69469.5|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|190455.08|67845.35|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|190455.08|99036.64|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|190455.08|120072.31|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|190455.08|60196.62|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|190455.08|29986.73|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|190455.08|2550|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|190455.08|71476.01|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|190455.08|171409.58|190455.08|1450|||| MS455|DRG||Combined Anterior And Posterior Spinal Fusion Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|190455.08|171409.58|190455.08|1450|||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|AETNA [1015]|AETNA ACO WILCO [101532]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MULTIPLAN [1680]|HMA [168003]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|TRUSTMARK [2030]|STARMARK [203000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|UMR [2035]|UMR OPTIONS [203501]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|HEALTHNET [1495]|HEALTHNET [149500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MULTIPLAN [1680]|IHC HS [168011]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|CHAMPVA [1240]|CHAMP VA [124000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|GEHA [1415]|GEHA [141500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|CORESOURCE [1315]|CORESOURCE [131500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|268705.47|139377.04|139377.04|11900|||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|268705.47|11900|139377.04|11900|||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|268705.47|33741.47|139377.04|11900|||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|||268705.47|80611.64|139377.04|11900|||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|268705.47|33741.47|139377.04|11900|||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|268705.47|139377.04|139377.04|11900|||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|268705.47||||||| MS456|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|268705.47||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|GEHA [1415]|GEHA [141500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|CORESOURCE [1315]|CORESOURCE [131500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|CHAMPVA [1240]|CHAMP VA [124000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|UMR [2035]|UMR OPTIONS [203501]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MULTIPLAN [1680]|IHC HS [168011]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MULTIPLAN [1680]|HMA [168003]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|HEALTHNET [1495]|HEALTHNET [149500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|TRUSTMARK [2030]|STARMARK [203000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|||259123.44|77737.03|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|259123.44|40619.88|77737.03|40619.88|||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|259123.44||||||| MS457|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|259123.44||||||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|153843.99||||||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|153843.99||||||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|153843.99||||||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|153843.99||||||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|153843.99||||||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|153843.99|79998.87|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|153843.99|71051.4|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|153843.99|1450|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|153843.99|72752.3|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|153843.99|18749.27|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153843.99|79998.87|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|153843.99|99998.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|||153843.99|46153.2|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153843.99|31393.7|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|153843.99||||||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|153843.99|89367.98|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|153843.99|40954.95|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|GEHA [1415]|GEHA [141500]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153843.99|54590.06|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|153843.99|72544.26|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|153843.99|153843.99|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|153843.99|138459.6|153843.99|1450|||| MS458|DRG||Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153843.99|138459.6|153843.99|1450|||| MS459|DRG||Spinal Fusion Except Cervical With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|GEHA [1415]|GEHA [141500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|CHAMPVA [1240]|CHAMP VA [124000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|UMR [2035]|UMR OPTIONS [203501]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MULTIPLAN [1680]|IHC HS [168011]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MULTIPLAN [1680]|HMA [168003]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|HEALTHNET [1495]|HEALTHNET [149500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|TRUSTMARK [2030]|STARMARK [203000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|AETNA [1015]|AETNA ACO WILCO [101532]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|184894.01|107380.13|107380.13|1700|||| MS459|DRG||Spinal Fusion Except Cervical With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|184894.01|20093.49|107380.13|1700|||| MS459|DRG||Spinal Fusion Except Cervical With McC|CORESOURCE [1315]|CORESOURCE [131500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|||184894.01|55468.2|107380.13|1700|||| MS459|DRG||Spinal Fusion Except Cervical With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|184894.01|20093.49|107380.13|1700|||| MS459|DRG||Spinal Fusion Except Cervical With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|184894.01|1700|107380.13|1700|||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|184894.01|107380.13|107380.13|1700|||| MS459|DRG||Spinal Fusion Except Cervical With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|184894.01||||||| MS459|DRG||Spinal Fusion Except Cervical With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|184894.01||||||| MS460|DRG||Spinal Fusion Except Cervical Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|161396.54|76185.9|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|161396.54|49529.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|161396.54|49529.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|161396.54|55690.96|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|161396.54|54865.97|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|161396.54|850|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MULTIPLAN [1680]|IHC HS [168011]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MULTIPLAN [1680]|HMA [168003]|161396.54|22537.87|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|161396.54|17222.17|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|161396.54|76185.9|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|TRUSTMARK [2030]|STARMARK [203000]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|HEALTHNET [1495]|HEALTHNET [149500]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|161396.54|57024.15|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|UMR [2035]|UMR OPTIONS [203501]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|161396.54|46059.45|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|161396.54|95232.38|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|||161396.54|48418.96|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|161396.54|17222.17|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|161396.54|49529.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|CHAMPVA [1240]|CHAMP VA [124000]|161396.54|128783.98|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|161396.54|24652.76|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|CORESOURCE [1315]|CORESOURCE [131500]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|161396.54|54865.97|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|GEHA [1415]|GEHA [141500]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|161396.54|131860.21|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|161396.54|146511.34|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|161396.54|54281.45|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|161396.54|49559.99|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|161396.54|1450|146511.34|850|||| MS460|DRG||Spinal Fusion Except Cervical Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|161396.54|85108.44|146511.34|850|||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|GEHA [1415]|GEHA [141500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|CORESOURCE [1315]|CORESOURCE [131500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|CHAMPVA [1240]|CHAMP VA [124000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|UMR [2035]|UMR OPTIONS [203501]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MULTIPLAN [1680]|IHC HS [168011]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MULTIPLAN [1680]|HMA [168003]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|HEALTHNET [1495]|HEALTHNET [149500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|TRUSTMARK [2030]|STARMARK [203000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|||205331.55|61599.46|61599.46|61599.46|||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|AETNA [1015]|AETNA ACO WILCO [101532]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205331.55||||||| MS461|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205331.55||||||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|152273.40|77359.39|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|152273.40|46574.57|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|152273.40|46574.57|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|152273.40|44525.02|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|152273.40|88437.97|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|152273.40|725|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|HEALTHNET [1495]|HEALTHNET [149500]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|TRUSTMARK [2030]|STARMARK [203000]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MULTIPLAN [1680]|HMA [168003]|152273.40|12049.28|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|152273.40|23743.41|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|152273.40|77359.39|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MULTIPLAN [1680]|IHC HS [168011]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|UMR [2035]|UMR OPTIONS [203501]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|152273.40|45590.9|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|152273.40|148768.06|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|152273.40|4250|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|152273.40|86419.35|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|152273.40|23743.41|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|152273.40|46574.57|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|CHAMPVA [1240]|CHAMP VA [124000]|152273.40|80012.93|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|CORESOURCE [1315]|CORESOURCE [131500]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|152273.40|88437.97|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|GEHA [1415]|GEHA [141500]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|152273.40|96699.24|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|||152273.40|45682.02|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|152273.40|36476.33|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|152273.40|19752.55|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|152273.40|46343.75|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|152273.40|133891.26|148768.06|725|||| MS462|DRG||Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|152273.40|44129.28|148768.06|725|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|158274.78||||||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158274.78||||||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158274.78||||||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158274.78||||||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|GEHA [1415]|GEHA [141500]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|158274.78|118706.09|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|||158274.78|47482.43|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158274.78|647641.46|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158274.78|996371.48|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158274.78|996371.48|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158274.78|578792.21|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158274.78|996371.48|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158274.78|996371.48|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MULTIPLAN [1680]|HMA [168003]|158274.78|33862.92|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158274.78|36250|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158274.78|996371.48|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158274.78|996371.48|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158274.78|996371.48|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|158274.78||||||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158274.78|163743.15|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158274.78|896734.33|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|158274.78|27310.35|996371.48|27310.35|||| MS463|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|158274.78|896734.33|996371.48|27310.35|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130854.30|80974.68|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130854.30|42121.89|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130854.30|30746.91|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130854.30|850|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|130854.30|2900|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|130854.30|15681.98|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|130854.30|16530.39|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130854.30|80974.68|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130854.30|43130.25|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130854.30|34339.9|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|||130854.30|39256.29|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130854.30|16530.39|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|130854.30|116009.01|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130854.30|22973.79|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130854.30|90458.07|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|130854.30|30746.91|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|GEHA [1415]|GEHA [141500]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130854.30|18697.94|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130854.30|101218.34|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130854.30|140148.47|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130854.30|155720.53|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130854.30|38448.18|155720.53|850|||| MS464|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130854.30|18697.94|155720.53|850|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79833.08|4250|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79833.08|46364.33|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79833.08|725|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79833.08|26732.2|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79833.08|26107.22|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79833.08|15716.37|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79833.08|46364.33|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|79833.08|62932.92|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79833.08|10478.83|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79833.08|36100.84|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|||79833.08|23949.92|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79833.08|40395.16|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79833.08|22273.78|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79833.08|62146.4|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79833.08|25437.88|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79833.08|15716.37|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79833.08|10478.83|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|79833.08|1127.21|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79833.08|11285.07|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79833.08|55931.76|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|79833.08|29484.13|62932.92|725|||| MS465|DRG||Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79833.08|55931.76|62932.92|725|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|CHAMPVA [1240]|CHAMP VA [124000]|230255.75||||||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|230255.75|87943.68|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|230255.75|75690.55|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|230255.75|77502.5|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|230255.75|130977.75|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|230255.75|2550|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|230255.75|2900|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|TRUSTMARK [2030]|STARMARK [203000]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|HEALTHNET [1495]|HEALTHNET [149500]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MULTIPLAN [1680]|IHC HS [168011]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MULTIPLAN [1680]|HMA [168003]|230255.75|14091.64|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|230255.75|47242.88|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|AETNA [1015]|AETNA ACO WILCO [101532]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|230255.75|87943.68|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|UMR [2035]|UMR OPTIONS [203501]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|230255.75|68181.36|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|230255.75|169122.46|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|230255.75|59302.53|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|230255.75|109929.6|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|||230255.75|69076.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|230255.75|98243.24|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|230255.75|33429.61|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|230255.75|47242.88|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|230255.75|68718.72|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|CORESOURCE [1315]|CORESOURCE [131500]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|230255.75|130977.75|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|GEHA [1415]|GEHA [141500]|230255.75|152210.21|169122.46|2550|||| MS466|DRG||Revision Of Hip Or Knee Replacement With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|230255.75|152210.21|169122.46|2550|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|GEHA [1415]|GEHA [141500]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|160268.20|72581.06|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|CORESOURCE [1315]|CORESOURCE [131500]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|CHAMPVA [1240]|CHAMP VA [124000]|160268.20|109608.02|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|160268.20|27798.64|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|160268.20|98216.89|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|160268.20|109900.1|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|160268.20|40845.72|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|160268.20|169077.08|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|160268.20|47019.86|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|UMR [2035]|UMR OPTIONS [203501]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|160268.20|87920.08|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|160268.20|27798.64|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MULTIPLAN [1680]|IHC HS [168011]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MULTIPLAN [1680]|HMA [168003]|160268.20|13510.98|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|HEALTHNET [1495]|HEALTHNET [149500]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|TRUSTMARK [2030]|STARMARK [203000]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|||160268.20|48080.46|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|160268.20|5075|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|160268.20|4250|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|160268.20|22024.21|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|160268.20|72581.06|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|160268.20|152169.37|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|160268.20|51854.9|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|160268.20|50642.57|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|160268.20|87920.08|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|160268.20|44445.41|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|160268.20|44445.41|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|160268.20|43923.41|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|160268.20|22437.26|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|160268.20|52053.6|169077.08|4250|||| MS467|DRG||Revision Of Hip Or Knee Replacement With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|160268.20|152169.37|169077.08|4250|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|138486.71|81050.91|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|138486.71|41758.81|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|138486.71|41758.81|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|138486.71|41758.81|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|138486.71|39707.44|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|138486.71|73969.22|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|138486.71|3400|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|138486.71|10084.64|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|138486.71|19545.44|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|138486.71|81050.91|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|138486.71|1450|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|138486.71|38085.84|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|138486.71|155867.13|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|138486.71|32704.72|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|138486.71|40658|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|138486.71|101313.64|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|||138486.71|41546.01|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|138486.71|90543.23|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|138486.71|17638.34|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|138486.71|19545.44|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|138486.71|72683.18|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|138486.71|41755.53|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|138486.71|73969.22|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|GEHA [1415]|GEHA [141500]|138486.71|140280.43|155867.13|1450|||| MS468|DRG||Revision Of Hip Or Knee Replacement Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|138486.71|140280.43|155867.13|1450|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136347.13||||||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|136347.13||||||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136347.13||||||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|GEHA [1415]|GEHA [141500]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|CORESOURCE [1315]|CORESOURCE [131500]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|CHAMPVA [1240]|CHAMP VA [124000]|136347.13|105322.37|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|||136347.13|40904.14|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136347.13|105473.11|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136347.13|36517.04|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136347.13|19049.14|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136347.13|162266.31|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136347.13|43277.52|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|UMR [2035]|UMR OPTIONS [203501]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136347.13|84378.48|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|FIRST HEALTH [1375]|QUALCHOICE [137513]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|FMH BENEFIT SERVICES [1390]|FMH [139000]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MULTIPLAN [1680]|IHC HS [168011]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MULTIPLAN [1680]|HMA [168003]|136347.13|7006.07|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|HEALTHNET [1495]|HEALTHNET [149500]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136347.13|94260.51|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|TRUSTMARK [2030]|STARMARK [203000]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|AETNA [1015]|AETNA ACO WILCO [101532]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|136347.13|4350|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136347.13|146039.68|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136347.13|44723.8|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136347.13|43678.19|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136347.13|84378.48|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136347.13||||||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|136347.13||||||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136347.13|19380.92|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136347.13|39268.56|162266.31|4350|||| MS469|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With McC Or Total Ankle Replacement|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136347.13|146039.68|162266.31|4350|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93499.97|17068.13|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93499.97|26904.48|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93499.97|27548.55|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93499.97|51846.95|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93499.97|850|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|93499.97|1450|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|HEALTHNET [1495]|HEALTHNET [149500]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MULTIPLAN [1680]|IHC HS [168011]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MULTIPLAN [1680]|HMA [168003]|93499.97|7929.48|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|93499.97|16755.77|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93499.97|17068.13|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|TRUSTMARK [2030]|STARMARK [203000]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|UMR [2035]|UMR OPTIONS [203501]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93499.97|27774.14|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93499.97|91513.17|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93499.97|22892.49|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93499.97|59483.55|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|||93499.97|28049.99|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93499.97|53159.98|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93499.97|12019.73|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93499.97|16755.77|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|CHAMPVA [1240]|CHAMP VA [124000]|93499.97|66575.12|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|93499.97|24617.42|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|CORESOURCE [1315]|CORESOURCE [131500]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|93499.97|51846.95|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|GEHA [1415]|GEHA [141500]|93499.97|82361.85|91513.17|850|||| MS470|DRG||Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93499.97|82361.85|91513.17|850|||| MS471|DRG||Cervical Spinal Fusion With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|GEHA [1415]|GEHA [141500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|CORESOURCE [1315]|CORESOURCE [131500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|CHAMPVA [1240]|CHAMP VA [124000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|UMR [2035]|UMR OPTIONS [203501]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MULTIPLAN [1680]|IHC HS [168011]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MULTIPLAN [1680]|HMA [168003]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|HEALTHNET [1495]|HEALTHNET [149500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|TRUSTMARK [2030]|STARMARK [203000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|AETNA [1015]|AETNA ACO WILCO [101532]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|236636.32||||||| MS471|DRG||Cervical Spinal Fusion With McC|||236636.32|70990.9|70990.9|70990.9|||| MS472|DRG||Cervical Spinal Fusion With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|116819.54|66450.89|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|116819.54|43236.37|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|116819.54|61439.36|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|116819.54|850|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|116819.54|725|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|TRUSTMARK [2030]|STARMARK [203000]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MULTIPLAN [1680]|IHC HS [168011]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MULTIPLAN [1680]|HMA [168003]|116819.54|9138.4|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|116819.54|11792.88|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|116819.54|66450.89|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|HEALTHNET [1495]|HEALTHNET [149500]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|UMR [2035]|UMR OPTIONS [203501]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|116819.54|38577.97|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|116819.54|127790.18|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|116819.54|35372.65|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|116819.54|44271.4|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|116819.54|83063.62|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|||116819.54|35045.86|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|116819.54|74233.32|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|116819.54|19187.01|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|116819.54|11792.88|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|CHAMPVA [1240]|CHAMP VA [124000]|116819.54|86520.26|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|116819.54|45165.33|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|CORESOURCE [1315]|CORESOURCE [131500]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|116819.54|61439.36|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|GEHA [1415]|GEHA [141500]|116819.54|115011.16|127790.18|725|||| MS472|DRG||Cervical Spinal Fusion With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|116819.54|115011.16|127790.18|725|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|GEHA [1415]|GEHA [141500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|108951.47|86061.32|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|108951.47|128980|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108951.47|9491.64|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|||108951.47|32685.44|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|108951.47|9491.64|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108951.47|1700|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108951.47|86061.32|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108951.47|15998.94|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108951.47|31420.85|128980|1700|||| MS473|DRG||Cervical Spinal Fusion Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108951.47|31420.85|128980|1700|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MULTIPLAN [1680]|HMA [168003]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|GEHA [1415]|GEHA [141500]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|128199.57|60599.56|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|128199.57||||||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|128199.57|6800|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|128199.57|20041.46|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|||128199.57|38459.87|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|128199.57|20872.99|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|128199.57|20041.46|60599.56|6800|||| MS474|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|128199.57|60599.56|60599.56|6800|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|95851.67||||||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|95851.67|108223.97|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|95851.67|9931.93|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|95851.67|46076.63|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|95851.67|51557.56|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|95851.67|79319.33|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|95851.67|29103.15|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|95851.67|16556.98|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|95851.67|9931.93|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|95851.67|166.94|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|95851.67|24434.63|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|||95851.67|28755.5|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|95851.67|2175|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|95851.67|5950|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|GEHA [1415]|GEHA [141500]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|95851.67|108223.97|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95851.67|71387.4|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95851.67|31807.2|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|95851.67|31063.57|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|95851.67|16556.98|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|95851.67|12699.07|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|95851.67|23490.76|108223.97|166.94|||| MS475|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|95851.67|71387.4|108223.97|166.94|||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59397.09||||||| MS476|DRG||Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/McC|||59397.09|17819.13|17819.13|17819.13|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|CHAMPVA [1240]|CHAMP VA [124000]|125497.89||||||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|GEHA [1415]|GEHA [141500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|125497.89|50066.99|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|125497.89|14981.71|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|125497.89|72901.75|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|||125497.89|37649.37|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|125497.89|81573.63|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125497.89|37859.14|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|125497.89|43712.86|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|UMR [2035]|UMR OPTIONS [203501]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|125497.89|65258.9|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|125497.89|14981.71|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|IHC HS [168011]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|HMA [168003]|125497.89|3016.74|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|125497.89|125497.89|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|HEALTHNET [1495]|HEALTHNET [149500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|TRUSTMARK [2030]|STARMARK [203000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|AETNA ACO WILCO [101532]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|125497.89|7975|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|125497.89|8500|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|CORESOURCE [1315]|CORESOURCE [131500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|125497.89|50066.99|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125497.89|48675.05|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|125497.89|47537.06|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|125497.89|65258.9|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125497.89|21074.39|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|125497.89|112948.1|125497.89|3016.74|||| MS477|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|125497.89|112948.1|125497.89|3016.74|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|TRUSTMARK [2030]|STARMARK [203000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|HEALTHNET [1495]|HEALTHNET [149500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MULTIPLAN [1680]|IHC HS [168011]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MULTIPLAN [1680]|HMA [168003]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|UMR [2035]|UMR OPTIONS [203501]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|CHAMPVA [1240]|CHAMP VA [124000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|CORESOURCE [1315]|CORESOURCE [131500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|GEHA [1415]|GEHA [141500]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|165880.27||||||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|165880.27|96359.87|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|165880.27|9350|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|165880.27|11126.32|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|||165880.27|49764.08|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|165880.27|15573.59|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|165880.27|11126.32|96359.87|9350|||| MS478|DRG||Biopsies Of Musculoskeletal System And Connective Tissue With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|165880.27|96359.87|96359.87|9350|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|GEHA [1415]|GEHA [141500]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|||38130.07|11439.02|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38130.07|24784.54|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38130.07|20726.99|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38130.07|23885.78|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38130.07|22149.76|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38130.07|13979.44|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|38130.07|112.7|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38130.07|725|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38130.07||||||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38130.07|34317.06|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38130.07|26234.85|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38130.07|25621.5|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38130.07|13979.44|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38130.07|22288.75|34317.06|112.7|||| MS479|DRG||Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38130.07|34317.06|34317.06|112.7|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|CHAMPVA [1240]|CHAMP VA [124000]|117316.17||||||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|117316.17|42829.94|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|117316.17|43855.25|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|117316.17|4350|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|AETNA [1015]|AETNA ACO WILCO [101532]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|TRUSTMARK [2030]|STARMARK [203000]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|HEALTHNET [1495]|HEALTHNET [149500]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MULTIPLAN [1680]|IHC HS [168011]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MULTIPLAN [1680]|HMA [168003]|117316.17|5903.33|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|117316.17|67342.22|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|117316.17|65359.94|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|UMR [2035]|UMR OPTIONS [203501]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|117316.17|11050|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|117316.17|93643.23|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|117316.17|40829.05|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|117316.17|17078.79|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|117316.17|35105.16|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|117316.17|81699.93|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|117316.17|65359.94|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|||117316.17|35194.85|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|117316.17|73014.63|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|117316.17|19008.67|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|117316.17|67342.22|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|117316.17|37750.3|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|CORESOURCE [1315]|CORESOURCE [131500]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|117316.17|93643.23|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|GEHA [1415]|GEHA [141500]|117316.17|113122.99|113122.99|4350|||| MS480|DRG||Hip And Femur Procedures Except Major Joint With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|117316.17|113122.99|113122.99|4350|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|GEHA [1415]|GEHA [141500]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|97255.02|50552.78|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|97255.02|13912.36|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|97255.02|56577.73|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|||97255.02|29176.51|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|97255.02|63307.87|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97255.02|24281.11|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|97255.02|27717.35|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|UMR [2035]|UMR OPTIONS [203501]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97255.02|15969.12|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|97255.02|13912.36|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MULTIPLAN [1680]|IHC HS [168011]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MULTIPLAN [1680]|HMA [168003]|97255.02|1512.56|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|HEALTHNET [1495]|HEALTHNET [149500]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|TRUSTMARK [2030]|STARMARK [203000]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|97255.02|2900|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|97255.02|3400|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|CORESOURCE [1315]|CORESOURCE [131500]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97255.02|12780.82|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|97255.02|50552.78|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|97255.02|87657.05|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|CHAMPVA [1240]|CHAMP VA [124000]|97255.02||||||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|97255.02|30384.75|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|97255.02|29674.38|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|97255.02|15969.12|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97255.02|13235.31|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|97255.02|31003.18|87657.05|1512.56|||| MS481|DRG||Hip And Femur Procedures Except Major Joint With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|97255.02|87657.05|87657.05|1512.56|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|76911.26||||||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76911.26|10352.58|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76911.26|13116.22|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76911.26|23320.33|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76911.26|23878.6|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76911.26|53272.89|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76911.26|10413.71|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76911.26|7650|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|76911.26|3213.09|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|76911.26|10998.33|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76911.26|13116.22|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|76911.26|2175|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76911.26|22567.58|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76911.26|19134.84|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76911.26|50682.2|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|||76911.26|23073.38|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76911.26|45294.31|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76911.26|10446.83|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76911.26|10998.33|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|76911.26|20576.63|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|76911.26|53272.89|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|GEHA [1415]|GEHA [141500]|76911.26|70175.35|70175.35|2175|||| MS482|DRG||Hip And Femur Procedures Except Major Joint Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76911.26|70175.35|70175.35|2175|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|GEHA [1415]|GEHA [141500]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104073.44|61934.98|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|CORESOURCE [1315]|CORESOURCE [131500]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|CHAMPVA [1240]|CHAMP VA [124000]|104073.44|72477.3|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104073.44|10887.82|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104073.44|57073.21|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104073.44|63862.26|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104073.44|27820.12|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104073.44|15042.51|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104073.44|32808.98|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|UMR [2035]|UMR OPTIONS [203501]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104073.44|19545.54|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104073.44|10887.82|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|FIRST HEALTH [1375]|QUALCHOICE [137513]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|FMH BENEFIT SERVICES [1390]|FMH [139000]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MULTIPLAN [1680]|IHC HS [168011]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MULTIPLAN [1680]|HMA [168003]|104073.44|9338.49|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|HEALTHNET [1495]|HEALTHNET [149500]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|TRUSTMARK [2030]|STARMARK [203000]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|||104073.44|31222.03|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|AETNA [1015]|AETNA ACO WILCO [101532]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104073.44|725|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104073.44|850|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104073.44|61934.98|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104073.44|88424.67|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104073.44|34601.35|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104073.44|33792.39|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104073.44|19545.54|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104073.44|29916.34|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104073.44|14826.08|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104073.44|35521.94|88424.67|725|||| MS483|DRG||Major Joint Or Limb Reattachment Procedures Of Upper Extremities|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104073.44|88424.67|88424.67|725|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|AETNA [1015]|AETNA ACO WILCO [101532]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|HEALTHNET [1495]|HEALTHNET [149500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MULTIPLAN [1680]|IHC HS [168011]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MULTIPLAN [1680]|HMA [168003]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|UMR [2035]|UMR OPTIONS [203501]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|TRUSTMARK [2030]|STARMARK [203000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|CORESOURCE [1315]|CORESOURCE [131500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|GEHA [1415]|GEHA [141500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|115246.40|66946.65|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|115246.40|11050|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|115246.40||||||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|115246.40|18092.68|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|||115246.40|34573.92|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|115246.40|21389.47|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|115246.40|18092.68|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|CHAMPVA [1240]|CHAMP VA [124000]|115246.40|47586.81|66946.65|11050|||| MS485|DRG||Knee Procedures With Principal Diagnosis Of Infection With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|115246.40|66946.65|66946.65|11050|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|GEHA [1415]|GEHA [141500]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|99701.19|93014.4|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99701.19|11699.91|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99701.19|44823.18|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|||99701.19|29910.36|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99701.19|50155.03|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99701.19|25011.48|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99701.19|30046.85|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|UMR [2035]|UMR OPTIONS [203501]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99701.19|16679.72|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|99701.19|11699.91|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MULTIPLAN [1680]|IHC HS [168011]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MULTIPLAN [1680]|HMA [168003]|99701.19|315.81|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|HEALTHNET [1495]|HEALTHNET [149500]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|TRUSTMARK [2030]|STARMARK [203000]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|99701.19|2175|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99701.19|7650|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|CORESOURCE [1315]|CORESOURCE [131500]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99701.19|93014.4|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99701.19|69445.42|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|CHAMPVA [1240]|CHAMP VA [124000]|99701.19||||||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99701.19|31151.8|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99701.19|30423.49|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99701.19|16679.72|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99701.19|13564.07|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99701.19|25730.2|93014.4|315.81|||| MS486|DRG||Knee Procedures With Principal Diagnosis Of Infection With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99701.19|69445.42|93014.4|315.81|||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|GEHA [1415]|GEHA [141500]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52051.46||||||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52051.46|30236.7|30236.7|3400|||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52051.46|3400|30236.7|3400|||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52051.46|11927.07|30236.7|3400|||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|||52051.46|15615.44|30236.7|3400|||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52051.46|11927.07|30236.7|3400|||| MS487|DRG||Knee Procedures With Principal Diagnosis Of Infection Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52051.46|30236.7|30236.7|3400|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|GEHA [1415]|GEHA [141500]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|80620.33|25864.56|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80620.33|10155.09|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80620.33|46832.37|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|||80620.33|24186.1|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80620.33|52403.21|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80620.33|22901.8|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80620.33|26992.68|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80620.33|13909.19|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|80620.33|10155.09|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MULTIPLAN [1680]|HMA [168003]|80620.33|1528.06|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|80620.33|725|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|80620.33||||||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80620.33|2550|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80620.33|25864.56|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80620.33|72558.3|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80620.33|28631.7|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80620.33|27962.31|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80620.33|13909.19|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80620.33|24627.43|72558.3|725|||| MS488|DRG||Knee Procedures Without Principal Diagnosis Of Infection With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80620.33|72558.3|72558.3|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|68000.93||||||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68000.93|18823.9|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68000.93|1700|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68000.93|725|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|68000.93|2355.36|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68000.93|9138.21|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68000.93|10647.7|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68000.93|17408.35|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68000.93|14642.17|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68000.93|44660.44|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68000.93|39110.04|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68000.93|18383.81|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68000.93|10647.7|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|||68000.93|20400.28|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68000.93|39912.69|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68000.93|8280.43|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68000.93|9138.21|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68000.93|18695.76|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68000.93|39110.04|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|GEHA [1415]|GEHA [141500]|68000.93|61837.54|61837.54|725|||| MS489|DRG||Knee Procedures Without Principal Diagnosis Of Infection Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68000.93|61837.54|61837.54|725|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|GEHA [1415]|GEHA [141500]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127017.41|61317.36|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|CORESOURCE [1315]|CORESOURCE [131500]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127017.41|7712.36|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127017.41|72624.79|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|||127017.41|38105.22|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127017.41|81263.77|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127017.41|40068.84|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127017.41|44626.82|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|UMR [2035]|UMR OPTIONS [203501]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127017.41|65011.02|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127017.41|7712.36|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MULTIPLAN [1680]|IHC HS [168011]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MULTIPLAN [1680]|HMA [168003]|127017.41|9255.37|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|HEALTHNET [1495]|HEALTHNET [149500]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|TRUSTMARK [2030]|STARMARK [203000]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|AETNA [1015]|AETNA ACO WILCO [101532]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127017.41|4350|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127017.41|6800|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127017.41|61317.36|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127017.41|112519.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|CHAMPVA [1240]|CHAMP VA [124000]|127017.41||||||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127017.41|50288.9|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127017.41|49113.18|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127017.41|65011.02|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127017.41|21766.08|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127017.41|43087.99|112519.08|4350|||| MS492|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127017.41|112519.08|112519.08|4350|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|CHAMPVA [1240]|CHAMP VA [124000]|110300.74||||||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|110300.74|16022.7|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|110300.74|72789.66|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|110300.74|32927.16|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|110300.74|33715.4|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|110300.74|53932.17|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|110300.74|1700|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|TRUSTMARK [2030]|STARMARK [203000]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|HEALTHNET [1495]|HEALTHNET [149500]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MULTIPLAN [1680]|IHC HS [168011]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MULTIPLAN [1680]|HMA [168003]|110300.74|12333.37|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|110300.74|8527.78|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|110300.74|72789.66|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|UMR [2035]|UMR OPTIONS [203501]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|110300.74|2900|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|110300.74|29792.67|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|110300.74|26772.26|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|110300.74|90987.07|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|||110300.74|33090.22|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|110300.74|81314.44|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|110300.74|14456.47|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|110300.74|8527.78|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|110300.74|34183.99|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|CORESOURCE [1315]|CORESOURCE [131500]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|110300.74|53932.17|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|GEHA [1415]|GEHA [141500]|110300.74|125982.1|125982.1|1700|||| MS493|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|110300.74|125982.1|125982.1|1700|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|81557.78||||||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81557.78|43955.74|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81557.78|8002.75|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81557.78|47376.91|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81557.78|53012.57|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81557.78|23743.82|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81557.78|12433.08|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81557.78|8002.75|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|81557.78|2732.82|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81557.78|21066.58|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|||81557.78|24467.33|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81557.78|2175|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81557.78|850|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|GEHA [1415]|GEHA [141500]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81557.78|43955.74|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81557.78|73402|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81557.78|26852.55|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81557.78|26224.76|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81557.78|12433.08|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81557.78|22653.93|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81557.78|22653.93|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81557.78|22653.93|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81557.78|11593.31|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81557.78|22649.17|73402|850|||| MS494|DRG||Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81557.78|73402|73402|850|||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|AETNA [1015]|AETNA ACO WILCO [101532]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|HEALTHNET [1495]|HEALTHNET [149500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MULTIPLAN [1680]|HMA [168003]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|UMR [2035]|UMR OPTIONS [203501]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MULTIPLAN [1680]|IHC HS [168011]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|TRUSTMARK [2030]|STARMARK [203000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|CHAMPVA [1240]|CHAMP VA [124000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|CORESOURCE [1315]|CORESOURCE [131500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|GEHA [1415]|GEHA [141500]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|157900.83||||||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|157900.83|91724.64|91724.64|4250|||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|157900.83|4250|91724.64|4250|||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|157900.83|11736.49|91724.64|4250|||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|||157900.83|47370.25|91724.64|4250|||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|157900.83|16788.99|91724.64|4250|||| MS495|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|157900.83|91724.64|91724.64|4250|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|83927.12||||||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|CHAMPVA [1240]|CHAMP VA [124000]|83927.12||||||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83927.12||||||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|83927.12||||||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83927.12||||||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|GEHA [1415]|GEHA [141500]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83927.12|48753.26|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|||83927.12|25178.14|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83927.12|54552.63|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83927.12|23731.02|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|UMR [2035]|UMR OPTIONS [203501]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83927.12|13960.87|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83927.12|26696.59|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MULTIPLAN [1680]|IHC HS [168011]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MULTIPLAN [1680]|HMA [168003]|83927.12|2256.65|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|HEALTHNET [1495]|HEALTHNET [149500]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|TRUSTMARK [2030]|STARMARK [203000]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|83927.12|7250|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|CORESOURCE [1315]|CORESOURCE [131500]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83927.12||||||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83927.12|75534.41|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83927.12|28791.2|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83927.12|28118.08|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83927.12|13960.87|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83927.12|11826.76|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83927.12|71589.83|75534.41|2256.65|||| MS496|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83927.12|75534.41|75534.41|2256.65|||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|GEHA [1415]|GEHA [141500]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108535.14||||||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108535.14|63038.99|63038.99|1700|||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108535.14|1700|63038.99|1700|||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|108535.14|7053.82|63038.99|1700|||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|||108535.14|32560.54|63038.99|1700|||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108535.14|7053.82|63038.99|1700|||| MS497|DRG||Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|108535.14|63038.99|63038.99|1700|||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|||186894.07|56068.22|56068.22|56068.22|||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|GEHA [1415]|GEHA [141500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MULTIPLAN [1680]|HMA [168003]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186894.07||||||| MS498|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|186894.07||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|GEHA [1415]|GEHA [141500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51332.78||||||| MS499|DRG||Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/McC|||51332.78|15399.83|15399.83|15399.83|||| MS500|DRG||Soft Tissue Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|MULTIPLAN [1680]|HMA [168003]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|GEHA [1415]|GEHA [141500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|||205647.30|61694.19|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|205647.30|37430.1|61694.19|37430.1|||| MS500|DRG||Soft Tissue Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|205647.30||||||| MS500|DRG||Soft Tissue Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|205647.30||||||| MS501|DRG||Soft Tissue Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87062.70|41592.15|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|87062.70|3625|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87062.70|1700|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|87062.70|6393.94|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87062.70|19515.14|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|||87062.70|26118.81|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|87062.70|1012.54|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87062.70|47190.43|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|87062.70|41592.15|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87062.70|6393.94|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87062.70|52803.88|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87062.70|22839.34|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87062.70|13302.76|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|GEHA [1415]|GEHA [141500]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87062.70|13302.76|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87062.70|25302.5|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87062.70|73113.06|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|87062.70|24917.78|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87062.70|24710.95|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87062.70|11057.1|73113.06|1012.54|||| MS501|DRG||Soft Tissue Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|87062.70||||||| MS501|DRG||Soft Tissue Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87062.70|11057.1|73113.06|1012.54|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|||67875.63|20362.69|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67875.63|9364.58|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67875.63|6578.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67875.63|32315.71|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67875.63|51112.4|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|67875.63|428.05|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67875.63|17085.22|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67875.63|15359.74|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67875.63|28880.32|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67875.63|6578.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|67875.63||||||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67875.63|19296.6|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67875.63|51112.4|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67875.63|18845.46|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67875.63|1450|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67875.63|14590.81|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67875.63|8383.03|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67875.63|850|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67875.63|44744.83|51112.4|428.05|||| MS502|DRG||Soft Tissue Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67875.63|9364.58|51112.4|428.05|||| MS503|DRG||Foot Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|109640.91||||||| MS503|DRG||Foot Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|109640.91||||||| MS503|DRG||Foot Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109640.91||||||| MS503|DRG||Foot Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109640.91||||||| MS503|DRG||Foot Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|109640.91||||||| MS503|DRG||Foot Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|109640.91||||||| MS503|DRG||Foot Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MULTIPLAN [1680]|HMA [168003]|109640.91||||||| MS503|DRG||Foot Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|109640.91||||||| MS503|DRG||Foot Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109640.91||||||| MS503|DRG||Foot Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|109640.91||||||| MS503|DRG||Foot Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109640.91||||||| MS503|DRG||Foot Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109640.91||||||| MS503|DRG||Foot Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109640.91||||||| MS503|DRG||Foot Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109640.91||||||| MS503|DRG||Foot Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|109640.91||||||| MS503|DRG||Foot Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109640.91||||||| MS503|DRG||Foot Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109640.91||||||| MS503|DRG||Foot Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109640.91||||||| MS503|DRG||Foot Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109640.91||||||| MS503|DRG||Foot Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109640.91||||||| MS503|DRG||Foot Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|GEHA [1415]|GEHA [141500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109640.91|53268.65|53268.65|850|||| MS503|DRG||Foot Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109640.91|850|53268.65|850|||| MS503|DRG||Foot Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|||109640.91|32892.27|53268.65|850|||| MS503|DRG||Foot Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109640.91||||||| MS503|DRG||Foot Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109640.91|15454.58|53268.65|850|||| MS503|DRG||Foot Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109640.91||||||| MS503|DRG||Foot Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109640.91||||||| MS503|DRG||Foot Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109640.91||||||| MS503|DRG||Foot Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109640.91||||||| MS503|DRG||Foot Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109640.91||||||| MS503|DRG||Foot Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109640.91|16548.93|53268.65|850|||| MS503|DRG||Foot Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|109640.91|53268.65|53268.65|850|||| MS503|DRG||Foot Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|109640.91|15454.58|53268.65|850|||| MS504|DRG||Foot Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|GEHA [1415]|GEHA [141500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119411.19|6563.47|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|||119411.19|35823.36|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119411.19|6563.47|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119411.19|57040.86|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119411.19|57040.86|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119411.19|4250|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119411.19||||||| MS504|DRG||Foot Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119411.19|11121.46|57040.86|4250|||| MS504|DRG||Foot Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119411.19|11121.46|57040.86|4250|||| MS505|DRG||Foot Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|||120839.87|36251.96|70195.87|3400|||| MS505|DRG||Foot Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|120839.87|4499.13|70195.87|3400|||| MS505|DRG||Foot Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120839.87|3400|70195.87|3400|||| MS505|DRG||Foot Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120839.87|70195.87|70195.87|3400|||| MS505|DRG||Foot Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120839.87|4499.13|70195.87|3400|||| MS505|DRG||Foot Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|120839.87|70195.87|70195.87|3400|||| MS505|DRG||Foot Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|120839.87||||||| MS505|DRG||Foot Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|120839.87||||||| MS506|DRG||Major Thumb Or Joint Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66113.18|7072.37|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|GEHA [1415]|GEHA [141500]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66113.18|39264.68|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|CORESOURCE [1315]|CORESOURCE [131500]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|||66113.18|19833.95|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66113.18|15567.92|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66113.18|18648.14|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MULTIPLAN [1680]|HMA [168003]|66113.18|515.18|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|CHAMPVA [1240]|CHAMP VA [124000]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66113.18|7072.37|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66113.18|24367.94|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|TRUSTMARK [2030]|STARMARK [203000]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66113.18|1700|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|HEALTHNET [1495]|HEALTHNET [149500]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66113.18|1450|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66113.18|10401.41|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66113.18|39264.68|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MULTIPLAN [1680]|IHC HS [168011]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66113.18|21397.65|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66113.18|21777.44|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66113.18|10401.41|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66113.18|20897.39|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|UMR [2035]|UMR OPTIONS [203501]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66113.18|11114.33|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66113.18||||||| MS506|DRG||Major Thumb Or Joint Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66113.18|33740.23|39264.68|515.18|||| MS506|DRG||Major Thumb Or Joint Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|66113.18|33740.23|39264.68|515.18|||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|||190389.03|57116.71|57116.71|57116.71|||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|190389.03||||||| MS507|DRG||Major Shoulder Or Elbow Joint Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|190389.03||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|GEHA [1415]|GEHA [141500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MULTIPLAN [1680]|HMA [168003]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|||149337.76|44801.33|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|149337.76||||||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|149337.76|17182.82|44801.33|17182.82|||| MS510|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|149337.76||||||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100489.54||||||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100489.54|13331.02|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100489.54||||||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|100489.54|725|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|100489.54||||||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|100489.54||||||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100489.54||||||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100489.54|28543.25|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|100489.54||||||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100489.54|27875.93|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100489.54|21913.25|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100489.54|24146.72|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|||100489.54|30146.86|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|100489.54|2217.6|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100489.54|45240.39|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100489.54|13331.02|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100489.54|12446.06|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|GEHA [1415]|GEHA [141500]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100489.54|62640.53|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100489.54|27979.79|62640.53|725|||| MS511|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100489.54|40430.97|62640.53|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|68675.68||||||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68675.68||||||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68675.68||||||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68675.68|17605.49|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68675.68||||||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68675.68|41613.81|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68675.68|20225.92|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|||68675.68|20602.7|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68675.68||||||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68675.68||||||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68675.68|46563.91|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68675.68|725|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68675.68|22564.9|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68675.68|10467.62|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68675.68|22037.35|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|68675.68|2133.04|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68675.68|16863.74|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68675.68|9804.5|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68675.68|64473.1|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68675.68|10467.62|64473.1|725|||| MS512|DRG||Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68675.68|16863.74|64473.1|725|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64842.99|46796.25|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64842.99|11678.07|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64842.99|22605.5|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64842.99|2550|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64842.99|1450|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64842.99|22077|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|||64842.99|19452.9|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64842.99|21457.59|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|64842.99|282.16|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64842.99|18341.67|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64842.99|5943.89|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64842.99|42147.94|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64842.99|5943.89|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64842.99|46796.25|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64842.99||||||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64842.99|11678.07|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64842.99|18692.49|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64842.99|58358.69|58358.69|282.16|||| MS513|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64842.99|37667.3|58358.69|282.16|||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|||65292.99|19587.9|37928.69|1700|||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65292.99|37928.69|37928.69|1700|||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65292.99|1700|37928.69|1700|||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65292.99|5641.58|37928.69|1700|||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65292.99|5641.58|37928.69|1700|||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65292.99|37928.69|37928.69|1700|||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65292.99||||||| MS514|DRG||Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65292.99||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|||118696.22|35608.87|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118696.22|14529.88|35608.87|14529.88|||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118696.22||||||| MS515|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118696.22||||||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|||85691.25|25707.37|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|85691.25||||||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85691.25|55699.31|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85691.25|22551.73|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85691.25|25444.64|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85691.25|49811.19|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85691.25|16500.46|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85691.25|49778.04|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85691.25|12084.59|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85691.25|12084.59|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85691.25|12400.07|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85691.25|2900|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85691.25|1700|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85691.25|49811.19|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|85691.25|2463.46|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85691.25|28435.95|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85691.25|27771.14|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85691.25|16500.46|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|85691.25|77122.13|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85691.25|12253.89|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85691.25|28795.03|77122.13|1700|||| MS516|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85691.25|77122.13|77122.13|1700|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66768.94|13930.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66768.94|19778.67|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66768.94|28789.56|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66768.94|850|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66768.94|725|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|66768.94||||||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66768.94|11401.29|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66768.94|13930.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|66768.94|158.98|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66768.94|16459.94|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66768.94|36785.46|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|||66768.94|20030.68|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66768.94|32874.88|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66768.94|20252.15|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66768.94|11401.29|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66768.94|17700.18|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66768.94|8892.57|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66768.94|28789.56|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66768.94|50933.72|50933.72|158.98|||| MS517|DRG||Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66768.94|19415.8|50933.72|158.98|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|CHAMPVA [1240]|CHAMP VA [124000]|123262.69|91921.34|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|CORESOURCE [1315]|CORESOURCE [131500]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|123262.69|76237.32|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|123262.69|39642.02|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|123262.69|85306|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|UMR [2035]|UMR OPTIONS [203501]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|123262.69|68244.81|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|123262.69|14568.03|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|FIRST HEALTH [1375]|QUALCHOICE [137513]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MULTIPLAN [1680]|HMA [168003]|123262.69|15883.56|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|AETNA [1015]|COVENTRY HEALTHCARE [101502]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|TRUSTMARK [2030]|STARMARK [203000]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|GEHA [1415]|GEHA [141500]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|123262.69|70369.47|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|123262.69|14568.03|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|123262.69|39113.36|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|||123262.69|36978.81|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|123262.69|725|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|123262.69|850|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|AETNA [1015]|AETNA ACO WILCO [101532]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|123262.69|70369.47|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MULTIPLAN [1680]|IHC HS [168011]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|123262.69|51972.35|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|123262.69|50757.27|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|123262.69|68244.81|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|FMH BENEFIT SERVICES [1390]|FMH [139000]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|123262.69|22487.59|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|123262.69|43408.52|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|HEALTHNET [1495]|HEALTHNET [149500]|123262.69|118116|118116|725|||| MS518|DRG||Back And Neck Procedures Except Spinal Fusion With McC Or Disc Device Or Neurostimulator|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|123262.69|22487.59|118116|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|CHAMPVA [1240]|CHAMP VA [124000]|81684.81||||||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81684.81|28386.65|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81684.81|1700|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81684.81|725|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81684.81|27722.99|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|HEALTHNET [1495]|HEALTHNET [149500]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MULTIPLAN [1680]|IHC HS [168011]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MULTIPLAN [1680]|HMA [168003]|81684.81|960.72|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81684.81|13297.91|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|TRUSTMARK [2030]|STARMARK [203000]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81684.81|22198.18|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81684.81|44951.99|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81684.81|39328.85|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|||81684.81|24505.44|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81684.81|35147.89|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81684.81|24387.38|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81684.81|8196.13|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81684.81|8196.13|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81684.81|23870.79|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|CORESOURCE [1315]|CORESOURCE [131500]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81684.81|44951.99|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|GEHA [1415]|GEHA [141500]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81684.81|54455.33|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81684.81|13297.91|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81684.81|12378.95|54455.33|725|||| MS519|DRG||Back And Neck Procedures Except Spinal Fusion With Cc|UMR [2035]|UMR OPTIONS [203501]|81684.81|54455.33|54455.33|725|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81035.53||||||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81035.53||||||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81035.53||||||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|GEHA [1415]|GEHA [141500]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81035.53|42578.96|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|||81035.53|24310.66|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81035.53|47643.87|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|81035.53|79152|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81035.53|17530.03|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81035.53||||||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81035.53||||||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|81035.53|603.7|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81035.53|15560.94|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81035.53|1450|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81035.53|20552.3|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81035.53|20071.8|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81035.53|9202.27|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81035.53|9021.21|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81035.53|9202.27|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81035.53|19868.89|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81035.53|65968.45|79152|603.7|||| MS520|DRG||Back And Neck Procedures Except Spinal Fusion Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81035.53|9021.21|79152|603.7|||| MS533|DRG||Fractures Of Femur With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|TRUSTMARK [2030]|STARMARK [203000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|HEALTHNET [1495]|HEALTHNET [149500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MULTIPLAN [1680]|IHC HS [168011]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MULTIPLAN [1680]|HMA [168003]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|AETNA [1015]|AETNA ACO WILCO [101532]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|CHAMPVA [1240]|CHAMP VA [124000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|UMR [2035]|UMR OPTIONS [203501]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|CORESOURCE [1315]|CORESOURCE [131500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|GEHA [1415]|GEHA [141500]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118951.16||||||| MS533|DRG||Fractures Of Femur With McC|||118951.16|35685.35|35685.35|35685.35|||| MS534|DRG||Fractures Of Femur Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|GEHA [1415]|GEHA [141500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|CORESOURCE [1315]|CORESOURCE [131500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|UMR [2035]|UMR OPTIONS [203501]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|MULTIPLAN [1680]|IHC HS [168011]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|MULTIPLAN [1680]|HMA [168003]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|TRUSTMARK [2030]|STARMARK [203000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|CHAMPVA [1240]|CHAMP VA [124000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|||53451.00|16035.3|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|HEALTHNET [1495]|HEALTHNET [149500]|53451.00||||||| MS534|DRG||Fractures Of Femur Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|53451.00|5113.48|16035.3|5113.48|||| MS534|DRG||Fractures Of Femur Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|53451.00||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|TRUSTMARK [2030]|STARMARK [203000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MULTIPLAN [1680]|IHC HS [168011]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MULTIPLAN [1680]|HMA [168003]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|UMR [2035]|UMR OPTIONS [203501]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|GEHA [1415]|GEHA [141500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|HEALTHNET [1495]|HEALTHNET [149500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42778.88|41242.45|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|CHAMPVA [1240]|CHAMP VA [124000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|CORESOURCE [1315]|CORESOURCE [131500]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42778.88|4250|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42778.88|6613.64|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42778.88||||||| MS535|DRG||Fractures Of Hip And Pelvis With McC|||42778.88|12833.66|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42778.88|8892.4|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42778.88|6613.64|41242.45|4250|||| MS535|DRG||Fractures Of Hip And Pelvis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42778.88|41242.45|41242.45|4250|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|CHAMPVA [1240]|CHAMP VA [124000]|34942.13||||||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|GEHA [1415]|GEHA [141500]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|||34942.13|10482.64|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34942.13|23504.22|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34942.13|8821.36|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34942.13|10200.84|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|CORESOURCE [1315]|CORESOURCE [131500]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34942.13|5814.81|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34942.13|5163.19|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MULTIPLAN [1680]|IHC HS [168011]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|HEALTHNET [1495]|HEALTHNET [149500]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|UMR [2035]|UMR OPTIONS [203501]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34942.13|5163.19|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|TRUSTMARK [2030]|STARMARK [203000]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34942.13|2175|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34942.13|1700|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34942.13|26300.12|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34942.13|14958.09|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34942.13|14958.09|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34942.13|11188.2|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34942.13|10926.63|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34942.13|5814.81|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34942.13|5007.83|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34942.13|9486.04|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34942.13|36415.54|36415.54|181.89|||| MS536|DRG||Fractures Of Hip And Pelvis Without McC|MULTIPLAN [1680]|HMA [168003]|34942.13|181.89|36415.54|181.89|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MULTIPLAN [1680]|HMA [168003]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|GEHA [1415]|GEHA [141500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30519.76||||||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|||30519.76|9155.93|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30519.76|6012.11|9155.93|6012.11|||| MS537|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30519.76||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|GEHA [1415]|GEHA [141500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23739.00||||||| MS538|DRG||Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/McC|||23739.00|7121.7|7121.7|7121.7|||| MS539|DRG||Osteomyelitis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|TRUSTMARK [2030]|STARMARK [203000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MULTIPLAN [1680]|IHC HS [168011]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MULTIPLAN [1680]|HMA [168003]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|UMR [2035]|UMR OPTIONS [203501]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|HEALTHNET [1495]|HEALTHNET [149500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|CORESOURCE [1315]|CORESOURCE [131500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|GEHA [1415]|GEHA [141500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|||85117.44|25535.23|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85117.44|12276.4|25535.23|12276.4|||| MS539|DRG||Osteomyelitis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85117.44||||||| MS539|DRG||Osteomyelitis With McC|CHAMPVA [1240]|CHAMP VA [124000]|85117.44||||||| MS540|DRG||Osteomyelitis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|GEHA [1415]|GEHA [141500]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81042.30|4461.31|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|||81042.30|24312.69|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81042.30|87487.3|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81042.30|87487.3|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81042.30|14490|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81042.30|87487.3|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MULTIPLAN [1680]|IHC HS [168011]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81042.30|9010.44|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|UMR [2035]|UMR OPTIONS [203501]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81042.30|9010.44|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81042.30|3625|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81042.30|850|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81042.30|50821.37|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81042.30|56866.75|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81042.30|4461.31|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81042.30|20983.42|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81042.30|87487.3|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MULTIPLAN [1680]|HMA [168003]|81042.30|1864.86|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81042.30|87487.3|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81042.30|87487.3|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|81042.30||||||| MS540|DRG||Osteomyelitis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|TRUSTMARK [2030]|STARMARK [203000]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81042.30|19984.21|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81042.30|16495.65|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81042.30|78738.57|87487.3|850|||| MS540|DRG||Osteomyelitis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81042.30|78738.57|87487.3|850|||| MS541|DRG||Osteomyelitis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51841.67|11903.74|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51841.67|12188.7|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51841.67|4350|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51841.67|7443.54|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51841.67|12777.75|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51841.67|10544.92|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51841.67|7443.54|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51841.67|49428.44|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|||51841.67|15552.5|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51841.67|44173.85|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|51841.67|1239.84|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|51841.67|11339.47|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51841.67||||||| MS541|DRG||Osteomyelitis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|GEHA [1415]|GEHA [141500]|51841.67|68439.39|68439.39|1239.84|||| MS541|DRG||Osteomyelitis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51841.67|68439.39|68439.39|1239.84|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|HEALTHNET [1495]|HEALTHNET [149500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|TRUSTMARK [2030]|STARMARK [203000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66107.76|57223.28|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66107.76|7627.54|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|||66107.76|19832.33|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66107.76|7627.54|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MULTIPLAN [1680]|HMA [168003]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66107.76|8500|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66107.76|57223.28|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66107.76|11431.84|57223.28|7627.54|||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|CORESOURCE [1315]|CORESOURCE [131500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|CHAMPVA [1240]|CHAMP VA [124000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|GEHA [1415]|GEHA [141500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|UMR [2035]|UMR OPTIONS [203501]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MULTIPLAN [1680]|IHC HS [168011]|66107.76||||||| MS542|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66107.76||||||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31106.30||||||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31106.30||||||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31106.30||||||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31106.30||||||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31106.30|9065.8|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31106.30|14774.17|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31106.30|15127.85|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31106.30|2900|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|TRUSTMARK [2030]|STARMARK [203000]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MULTIPLAN [1680]|IHC HS [168011]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MULTIPLAN [1680]|HMA [168003]|31106.30|338.03|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31106.30|9065.8|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|UMR [2035]|UMR OPTIONS [203501]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31106.30|14598.9|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31106.30|12284.77|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|31106.30||||||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31106.30|33470.06|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|||31106.30|9331.89|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31106.30||||||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31106.30|29911.95|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31106.30|5799.93|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31106.30|13210.42|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|GEHA [1415]|GEHA [141500]|31106.30|46343.16|46343.16|338.03|||| MS543|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31106.30|46343.16|46343.16|338.03|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32951.18||||||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|||32951.18|9885.35|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32951.18|5036.41|9885.35|5036.41|||| MS544|DRG||Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32951.18|5036.41|9885.35|5036.41|||| MS545|DRG||Connective Tissue Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MULTIPLAN [1680]|HMA [168003]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|GEHA [1415]|GEHA [141500]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68634.54||||||| MS545|DRG||Connective Tissue Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|||68634.54|20590.36|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68634.54|15746.01|20590.36|15746.01|||| MS545|DRG||Connective Tissue Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68634.54|15746.01|20590.36|15746.01|||| MS546|DRG||Connective Tissue Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38445.87|16420.9|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38445.87|5750.04|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|||38445.87|11533.76|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|GEHA [1415]|GEHA [141500]|38445.87||||||| MS546|DRG||Connective Tissue Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38445.87|5750.04|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38445.87|850|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38445.87|16420.9|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38445.87|8714.7|16420.9|850|||| MS546|DRG||Connective Tissue Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38445.87|8714.7|16420.9|850|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|15153.64||||||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|||15153.64|4546.09|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|15153.64|5389.41|5389.41|4546.09|||| MS547|DRG||Connective Tissue Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15153.64|5389.41|5389.41|4546.09|||| MS548|DRG||Septic Arthritis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|GEHA [1415]|GEHA [141500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|CORESOURCE [1315]|CORESOURCE [131500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|CHAMPVA [1240]|CHAMP VA [124000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|UMR [2035]|UMR OPTIONS [203501]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MULTIPLAN [1680]|IHC HS [168011]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MULTIPLAN [1680]|HMA [168003]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|HEALTHNET [1495]|HEALTHNET [149500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|TRUSTMARK [2030]|STARMARK [203000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|215590.00||||||| MS548|DRG||Septic Arthritis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|215590.00|125236.21|125236.21|10200|||| MS548|DRG||Septic Arthritis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|215590.00|17603.52|125236.21|10200|||| MS548|DRG||Septic Arthritis With McC|||215590.00|64677|125236.21|10200|||| MS548|DRG||Septic Arthritis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|215590.00|17603.52|125236.21|10200|||| MS548|DRG||Septic Arthritis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|215590.00|10200|125236.21|10200|||| MS548|DRG||Septic Arthritis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|215590.00|125236.21|125236.21|10200|||| MS549|DRG||Septic Arthritis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|52932.90||||||| MS549|DRG||Septic Arthritis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52932.90|9297.56|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52932.90|17657.35|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52932.90|17668.28|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52932.90|850|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52932.90|2175|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|TRUSTMARK [2030]|STARMARK [203000]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MULTIPLAN [1680]|IHC HS [168011]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MULTIPLAN [1680]|HMA [168003]|52932.90|1276.79|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52932.90|8798.06|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52932.90|9297.56|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|UMR [2035]|UMR OPTIONS [203501]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52932.90|16150.99|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52932.90|13875.75|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52932.90|10430.8|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52932.90|37234.69|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|||52932.90|15879.87|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52932.90|33276.38|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52932.90|7961.62|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52932.90|8798.06|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52932.90|5915.72|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52932.90|17668.28|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|GEHA [1415]|GEHA [141500]|52932.90|51555.73|51555.73|850|||| MS549|DRG||Septic Arthritis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52932.90|51555.73|51555.73|850|||| MS550|DRG||Septic Arthritis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|GEHA [1415]|GEHA [141500]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12587.20|7311.89|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12587.20|5652.49|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12587.20|44975.97|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|||12587.20|3776.16|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12587.20|10048.32|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12587.20|12176.11|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12587.20|50326.02|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12587.20|6774.93|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12587.20|5652.49|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|12587.20|420.15|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12587.20||||||| MS550|DRG||Septic Arthritis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12587.20|2175|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12587.20|850|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12587.20|7311.89|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12587.20|69682.19|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12587.20|12799.15|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12587.20|12499.91|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12587.20|6774.93|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12587.20|15090.45|69682.19|420.15|||| MS550|DRG||Septic Arthritis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12587.20|69682.19|69682.19|420.15|||| MS551|DRG||Medical Back Problems With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|89121.90|6840|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|89121.90|7912.63|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|89121.90|5509.99|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|89121.90|6689.35|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|89121.90|23534.95|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|89121.90|4350|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|AETNA [1015]|AETNA ACO WILCO [101532]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|TRUSTMARK [2030]|STARMARK [203000]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|HEALTHNET [1495]|HEALTHNET [149500]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MULTIPLAN [1680]|IHC HS [168011]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MULTIPLAN [1680]|HMA [168003]|89121.90|191.04|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|89121.90|5569.29|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|89121.90|6840|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|UMR [2035]|UMR OPTIONS [203501]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|89121.90|2550|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|89121.90|21000.62|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|89121.90|20868.26|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|89121.90|5742|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|89121.90|18484.72|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|89121.90|31203.12|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|||89121.90|26736.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|89121.90|27886.01|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|89121.90|10299.54|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|89121.90|5569.29|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|CHAMPVA [1240]|CHAMP VA [124000]|89121.90|61518.26|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|89121.90|18097.57|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|CORESOURCE [1315]|CORESOURCE [131500]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|89121.90|20868.26|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|GEHA [1415]|GEHA [141500]|89121.90|43204.33|61518.26|191.04|||| MS551|DRG||Medical Back Problems With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|89121.90|43204.33|61518.26|191.04|||| MS552|DRG||Medical Back Problems Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|GEHA [1415]|GEHA [141500]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|87072.14|48271.62|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|CHAMPVA [1240]|CHAMP VA [124000]|87072.14|91921.34|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|87072.14|14872|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|87072.14|46517.6|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|||87072.14|26121.64|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87072.14|10605.4|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|87072.14|12084.18|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87072.14|13455|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87072.14|7023.64|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|87072.14|19255.39|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|UMR [2035]|UMR OPTIONS [203501]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MULTIPLAN [1680]|IHC HS [168011]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MULTIPLAN [1680]|HMA [168003]|87072.14|224.01|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|HEALTHNET [1495]|HEALTHNET [149500]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|87072.14|27866.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|TRUSTMARK [2030]|STARMARK [203000]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|87072.14|3625|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|87072.14|9350|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|87072.14|48271.62|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|87072.14|22797.44|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87072.14|13659|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87072.14|13339.66|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|CORESOURCE [1315]|CORESOURCE [131500]|87072.14|38584.8|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|87072.14|7023.64|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87072.14|21711.84|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|87072.14|13541.43|91921.34|224.01|||| MS552|DRG||Medical Back Problems Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|87072.14|38584.8|91921.34|224.01|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52772.47||||||| MS553|DRG||Bone Diseases And Arthropathies With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52772.47||||||| MS553|DRG||Bone Diseases And Arthropathies With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52772.47||||||| MS553|DRG||Bone Diseases And Arthropathies With McC|CHAMPVA [1240]|CHAMP VA [124000]|52772.47||||||| MS553|DRG||Bone Diseases And Arthropathies With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52772.47||||||| MS553|DRG||Bone Diseases And Arthropathies With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52772.47|9841|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52772.47|18390.35|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|AETNA [1015]|AETNA ACO WILCO [101532]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|TRUSTMARK [2030]|STARMARK [203000]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|HEALTHNET [1495]|HEALTHNET [149500]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MULTIPLAN [1680]|IHC HS [168011]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MULTIPLAN [1680]|HMA [168003]|52772.47|279.14|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52772.47|1450|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52772.47|9841|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|UMR [2035]|UMR OPTIONS [203501]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52772.47|17960.4|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52772.47|17428.63|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52772.47|14950.37|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52772.47||||||| MS553|DRG||Bone Diseases And Arthropathies With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52772.47|33602.81|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|||52772.47|15831.74|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52772.47|30030.56|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52772.47|8094.61|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52772.47|16105.86|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|CORESOURCE [1315]|CORESOURCE [131500]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|GEHA [1415]|GEHA [141500]|52772.47|46526.97|46526.97|279.14|||| MS553|DRG||Bone Diseases And Arthropathies With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52772.47|46526.97|46526.97|279.14|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|CHAMPVA [1240]|CHAMP VA [124000]|35861.49||||||| MS554|DRG||Bone Diseases And Arthropathies Without McC|GEHA [1415]|GEHA [141500]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35861.49|17195.14|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|CORESOURCE [1315]|CORESOURCE [131500]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35861.49|8223|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35861.49|10451.67|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|||35861.49|10758.45|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35861.49|11694.93|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35861.49|9155.14|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|UMR [2035]|UMR OPTIONS [203501]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35861.49|5873.76|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35861.49|8223|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MULTIPLAN [1680]|IHC HS [168011]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MULTIPLAN [1680]|HMA [168003]|35861.49|50.75|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35861.49|10161.63|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|HEALTHNET [1495]|HEALTHNET [149500]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|TRUSTMARK [2030]|STARMARK [203000]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35861.49|725|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35861.49|850|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35861.49|17195.14|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35861.49|16192.98|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35861.49|11460.8|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35861.49|11192.85|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35861.49|5873.76|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35861.49|5124.65|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35861.49|11689.68|17195.14|50.75|||| MS554|DRG||Bone Diseases And Arthropathies Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35861.49|16192.98|17195.14|50.75|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|CHAMPVA [1240]|CHAMP VA [124000]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44616.89|19760.6|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44616.89|2175|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|AETNA ACO WILCO [101532]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|TRUSTMARK [2030]|STARMARK [203000]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44616.89|19298.61|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|HEALTHNET [1495]|HEALTHNET [149500]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|IHC HS [168011]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|HMA [168003]|44616.89|233.42|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44616.89|10203.57|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44616.89|10203.57|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|UMR [2035]|UMR OPTIONS [203501]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44616.89|17196.09|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44616.89||||||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44616.89|15296.94|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44616.89|28446.53|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|||44616.89|13385.07|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44616.89|25422.43|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44616.89|15785.85|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|CORESOURCE [1315]|CORESOURCE [131500]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|GEHA [1415]|GEHA [141500]|44616.89|39387.5|39387.5|233.42|||| MS555|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44616.89|39387.5|39387.5|233.42|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|GEHA [1415]|GEHA [141500]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27107.38|10689.38|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|CORESOURCE [1315]|CORESOURCE [131500]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|CHAMPVA [1240]|CHAMP VA [124000]|27107.38|23213.67|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27107.38|14096.37|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|||27107.38|8132.21|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27107.38|9208.63|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27107.38|10532.08|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27107.38|5800.27|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27107.38|3145.12|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|UMR [2035]|UMR OPTIONS [203501]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MULTIPLAN [1680]|IHC HS [168011]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MULTIPLAN [1680]|HMA [168003]|27107.38|477.2|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|HEALTHNET [1495]|HEALTHNET [149500]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27107.38|15773.18|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|TRUSTMARK [2030]|STARMARK [203000]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27107.38|3145.12|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27107.38|1450|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27107.38|1700|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27107.38|10689.38|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27107.38|21839.79|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27107.38|11691.35|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27107.38|11418.01|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27107.38|5800.27|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27107.38|12019.73|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27107.38|9902.5|23213.67|477.2|||| MS556|DRG||Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27107.38|21839.79|23213.67|477.2|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|CHAMPVA [1240]|CHAMP VA [124000]|64448.54||||||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64448.54|11522.22|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64448.54|34409.82|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64448.54|5100|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64448.54|1450|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|TRUSTMARK [2030]|STARMARK [203000]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MULTIPLAN [1680]|IHC HS [168011]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MULTIPLAN [1680]|HMA [168003]|64448.54|41.33|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|HEALTHNET [1495]|HEALTHNET [149500]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64448.54|7272.16|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64448.54|11522.22|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|UMR [2035]|UMR OPTIONS [203501]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64448.54|16958.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64448.54|11395.85|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|||64448.54|19334.56|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64448.54|10184.39|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64448.54|8875.17|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64448.54|7272.16|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64448.54|17532.08|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|CORESOURCE [1315]|CORESOURCE [131500]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64448.54|34409.82|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|GEHA [1415]|GEHA [141500]|64448.54|15778.87|34409.82|41.33|||| MS557|DRG||Tendonitis, Myositis And Bursitis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64448.54|15778.87|34409.82|41.33|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|CHAMPVA [1240]|CHAMP VA [124000]|39988.48||||||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|GEHA [1415]|GEHA [141500]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39988.48|15142.65|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|CORESOURCE [1315]|CORESOURCE [131500]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39988.48|4355.89|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|||39988.48|11996.54|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39988.48|25536.32|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39988.48|10018.08|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|UMR [2035]|UMR OPTIONS [203501]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39988.48|6881.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39988.48|4355.89|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MULTIPLAN [1680]|IHC HS [168011]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39988.48|11581.23|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MULTIPLAN [1680]|HMA [168003]|39988.48|221.68|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|HEALTHNET [1495]|HEALTHNET [149500]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|TRUSTMARK [2030]|STARMARK [203000]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39988.48|22821.61|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39988.48|725|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39988.48|850|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39988.48|15142.65|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39988.48|35357.98|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39988.48|12445.35|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39988.48|12154.39|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39988.48|6881.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39988.48|5446.62|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39988.48|12791.52|35357.98|221.68|||| MS558|DRG||Tendonitis, Myositis And Bursitis Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39988.48|35357.98|35357.98|221.68|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96096.72|7967.3|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96096.72|5525.9|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96096.72|6710|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96096.72|27084.55|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96096.72|31668.94|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96096.72|36778.67|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96096.72|7250|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|AETNA ACO WILCO [101532]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|TRUSTMARK [2030]|STARMARK [203000]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|HEALTHNET [1495]|HEALTHNET [149500]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|IHC HS [168011]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MULTIPLAN [1680]|HMA [168003]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96096.72|15754.41|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96096.72|11400|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96096.72|15525|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|UMR [2035]|UMR OPTIONS [203501]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96096.72|7650|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96096.72|22731.18|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96096.72|20954.93|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96096.72|9570|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96096.72|42774.45|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96096.72|11400|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|||96096.72|28829.02|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96096.72|38227.2|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96096.72|30160.89|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96096.72|12168|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|CHAMPVA [1240]|CHAMP VA [124000]|96096.72|56669.09|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96096.72|8052|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|CORESOURCE [1315]|CORESOURCE [131500]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96096.72|36778.67|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|GEHA [1415]|GEHA [141500]|96096.72|59226.16|59226.16|5525.9|||| MS559|DRG||Aftercare, Musculoskeletal System And Connective Tissue With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96096.72|59226.16|59226.16|5525.9|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|GEHA [1415]|GEHA [141500]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86560.78|40314.79|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|CHAMPVA [1240]|CHAMP VA [124000]|86560.78|53550.75|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86560.78|45840.07|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|||86560.78|25968.23|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86560.78|44959.14|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86560.78|12135.91|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86560.78|14563.74|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86560.78|12420|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86560.78|13680|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86560.78|15754.41|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|UMR [2035]|UMR OPTIONS [203501]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MULTIPLAN [1680]|IHC HS [168011]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MULTIPLAN [1680]|HMA [168003]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|HEALTHNET [1495]|HEALTHNET [149500]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|TRUSTMARK [2030]|STARMARK [203000]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|86560.78|19174.04|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86560.78|8700|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86560.78|7650|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86560.78|12168|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86560.78|22036.64|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|CORESOURCE [1315]|CORESOURCE [131500]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86560.78|40314.79|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86560.78|62251.11|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86560.78|26576.32|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86560.78|15607.8|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86560.78|11484|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86560.78|13680|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86560.78|9560.76|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86560.78|6631.08|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86560.78|8052|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86560.78|25310.78|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86560.78|22036.64|62251.11|6631.08|||| MS560|DRG||Aftercare, Musculoskeletal System And Connective Tissue With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86560.78|62251.11|62251.11|6631.08|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71043.54|19872.18|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71043.54|11400|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71043.54|7967.3|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71043.54|6710|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71043.54|9570|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71043.54|11470.95|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71043.54|37502.58|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71043.54|19872.18|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71043.54|9350|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71043.54|7250|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71043.54|19255.39|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71043.54|11400|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71043.54|12420|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71043.54|10290.07|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71043.54|20808.7|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71043.54|8692.26|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71043.54|39338.65|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|||71043.54|21313.06|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71043.54|35156.66|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71043.54|5525.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71043.54|19817.81|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71043.54|14872|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|71043.54|58380.98|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71043.54|8052|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71043.54|37502.58|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|GEHA [1415]|GEHA [141500]|71043.54|54468.9|58380.98|5525.9|||| MS561|DRG||Aftercare, Musculoskeletal System And Connective Tissue Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71043.54|54468.9|58380.98|5525.9|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|CHAMPVA [1240]|CHAMP VA [124000]|54210.33||||||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|GEHA [1415]|GEHA [141500]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54210.33|31251.76|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|CORESOURCE [1315]|CORESOURCE [131500]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54210.33|5621.27|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|||54210.33|16263.1|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54210.33|19007.21|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54210.33|15666.77|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54210.33|18683.29|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|UMR [2035]|UMR OPTIONS [203501]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54210.33|11067.6|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54210.33|5621.27|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MULTIPLAN [1680]|IHC HS [168011]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MULTIPLAN [1680]|HMA [168003]|54210.33|71.05|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|HEALTHNET [1495]|HEALTHNET [149500]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|TRUSTMARK [2030]|STARMARK [203000]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54210.33|16986.6|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|AETNA [1015]|AETNA ACO WILCO [101532]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54210.33|725|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54210.33|5100|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54210.33|31251.76|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54210.33|26317.68|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54210.33|20416|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54210.33|19938.69|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54210.33|11067.6|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54210.33|8962.78|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54210.33|16847.25|31251.76|71.05|||| MS562|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54210.33|26317.68|31251.76|71.05|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31374.20|6262.97|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31374.20|12331.4|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31374.20|12626.6|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31374.20|16488.42|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31374.20|850|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31374.20|3625|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|TRUSTMARK [2030]|STARMARK [203000]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|HEALTHNET [1495]|HEALTHNET [149500]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MULTIPLAN [1680]|HMA [168003]|31374.20|412.8|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MULTIPLAN [1680]|IHC HS [168011]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31374.20|3815.25|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31374.20|6262.97|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|UMR [2035]|UMR OPTIONS [203501]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31374.20|11133.72|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31374.20|5624.3|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31374.20|9932.02|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31374.20|26295.38|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|||31374.20|9412.26|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31374.20|23499.97|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31374.20|5658.29|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|CHAMPVA [1240]|CHAMP VA [124000]|31374.20||||||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31374.20|3815.25|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31374.20|10680.39|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|CORESOURCE [1315]|CORESOURCE [131500]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31374.20|16488.42|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|GEHA [1415]|GEHA [141500]|31374.20|36408.99|36408.99|412.8|||| MS563|DRG||Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31374.20|36408.99|36408.99|412.8|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|GEHA [1415]|GEHA [141500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66302.88|33452.98|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66302.88|9082.28|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|||66302.88|19890.86|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66302.88||||||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66302.88|9082.28|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66302.88|3400|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66302.88|33452.98|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66302.88|9620.3|33452.98|3400|||| MS564|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66302.88|9620.3|33452.98|3400|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|CHAMPVA [1240]|CHAMP VA [124000]|44260.34||||||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44260.34|7588.89|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44260.34|14250.21|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44260.34|24143.85|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44260.34|3400|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44260.34|1450|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|TRUSTMARK [2030]|STARMARK [203000]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|HEALTHNET [1495]|HEALTHNET [149500]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MULTIPLAN [1680]|IHC HS [168011]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MULTIPLAN [1680]|HMA [168003]|44260.34|127.07|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44260.34|6327.44|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44260.34|7588.89|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|UMR [2035]|UMR OPTIONS [203501]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44260.34|12880.5|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44260.34|11403.22|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44260.34|7117.73|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44260.34|23148.64|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|||44260.34|13278.1|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44260.34|20687.76|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44260.34|6466.39|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44260.34|6327.44|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44260.34|14560.12|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|CORESOURCE [1315]|CORESOURCE [131500]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44260.34|24143.85|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|GEHA [1415]|GEHA [141500]|44260.34|32051.95|32051.95|127.07|||| MS565|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44260.34|32051.95|32051.95|127.07|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|GEHA [1415]|GEHA [141500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45203.00|21311.18|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|45203.00|33902.25|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45203.00|3438.71|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45203.00||||||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|||45203.00|13560.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45203.00|3438.71|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45203.00|1700|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45203.00|21311.18|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45203.00|4882.9|33902.25|1700|||| MS566|DRG||Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45203.00|4882.9|33902.25|1700|||| MS570|DRG||Skin Debridement With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124222.24||||||| MS570|DRG||Skin Debridement With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|124222.24||||||| MS570|DRG||Skin Debridement With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124222.24||||||| MS570|DRG||Skin Debridement With McC|CHAMPVA [1240]|CHAMP VA [124000]|124222.24||||||| MS570|DRG||Skin Debridement With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|124222.24||||||| MS570|DRG||Skin Debridement With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124222.24|64595.56|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124222.24|40164.84|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124222.24|41126.35|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|124222.24|3625|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|AETNA [1015]|AETNA ACO WILCO [101532]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|TRUSTMARK [2030]|STARMARK [203000]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|HEALTHNET [1495]|HEALTHNET [149500]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MULTIPLAN [1680]|IHC HS [168011]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MULTIPLAN [1680]|HMA [168003]|124222.24|1961.94|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124222.24|64595.56|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|UMR [2035]|UMR OPTIONS [203501]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124222.24|35081.7|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124222.24|33415.32|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124222.24|80744.45|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|||124222.24|37266.67|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124222.24||||||| MS570|DRG||Skin Debridement With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124222.24|72160.71|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124222.24|17839.07|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|124222.24|62111.12|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|CORESOURCE [1315]|CORESOURCE [131500]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|GEHA [1415]|GEHA [141500]|124222.24|111800.01|111800.01|1961.94|||| MS570|DRG||Skin Debridement With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124222.24|111800.01|111800.01|1961.94|||| MS571|DRG||Skin Debridement With Cc|CHAMPVA [1240]|CHAMP VA [124000]|78664.67||||||| MS571|DRG||Skin Debridement With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|GEHA [1415]|GEHA [141500]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|CORESOURCE [1315]|CORESOURCE [131500]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78664.67|10829.73|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78664.67|46337.88|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|||78664.67|23599.4|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78664.67|19448.85|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78664.67|22020.02|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78664.67|11841.18|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|78664.67|10829.73|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|UMR [2035]|UMR OPTIONS [203501]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MULTIPLAN [1680]|IHC HS [168011]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MULTIPLAN [1680]|HMA [168003]|78664.67|1126.13|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|HEALTHNET [1495]|HEALTHNET [149500]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78664.67|51849.9|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|TRUSTMARK [2030]|STARMARK [203000]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|78664.67|2900|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78664.67|3400|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|78664.67|50880.68|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78664.67|50880.68|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78664.67|71792.17|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78664.67|23675.6|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78664.67|23122.08|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78664.67|11841.18|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78664.67|10359.82|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78664.67|24833.14|71792.17|1126.13|||| MS571|DRG||Skin Debridement With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78664.67|71792.17|71792.17|1126.13|||| MS572|DRG||Skin Debridement Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|GEHA [1415]|GEHA [141500]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|94382.62||||||| MS572|DRG||Skin Debridement Without Cc/McC|||94382.62|28314.79|28314.79|28314.79|||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|UMR [2035]|UMR OPTIONS [203501]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MULTIPLAN [1680]|IHC HS [168011]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MULTIPLAN [1680]|HMA [168003]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|TRUSTMARK [2030]|STARMARK [203000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|GEHA [1415]|GEHA [141500]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|263157.36||||||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|263157.36|152868.11|152868.11|10200|||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|263157.36|18158.81|152868.11|10200|||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|||263157.36|78947.21|152868.11|10200|||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|263157.36|18158.81|152868.11|10200|||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|263157.36|10200|152868.11|10200|||| MS574|DRG||Skin Graft For Skin Ulcer Or Cellulitis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|263157.36|152868.11|152868.11|10200|||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|TRUSTMARK [2030]|STARMARK [203000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|HEALTHNET [1495]|HEALTHNET [149500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MULTIPLAN [1680]|IHC HS [168011]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MULTIPLAN [1680]|HMA [168003]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|UMR [2035]|UMR OPTIONS [203501]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|CHAMPVA [1240]|CHAMP VA [124000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|CORESOURCE [1315]|CORESOURCE [131500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|GEHA [1415]|GEHA [141500]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|265488.59||||||| MS576|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With McC|||265488.59|79646.58|79646.58|79646.58|||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86018.94|49968.4|49968.4|5100|||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86018.94|16332.67|49968.4|5100|||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|||86018.94|25805.68|49968.4|5100|||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86018.94|16332.67|49968.4|5100|||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86018.94|5100|49968.4|5100|||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86018.94|49968.4|49968.4|5100|||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MULTIPLAN [1680]|HMA [168003]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|TRUSTMARK [2030]|STARMARK [203000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|UMR [2035]|UMR OPTIONS [203501]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|GEHA [1415]|GEHA [141500]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|MULTIPLAN [1680]|IHC HS [168011]|86018.94||||||| MS577|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|86018.94||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|||100795.50|30238.65|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|100795.50|76125.53|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100795.50|9350|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|100795.50|11522.08|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100795.50|11522.08|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|GEHA [1415]|GEHA [141500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100795.50|76125.53|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100795.50|10346.78|76125.53|9350|||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100795.50||||||| MS578|DRG||Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100795.50||||||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|97206.86|83623.87|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|97206.86|42453.1|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|97206.86||||||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|97206.86|11125.56|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|||97206.86|29162.06|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|97206.86|11125.56|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|97206.86|83623.87|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|97206.86|35971.31|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|97206.86|3625|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|97206.86|41460.58|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|GEHA [1415]|GEHA [141500]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|97206.86|41322.37|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|97206.86|46237.8|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|97206.86|44342.66|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|97206.86|22014.87|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|97206.86|18407.72|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|97206.86|22014.87|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|97206.86|15300|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|97206.86|64021.57|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|MULTIPLAN [1680]|HMA [168003]|97206.86|766.81|83623.87|766.81|||| MS579|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|97206.86|34728.34|83623.87|766.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82706.52|2550|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82706.52|22661.85|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82706.52|23204.35|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82706.52|2900|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82706.52|12699.55|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82706.52|21034.42|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82706.52|18709.18|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82706.52|6641|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|||82706.52|24811.96|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82706.52|37522.84|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|82706.52|746.81|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82706.52|48224.74|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82706.52|12699.55|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82706.52|41986.29|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|82706.52|53763.85|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82706.52|10157.86|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82706.52|20118.9|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82706.52|6641|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82706.52|48224.74|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|GEHA [1415]|GEHA [141500]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|82706.52|58134.87|58134.87|746.81|||| MS580|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82706.52|10157.86|58134.87|746.81|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64225.18|9155.44|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64225.18|17730.99|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|64225.18||||||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64225.18|725|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64225.18|38827.67|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64225.18|29022.49|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64225.18|14593.32|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64225.18|5070.35|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64225.18|9155.44|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64225.18|7993.93|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64225.18|18155.45|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|||64225.18|19267.55|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64225.18|32474.8|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64225.18|38827.67|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64225.18|16548.48|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64225.18|5070.35|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64225.18|2550|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64225.18|44965.1|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64225.18|11838.23|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|64225.18|506.9|44965.1|506.9|||| MS581|DRG||Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|64225.18|11838.23|44965.1|506.9|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|179592.22|23164.56|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|179592.22|23719.1|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|179592.22|2900|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MULTIPLAN [1680]|HMA [168003]|179592.22|2203.85|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|179592.22|93387.95|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|179592.22|93387.95|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|179592.22|116734.94|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|||179592.22|53877.67|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|179592.22|20037.99|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|179592.22||||||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|179592.22|18360.28|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|GEHA [1415]|GEHA [141500]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|179592.22|161633|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|179592.22|104325.1|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|179592.22|22738.96|161633|2203.85|||| MS582|DRG||Mastectomy For Malignancy With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|179592.22|161633|161633|2203.85|||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|||103877.74|31163.32|31163.32|31163.32|||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103877.74||||||| MS583|DRG||Mastectomy For Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103877.74||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|||45970.83|13791.25|13791.25|13791.25|||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45970.83||||||| MS584|DRG||Breast Biopsy, Local Excision And Other Breast Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45970.83||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|220652.84|123912.31|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|220652.84|6871.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|220652.84|128177.24|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|220652.84|19739.6|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|220652.84|143424.35|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|220652.84|114739.48|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|220652.84|21526.54|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|220652.84|3191.41|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|220652.84||||||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|220652.84|3400|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|220652.84|2900|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|220652.84|114739.48|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|220652.84|148177.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|220652.84|25180.7|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|220652.84|24591.99|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|220652.84|6871.52|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|220652.84|198587.56|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|||220652.84|66195.85|198587.56|2900|||| MS585|DRG||Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|220652.84|123912.31|198587.56|2900|||| MS592|DRG||Skin Ulcers With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|MULTIPLAN [1680]|HMA [168003]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|AETNA [1015]|AETNA ACO WILCO [101532]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|TRUSTMARK [2030]|STARMARK [203000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|HEALTHNET [1495]|HEALTHNET [149500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|GEHA [1415]|GEHA [141500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|CHAMPVA [1240]|CHAMP VA [124000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|CORESOURCE [1315]|CORESOURCE [131500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|MULTIPLAN [1680]|IHC HS [168011]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66898.45|86125.29|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|UMR [2035]|UMR OPTIONS [203501]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66898.45|12490.31|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|||66898.45|20069.53|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66898.45|86125.29|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66898.45|6800|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66898.45|12490.31|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66898.45||||||| MS592|DRG||Skin Ulcers With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66898.45|10694.79|86125.29|6800|||| MS592|DRG||Skin Ulcers With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66898.45||||||| MS593|DRG||Skin Ulcers With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|CORESOURCE [1315]|CORESOURCE [131500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|GEHA [1415]|GEHA [141500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|CHAMPVA [1240]|CHAMP VA [124000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|MULTIPLAN [1680]|HMA [168003]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|HEALTHNET [1495]|HEALTHNET [149500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|TRUSTMARK [2030]|STARMARK [203000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|47383.97|7686.18|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47383.97|7233.85|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|MULTIPLAN [1680]|IHC HS [168011]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|||47383.97|14215.19|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47383.97|7686.18|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47383.97|850|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|UMR [2035]|UMR OPTIONS [203501]|47383.97||||||| MS593|DRG||Skin Ulcers With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47383.97|7267.41|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|47383.97|7233.85|14215.19|850|||| MS593|DRG||Skin Ulcers With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47383.97|7267.41|14215.19|850|||| MS595|DRG||Major Skin Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|200642.64|28493.35|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|200642.64|29175.45|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|200642.64|13775|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|MULTIPLAN [1680]|HMA [168003]|200642.64|3991.32|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|200642.64|104334.17|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|200642.64|104334.17|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|200642.64||||||| MS595|DRG||Major Skin Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|200642.64|28648.88|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|200642.64|23639.14|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|GEHA [1415]|GEHA [141500]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|200642.64|130417.72|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|200642.64|116553.3|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|200642.64|180578.38|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|200642.64|30183.48|180578.38|3991.32|||| MS595|DRG||Major Skin Disorders With McC|||200642.64|60192.79|180578.38|3991.32|||| MS596|DRG||Major Skin Disorders Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|CORESOURCE [1315]|CORESOURCE [131500]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|GEHA [1415]|GEHA [141500]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|CHAMPVA [1240]|CHAMP VA [124000]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36336.98|18054.38|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36336.98|5472.94|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36336.98|31072.5|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36336.98|13237.43|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36336.98|34768.67|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36336.98|7693.05|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|UMR [2035]|UMR OPTIONS [203501]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36336.98|5472.94|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|HEALTHNET [1495]|HEALTHNET [149500]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MULTIPLAN [1680]|HMA [168003]|36336.98|66.27|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MULTIPLAN [1680]|IHC HS [168011]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|TRUSTMARK [2030]|STARMARK [203000]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36336.98||||||| MS596|DRG||Major Skin Disorders Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36336.98|11328.78|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36336.98|1450|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36336.98|7693.05|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36336.98|53490.26|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36336.98|1700|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36336.98|14343.4|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36336.98|18054.38|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36336.98|14008.06|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36336.98|48141.24|53490.26|66.27|||| MS596|DRG||Major Skin Disorders Without McC|||36336.98|10901.09|53490.26|66.27|||| MS597|DRG||Malignant Breast Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|||103166.82|30950.05|30950.05|850|||| MS597|DRG||Malignant Breast Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103166.82|6538.67|30950.05|850|||| MS597|DRG||Malignant Breast Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|GEHA [1415]|GEHA [141500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103166.82|850|30950.05|850|||| MS597|DRG||Malignant Breast Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103166.82|20108.56|30950.05|850|||| MS597|DRG||Malignant Breast Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MULTIPLAN [1680]|HMA [168003]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103166.82||||||| MS597|DRG||Malignant Breast Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103166.82|6538.67|30950.05|850|||| MS597|DRG||Malignant Breast Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103166.82|20108.56|30950.05|850|||| MS598|DRG||Malignant Breast Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|GEHA [1415]|GEHA [141500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49627.70|35448.62|35448.62|4600.66|||| MS598|DRG||Malignant Breast Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49627.70|4600.66|35448.62|4600.66|||| MS598|DRG||Malignant Breast Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49627.70|5950|35448.62|4600.66|||| MS598|DRG||Malignant Breast Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|||49627.70|14888.31|35448.62|4600.66|||| MS598|DRG||Malignant Breast Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49627.70|35448.62|35448.62|4600.66|||| MS598|DRG||Malignant Breast Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49627.70||||||| MS598|DRG||Malignant Breast Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49627.70|4600.66|35448.62|4600.66|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MULTIPLAN [1680]|HMA [168003]|19098.43|5393.5|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19098.43|7915.92|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19098.43|5346|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19098.43|11155.5|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19098.43|58157.74|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|||19098.43|5729.53|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19098.43|51975.11|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|GEHA [1415]|GEHA [141500]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19098.43|11094.27|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19098.43|12935.94|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19098.43|5346|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19098.43||||||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19098.43|7915.92|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19098.43|14100.11|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19098.43|14437.65|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19098.43|11094.27|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19098.43|14243.82|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19098.43|850|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19098.43|80526.1|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19098.43|4350|80526.1|850|||| MS600|DRG||Non-Malignant Breast Disorders With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19098.43|80526.1|80526.1|850|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|||27648.38|8294.51|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27648.38|7196.64|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27648.38|8506.78|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27648.38|5098.56|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|27648.38|411.57|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27648.38|17971.45|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27648.38||||||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27648.38|16060.93|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27648.38|1450|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27648.38|9970.2|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27648.38|9188.99|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27648.38|5098.56|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27648.38|24883.54|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27648.38|9737.1|24883.54|411.57|||| MS601|DRG||Non-Malignant Breast Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27648.38|24883.54|24883.54|411.57|||| MS602|DRG||Cellulitis With McC|CHAMPVA [1240]|CHAMP VA [124000]|49601.88||||||| MS602|DRG||Cellulitis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49601.88|20343.69|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49601.88|20830.7|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49601.88|29447.72|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49601.88|2550|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|TRUSTMARK [2030]|STARMARK [203000]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|HEALTHNET [1495]|HEALTHNET [149500]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MULTIPLAN [1680]|HMA [168003]|49601.88|961.63|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49601.88|8171.73|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|UMR [2035]|UMR OPTIONS [203501]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49601.88|11754.78|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49601.88|19555.33|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49601.88|2900|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49601.88|16628.57|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49601.88|27286.68|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|||49601.88|14880.56|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49601.88|24385.9|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49601.88|11754.78|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49601.88|9140.52|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49601.88|21232.09|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|GEHA [1415]|GEHA [141500]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|MULTIPLAN [1680]|IHC HS [168011]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49601.88|29447.72|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49601.88|8171.73|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|49601.88|37781.55|37781.55|961.63|||| MS602|DRG||Cellulitis With McC|CORESOURCE [1315]|CORESOURCE [131500]|49601.88|37781.55|37781.55|961.63|||| MS603|DRG||Cellulitis Without McC|||39966.02|11989.81|28982.98|850|||| MS603|DRG||Cellulitis Without McC|GEHA [1415]|GEHA [141500]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|CHAMPVA [1240]|CHAMP VA [124000]|39966.02|16508.31|28982.98|850|||| MS603|DRG||Cellulitis Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39966.02|4488.58|28982.98|850|||| MS603|DRG||Cellulitis Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39966.02|17760.52|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39966.02|18706.9|28982.98|850|||| MS603|DRG||Cellulitis Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39966.02|20932.16|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39966.02|9809.91|28982.98|850|||| MS603|DRG||Cellulitis Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39966.02|11496.06|28982.98|850|||| MS603|DRG||Cellulitis Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39966.02|4488.58|28982.98|850|||| MS603|DRG||Cellulitis Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MULTIPLAN [1680]|IHC HS [168011]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MULTIPLAN [1680]|HMA [168003]|39966.02|1027.2|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|HEALTHNET [1495]|HEALTHNET [149500]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|TRUSTMARK [2030]|STARMARK [203000]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39966.02|6820.95|28982.98|850|||| MS603|DRG||Cellulitis Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39966.02|2900|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39966.02|850|28982.98|850|||| MS603|DRG||Cellulitis Without McC|UMR [2035]|UMR OPTIONS [203501]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39966.02|5462.73|28982.98|850|||| MS603|DRG||Cellulitis Without McC|CORESOURCE [1315]|CORESOURCE [131500]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39966.02|17760.52|28982.98|850|||| MS603|DRG||Cellulitis Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39966.02|12249.6|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39966.02|28982.98|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39966.02|5500.99|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39966.02|10549.07|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39966.02|10637.25|28982.98|850|||| MS603|DRG||Cellulitis Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39966.02|11963.21|28982.98|850|||| MS603|DRG||Cellulitis Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39966.02|6820.95|28982.98|850|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|AETNA [1015]|AETNA ACO WILCO [101532]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|HEALTHNET [1495]|HEALTHNET [149500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MULTIPLAN [1680]|IHC HS [168011]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MULTIPLAN [1680]|HMA [168003]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|UMR [2035]|UMR OPTIONS [203501]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|CHAMPVA [1240]|CHAMP VA [124000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|CORESOURCE [1315]|CORESOURCE [131500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|TRUSTMARK [2030]|STARMARK [203000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|GEHA [1415]|GEHA [141500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|33047.40||||||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33047.40|19197.23|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33047.40|1700|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33047.40|19197.23|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33047.40|5289.48|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|||33047.40|9914.22|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33047.40|9480.45|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33047.40|5289.48|19197.23|1700|||| MS604|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33047.40|9480.45|19197.23|1700|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|CHAMPVA [1240]|CHAMP VA [124000]|25175.42||||||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25175.42|23023.13|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25175.42|3323.81|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|CORESOURCE [1315]|CORESOURCE [131500]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25175.42|6135.98|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|||25175.42|7552.63|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25175.42|6865.88|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25175.42|10184.39|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25175.42|10562.89|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|UMR [2035]|UMR OPTIONS [203501]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25175.42|3323.81|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MULTIPLAN [1680]|HMA [168003]|25175.42|375.16|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|HEALTHNET [1495]|HEALTHNET [149500]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MULTIPLAN [1680]|IHC HS [168011]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|TRUSTMARK [2030]|STARMARK [203000]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25175.42|725|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25175.42|6188.68|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25175.42|3400|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|GEHA [1415]|GEHA [141500]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25175.42|23023.13|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25175.42|10562.89|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25175.42|10562.89|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25175.42|6188.68|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25175.42|5862.95|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25175.42|10084.27|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25175.42|9506.6|23023.13|375.16|||| MS605|DRG||Trauma To The Skin, Subcutaneous Tissue And Breast Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25175.42|5862.95|23023.13|375.16|||| MS606|DRG||Minor Skin Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51461.41|5100|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|51461.41||||||| MS606|DRG||Minor Skin Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51461.41|21909.5|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51461.41|34024.87|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MULTIPLAN [1680]|HMA [168003]|51461.41|119|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51461.41|11033.68|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51461.41|8903.2|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51461.41|18688.7|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51461.41|1450|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51461.41|17392.67|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51461.41|21397.27|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51461.41|11033.68|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51461.41|19228.07|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|||51461.41|15438.42|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51461.41|17183.99|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51461.41|9602.89|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51461.41|16393.46|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|GEHA [1415]|GEHA [141500]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51461.41|34024.87|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51461.41|8903.2|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51461.41|26623.48|34024.87|119|||| MS606|DRG||Minor Skin Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51461.41|26623.48|34024.87|119|||| MS607|DRG||Minor Skin Disorders Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42747.80|15763.94|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|GEHA [1415]|GEHA [141500]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|CHAMPVA [1240]|CHAMP VA [124000]|42747.80|11858.22|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42747.80|3042.52|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|CORESOURCE [1315]|CORESOURCE [131500]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42747.80|21336.78|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|||42747.80|12824.34|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42747.80|23874.85|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42747.80|9607.54|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42747.80|10679.45|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42747.80|3042.52|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MULTIPLAN [1680]|HMA [168003]|42747.80|55.84|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|HEALTHNET [1495]|HEALTHNET [149500]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|TRUSTMARK [2030]|STARMARK [203000]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MULTIPLAN [1680]|IHC HS [168011]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42747.80|4350|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42747.80|3400|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|UMR [2035]|UMR OPTIONS [203501]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42747.80|15763.94|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42747.80|11971.2|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42747.80|33057.49|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42747.80|5384.86|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42747.80|8404.51|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42747.80|5891.52|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42747.80|11691.32|33057.49|55.84|||| MS607|DRG||Minor Skin Disorders Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42747.80|5891.52|33057.49|55.84|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81064.83|19898.42|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81064.83|33799.47|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81064.83|34608.6|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81064.83|42933.22|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|81064.83|314.31|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81064.83|18487.21|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81064.83|19898.42|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81064.83|31758.48|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81064.83|28299.28|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81064.83||||||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81064.83|51713.24|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|||81064.83|24319.45|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81064.83|46215.72|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81064.83|18487.21|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81064.83|42933.22|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81064.83|1700|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81064.83|21817.59|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81064.83|725|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81064.83|71602.95|71602.95|314.31|||| MS614|DRG||Adrenal And Pituitary Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81064.83|71602.95|71602.95|314.31|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|76686.00||||||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|76686.00|43672.06|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76686.00|11083.31|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76686.00|36513.73|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|||76686.00|23005.8|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76686.00|40857.16|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76686.00|17260.08|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76686.00|19940.65|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76686.00|11501.22|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|76686.00|11083.31|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|76686.00|214.83|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|76686.00|1450|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76686.00|1700|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76686.00|43672.06|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76686.00|22824.45|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76686.00|11501.22|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76686.00|16421.04|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76686.00|56571.46|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|76686.00|22680.42|56571.46|214.83|||| MS615|DRG||Adrenal And Pituitary Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76686.00|22290.83|56571.46|214.83|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|145395.54||||||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145395.54|56485.4|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145395.54|57837.6|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145395.54|58209.66|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145395.54|5950|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|145395.54|26577.82|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MULTIPLAN [1680]|HMA [168003]|145395.54|493.41|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145395.54|54661.36|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|145395.54|2900|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145395.54|46529.3|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145395.54|49860.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|||145395.54|43618.66|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145395.54|44559.66|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145395.54|33600.88|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145395.54|13861.52|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145395.54|33600.88|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|145395.54|41205.48|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|GEHA [1415]|GEHA [141500]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|145395.54|58209.66|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145395.54|26577.82|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145395.54|69037.16|69037.16|493.41|||| MS616|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145395.54|69037.16|69037.16|493.41|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|108584.32||||||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|GEHA [1415]|GEHA [141500]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|108584.32|11439.44|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|108584.32|67486.68|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|108584.32|59145.23|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|108584.32|66180.77|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|108584.32|28364.96|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|108584.32|11439.44|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|108584.32|3002.35|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|108584.32|23856.62|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|108584.32|52944.61|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|108584.32|5075|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|||108584.32|32575.3|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|108584.32|5100|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|108584.32|12753.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|108584.32|67486.68|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|108584.32|29494.45|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|108584.32|52944.61|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|108584.32|12853.74|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|108584.32|30461.17|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|108584.32|91634.92|91634.92|3002.35|||| MS617|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|108584.32|28804.89|91634.92|3002.35|||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54964.72|31929.02|31929.02|2550|||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54964.72|2550|31929.02|2550|||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54964.72|6583.5|31929.02|2550|||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|||54964.72|16489.42|31929.02|2550|||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54964.72|31929.02|31929.02|2550|||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54964.72|6583.5|31929.02|2550|||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|54964.72||||||| MS618|DRG||Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54964.72||||||| MS619|DRG||O.R. Procedures For Obesity With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|CHAMPVA [1240]|CHAMP VA [124000]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|GEHA [1415]|GEHA [141500]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|127512.19|207300.17|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|CORESOURCE [1315]|CORESOURCE [131500]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|127512.19|22908.27|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|127512.19|69552.36|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|||127512.19|38253.66|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|127512.19|35802.96|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|127512.19|22908.27|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|127512.19|62260.67|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|UMR [2035]|UMR OPTIONS [203501]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MULTIPLAN [1680]|IHC HS [168011]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MULTIPLAN [1680]|HMA [168003]|127512.19|1457.19|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|HEALTHNET [1495]|HEALTHNET [149500]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|TRUSTMARK [2030]|STARMARK [203000]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|127512.19|42140.49|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|AETNA [1015]|AETNA ACO WILCO [101532]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|127512.19||||||| MS619|DRG||O.R. Procedures For Obesity With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|127512.19|2175|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|127512.19|77825.83|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|127512.19|12750|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|127512.19|207300.17|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127512.19|44385.95|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|127512.19|45714.77|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|127512.19|43348.24|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127512.19|107758.85|207300.17|1457.19|||| MS619|DRG||O.R. Procedures For Obesity With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|127512.19|62260.67|207300.17|1457.19|||| MS620|DRG||O.R. Procedures For Obesity With Cc|CHAMPVA [1240]|CHAMP VA [124000]|82966.50||||||| MS620|DRG||O.R. Procedures For Obesity With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82966.50|14914.53|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82966.50|25535.95|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82966.50|52860.96|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82966.50|5100|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82966.50|725|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|TRUSTMARK [2030]|STARMARK [203000]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|HEALTHNET [1495]|HEALTHNET [149500]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MULTIPLAN [1680]|IHC HS [168011]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MULTIPLAN [1680]|HMA [168003]|82966.50|807.41|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82966.50|14914.53|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|UMR [2035]|UMR OPTIONS [203501]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82966.50|10556.77|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82966.50|24814.61|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82966.50|20871.2|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82966.50|24938.94|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82966.50|49100.52|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|||82966.50|24889.95|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82966.50|43880.76|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82966.50|11157.15|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82966.50|26649.25|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|GEHA [1415]|GEHA [141500]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82966.50|52860.96|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|CORESOURCE [1315]|CORESOURCE [131500]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82966.50|10556.77|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82966.50|67985.33|67985.33|725|||| MS620|DRG||O.R. Procedures For Obesity With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82966.50|67985.33|67985.33|725|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72194.07|42437.58|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72194.07|47485.67|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72194.07|10133.61|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72194.07|21396.75|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72194.07|17429.81|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72194.07|8947.03|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|72194.07|919.6|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72194.07|12462.96|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72194.07|1450|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72194.07|850|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72194.07|18282.36|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|||72194.07|21658.22|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72194.07|41868.8|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72194.07|23147.8|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72194.07|23343.71|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72194.07|10047.7|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72194.07|23343.71|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72194.07|12462.96|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72194.07|22606.62|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|GEHA [1415]|GEHA [141500]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72194.07|41868.8|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72194.07|19659.92|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|72194.07|49924.9|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72194.07|8947.03|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72194.07|65749.38|65749.38|850|||| MS621|DRG||O.R. Procedures For Obesity Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72194.07|10047.7|65749.38|850|||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MULTIPLAN [1680]|HMA [168003]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|GEHA [1415]|GEHA [141500]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111777.32||||||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111777.32|62974.88|62974.88|5100|||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111777.32|5100|62974.88|5100|||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111777.32|22139.23|62974.88|5100|||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|||111777.32|33533.2|62974.88|5100|||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111777.32|22139.23|62974.88|5100|||| MS622|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111777.32|62974.88|62974.88|5100|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|GEHA [1415]|GEHA [141500]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84965.61|37156.75|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84965.61|15008.67|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84965.61|57620.9|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|||84965.61|25489.68|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84965.61|64475.11|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84965.61|22708.74|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84965.61|25647.44|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84965.61|14783.71|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84965.61|15008.67|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|84965.61|1376.27|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84965.61|5800|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84965.61|3400|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84965.61|37156.75|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84965.61|89273.23|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|84965.61||||||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84965.61|27157.05|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84965.61|26522.14|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84965.61|14783.71|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84965.61|11851.95|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84965.61|35526.87|89273.23|1376.27|||| MS623|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84965.61|89273.23|89273.23|1376.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24570.32||||||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|||24570.32|7371.1|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24570.32|7013.27|7371.1|7013.27|||| MS624|DRG||Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24570.32|7013.27|7371.1|7013.27|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|GEHA [1415]|GEHA [141500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MULTIPLAN [1680]|HMA [168003]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72191.00||||||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|||72191.00|21657.3|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72191.00|18038.25|21657.3|18038.25|||| MS625|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72191.00|18038.25|21657.3|18038.25|||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|GEHA [1415]|GEHA [141500]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56177.96||||||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56177.96|32652.15|32652.15|1700|||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56177.96|1700|32652.15|1700|||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56177.96|10643.88|32652.15|1700|||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|||56177.96|16853.39|32652.15|1700|||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56177.96|10643.88|32652.15|1700|||| MS626|DRG||Thyroid, Parathyroid And Thyroglossal Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56177.96|32652.15|32652.15|1700|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46921.37|26460.8|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46921.37|7367.71|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46921.37|24479.67|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|||46921.37|14076.41|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46921.37|27391.62|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46921.37|13277.97|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46921.37|14339.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46921.37|6995.37|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46921.37|7367.71|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|46921.37|215.02|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46921.37|725|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46921.37|1700|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46921.37|26460.8|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46921.37|37926.86|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46921.37|17136.1|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46921.37|16735.47|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46921.37|6995.37|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|46921.37||||||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46921.37|7374.9|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46921.37|9283.31|37926.86|215.02|||| MS627|DRG||Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46921.37|37926.86|37926.86|215.02|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|166198.02||||||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|166198.02||||||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|166198.02||||||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|166198.02||||||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|166198.02||||||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|166198.02|116681.1|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|166198.02|52368.79|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|166198.02|13050|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|166198.02|1134.7|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|166198.02|116681.1|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|166198.02|53622.45|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|166198.02|48351.58|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|166198.02|42906.56|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|166198.02|145851.37|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|166198.02||||||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|||166198.02|49859.41|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|166198.02|130346.28|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|166198.02|23194.81|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|166198.02|46139.53|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|166198.02|201948.06|201948.06|1134.7|||| MS628|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|166198.02|201948.06|201948.06|1134.7|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|113052.70||||||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113052.70|33987.73|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113052.70|11842.76|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113052.70|92058.11|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|||113052.70|33915.81|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113052.70|103008.73|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113052.70|31308.26|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113052.70|82406.99|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113052.70|11842.76|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|113052.70|2440.31|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113052.70|27014.16|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113052.70|5800|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113052.70|2550|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113052.70|33987.73|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113052.70|142627.47|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113052.70|34028.6|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113052.70|33233.03|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113052.70|82406.99|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113052.70|14797.05|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113052.70|38349.43|142627.47|2440.31|||| MS629|DRG||Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113052.70|142627.47|142627.47|2440.31|||| MS637|DRG||Diabetes With McC|CHAMPVA [1240]|CHAMP VA [124000]|76081.76||||||| MS637|DRG||Diabetes With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|76081.76|20577.22|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|76081.76|20577.22|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|76081.76|20577.22|59674.38|565.28|||| MS637|DRG||Diabetes With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|76081.76|19933.15|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|76081.76|3400|59674.38|565.28|||| MS637|DRG||Diabetes With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|76081.76|1450|59674.38|565.28|||| MS637|DRG||Diabetes With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|AETNA [1015]|AETNA ACO WILCO [101532]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|TRUSTMARK [2030]|STARMARK [203000]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|HEALTHNET [1495]|HEALTHNET [149500]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MULTIPLAN [1680]|IHC HS [168011]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|76081.76|8444.65|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MULTIPLAN [1680]|HMA [168003]|76081.76|565.28|59674.38|565.28|||| MS637|DRG||Diabetes With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|76081.76|11259.78|59674.38|565.28|||| MS637|DRG||Diabetes With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|UMR [2035]|UMR OPTIONS [203501]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|76081.76|44822.18|59674.38|565.28|||| MS637|DRG||Diabetes With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|76081.76|18045.14|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76081.76|19467.13|59674.38|565.28|||| MS637|DRG||Diabetes With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76081.76|16115.69|59674.38|565.28|||| MS637|DRG||Diabetes With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|76081.76|43098.16|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|76081.76|11259.78|59674.38|565.28|||| MS637|DRG||Diabetes With McC|||76081.76|22824.53|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|76081.76|38516.5|59674.38|565.28|||| MS637|DRG||Diabetes With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|76081.76|8755.85|59674.38|565.28|||| MS637|DRG||Diabetes With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|76081.76|8444.65|59674.38|565.28|||| MS637|DRG||Diabetes With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|76081.76|17329.99|59674.38|565.28|||| MS637|DRG||Diabetes With McC|CORESOURCE [1315]|CORESOURCE [131500]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|76081.76|44822.18|59674.38|565.28|||| MS637|DRG||Diabetes With McC|GEHA [1415]|GEHA [141500]|76081.76|59674.38|59674.38|565.28|||| MS637|DRG||Diabetes With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|76081.76|59674.38|59674.38|565.28|||| MS638|DRG||Diabetes With Cc|GEHA [1415]|GEHA [141500]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45269.81|26379.55|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|CORESOURCE [1315]|CORESOURCE [131500]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|CHAMPVA [1240]|CHAMP VA [124000]|45269.81|40536.43|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45269.81|5849.05|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45269.81|22885.29|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|||45269.81|13580.94|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45269.81|25607.58|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45269.81|10282.08|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45269.81|11508.22|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|UMR [2035]|UMR OPTIONS [203501]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45269.81|6670.76|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45269.81|7482.72|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MULTIPLAN [1680]|IHC HS [168011]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MULTIPLAN [1680]|HMA [168003]|45269.81|59.59|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|HEALTHNET [1495]|HEALTHNET [149500]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|TRUSTMARK [2030]|STARMARK [203000]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45269.81|2175|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45269.81|850|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45269.81|26379.55|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45269.81|35456.64|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45269.81|12751.3|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45269.81|12453.18|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45269.81|6670.76|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45269.81|11156.83|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45269.81|11156.83|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45269.81|11056.83|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45269.81|5810.31|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45269.81|5677.75|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45269.81|13128.61|40536.43|59.59|||| MS638|DRG||Diabetes With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45269.81|35456.64|40536.43|59.59|||| MS639|DRG||Diabetes Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|41085.17||||||| MS639|DRG||Diabetes Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|41085.17|4899.91|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|41085.17|7668.87|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|41085.17|7668.87|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|41085.17|7668.87|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|41085.17|8628.3|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|41085.17|8834.85|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|41085.17|25360.25|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|41085.17|2550|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|41085.17|398.66|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|41085.17|4901.74|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|41085.17|4899.91|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|41085.17|725|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|41085.17|8459.46|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|41085.17|7131.52|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|41085.17|23379.27|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|||41085.17|12325.55|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|41085.17|20893.86|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|41085.17|4076.37|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|41085.17|4901.74|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|41085.17|9105.83|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|41085.17|25360.25|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|GEHA [1415]|GEHA [141500]|41085.17|32371.29|32371.29|398.66|||| MS639|DRG||Diabetes Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|41085.17|32371.29|32371.29|398.66|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|GEHA [1415]|GEHA [141500]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|CORESOURCE [1315]|CORESOURCE [131500]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|CHAMPVA [1240]|CHAMP VA [124000]|55130.72|46983.47|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55130.72|11236.8|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55130.72|16441.41|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55130.72|18397.18|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55130.72|15850.85|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|UMR [2035]|UMR OPTIONS [203501]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55130.72|8918.03|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55130.72|10764.96|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MULTIPLAN [1680]|IHC HS [168011]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MULTIPLAN [1680]|HMA [168003]|55130.72|162.05|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|HEALTHNET [1495]|HEALTHNET [149500]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|TRUSTMARK [2030]|STARMARK [203000]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55130.72|14121.15|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|||55130.72|16539.22|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|AETNA [1015]|AETNA ACO WILCO [101532]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55130.72|725|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55130.72|1700|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55130.72|21017.67|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55130.72|21017.67|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55130.72|25473.02|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55130.72|17803.1|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55130.72|17386.88|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55130.72|8918.03|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55130.72|7842.92|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55130.72|15185.16|46983.47|162.05|||| MS640|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55130.72|25473.02|46983.47|162.05|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37287.81|5693.68|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37287.81|9462.27|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37287.81|10663.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37287.81|15458.16|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37287.81|1700|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|TRUSTMARK [2030]|STARMARK [203000]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MULTIPLAN [1680]|IHC HS [168011]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MULTIPLAN [1680]|HMA [168003]|37287.81|408.07|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37287.81|5863.72|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37287.81|5693.68|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|HEALTHNET [1495]|HEALTHNET [149500]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|UMR [2035]|UMR OPTIONS [203501]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37287.81|2900|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37287.81|10087.27|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37287.81|8799.26|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37287.81|10918.5|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37287.81|23482.68|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|||37287.81|11186.34|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37287.81|20986.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37287.81|4892.23|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37287.81|5863.72|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|CHAMPVA [1240]|CHAMP VA [124000]|37287.81|15496.74|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37287.81|11235.28|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|CORESOURCE [1315]|CORESOURCE [131500]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37287.81|15458.16|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|GEHA [1415]|GEHA [141500]|37287.81|32514.47|32514.47|408.07|||| MS641|DRG||Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37287.81|32514.47|32514.47|408.07|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75090.79||||||| MS642|DRG||Inborn And Other Disorders Of Metabolism|CHAMPVA [1240]|CHAMP VA [124000]|75090.79||||||| MS642|DRG||Inborn And Other Disorders Of Metabolism|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75090.79||||||| MS642|DRG||Inborn And Other Disorders Of Metabolism|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75090.79||||||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75090.79||||||| MS642|DRG||Inborn And Other Disorders Of Metabolism|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|GEHA [1415]|GEHA [141500]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75090.79|16265|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|||75090.79|22527.24|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75090.79|18199.78|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75090.79|14139.75|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|UMR [2035]|UMR OPTIONS [203501]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75090.79|9228.92|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|FIRST HEALTH [1375]|QUALCHOICE [137513]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75090.79|16912.17|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|FMH BENEFIT SERVICES [1390]|FMH [139000]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MULTIPLAN [1680]|IHC HS [168011]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MULTIPLAN [1680]|HMA [168003]|75090.79|37.79|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|HEALTHNET [1495]|HEALTHNET [149500]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|TRUSTMARK [2030]|STARMARK [203000]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|AETNA [1015]|AETNA ACO WILCO [101532]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75090.79|1450|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|CORESOURCE [1315]|CORESOURCE [131500]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75090.79||||||| MS642|DRG||Inborn And Other Disorders Of Metabolism|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75090.79|25199.68|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75090.79|18668.75|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75090.79|18232.29|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75090.79|9228.92|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75090.79|8213.94|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75090.79|18054.25|25199.68|37.79|||| MS642|DRG||Inborn And Other Disorders Of Metabolism|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75090.79|25199.68|25199.68|37.79|||| MS643|DRG||Endocrine Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|69905.27||||||| MS643|DRG||Endocrine Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69905.27|13291.45|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69905.27|23553.99|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69905.27|24117.85|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69905.27|22058.1|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69905.27|2550|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69905.27|2900|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MULTIPLAN [1680]|HMA [168003]|69905.27|1775.12|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69905.27|6805.82|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69905.27|13291.45|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69905.27|21515.73|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69905.27|18904.57|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69905.27|58704.97|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|||69905.27|20971.58|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69905.27|52464.19|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69905.27|10976.84|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69905.27|6805.82|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69905.27|18144.92|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69905.27|22058.1|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|GEHA [1415]|GEHA [141500]|69905.27|81283.8|81283.8|1775.12|||| MS643|DRG||Endocrine Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69905.27|81283.8|81283.8|1775.12|||| MS644|DRG||Endocrine Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|45503.80||||||| MS644|DRG||Endocrine Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45503.80|50231.34|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45503.80|5419.39|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45503.80|25597.46|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45503.80|28642.35|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45503.80|13551.1|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45503.80|8235.69|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45503.80|5419.39|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|45503.80|185.32|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45503.80|11956.8|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|||45503.80|13651.14|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45503.80|725|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45503.80|6800|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45503.80|50231.34|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45503.80|14765.35|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|GEHA [1415]|GEHA [141500]|45503.80|39658.63|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45503.80|14420.15|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45503.80|8235.69|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45503.80|6540.96|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45503.80|15059.74|50231.34|185.32|||| MS644|DRG||Endocrine Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45503.80|39658.63|50231.34|185.32|||| MS645|DRG||Endocrine Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|32044.99||||||| MS645|DRG||Endocrine Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32044.99|10872.82|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32044.99|11133.1|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32044.99|1450|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|32044.99|496.95|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32044.99|4829.55|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32044.99|5797.85|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32044.99|1700|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32044.99|15431.02|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32044.99|9988.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32044.99|8899.28|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32044.99|18036.47|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32044.99|5797.85|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|||32044.99|9613.5|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32044.99|16119.07|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32044.99|5125.19|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32044.99|4829.55|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32044.99|9569.83|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32044.99|15431.02|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|32044.99|24973.58|24973.58|496.95|||| MS645|DRG||Endocrine Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32044.99|24973.58|24973.58|496.95|||| MS653|DRG||Major Bladder Procedures With McC|GEHA [1415]|GEHA [141500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MULTIPLAN [1680]|HMA [168003]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59304.72||||||| MS653|DRG||Major Bladder Procedures With McC|||59304.72|17791.42|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59304.72|34077.18|34077.18|17791.42|||| MS653|DRG||Major Bladder Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59304.72|34077.18|34077.18|17791.42|||| MS654|DRG||Major Bladder Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|106305.95||||||| MS654|DRG||Major Bladder Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106305.95|25010.7|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106305.95|41069.73|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106305.95|42052.9|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106305.95|77972.68|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106305.95|5950|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|106305.95|445.29|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|106305.95|25401.25|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106305.95|25010.7|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|106305.95|725|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106305.95|37485.55|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106305.95|32705.89|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106305.95|47616.27|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|||106305.95|31891.78|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106305.95|42554.3|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106305.95|18236.18|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106305.95|25401.25|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|106305.95|32410.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|106305.95|77972.68|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|GEHA [1415]|GEHA [141500]|106305.95|65930.23|77972.68|445.29|||| MS654|DRG||Major Bladder Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106305.95|65930.23|77972.68|445.29|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|145725.84||||||| MS655|DRG||Major Bladder Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|||145725.84|43717.75|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|145725.84|17311.42|43717.75|17311.42|||| MS655|DRG||Major Bladder Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|145725.84|17311.42|43717.75|17311.42|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|AETNA [1015]|AETNA ACO WILCO [101532]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|TRUSTMARK [2030]|STARMARK [203000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|HEALTHNET [1495]|HEALTHNET [149500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MULTIPLAN [1680]|IHC HS [168011]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MULTIPLAN [1680]|HMA [168003]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|UMR [2035]|UMR OPTIONS [203501]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|CHAMPVA [1240]|CHAMP VA [124000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|CORESOURCE [1315]|CORESOURCE [131500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|GEHA [1415]|GEHA [141500]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120181.49||||||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|||120181.49|36054.45|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|120181.49|22271.68|36054.45|22271.68|||| MS656|DRG||Kidney And Ureter Procedures For Neoplasm With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120181.49|22271.68|36054.45|22271.68|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|GEHA [1415]|GEHA [141500]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|104787.59|24722.24|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|CORESOURCE [1315]|CORESOURCE [131500]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|CHAMPVA [1240]|CHAMP VA [124000]|104787.59|65975.52|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|104787.59|12789.12|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|104787.59|60871.1|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|||104787.59|31436.28|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|104787.59|68111.93|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|104787.59|22494.75|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|104787.59|26743.91|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|UMR [2035]|UMR OPTIONS [203501]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|104787.59|54489.55|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|104787.59|12789.12|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MULTIPLAN [1680]|IHC HS [168011]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MULTIPLAN [1680]|HMA [168003]|104787.59|1397.4|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|HEALTHNET [1495]|HEALTHNET [149500]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|TRUSTMARK [2030]|STARMARK [203000]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|104787.59|2175|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|104787.59|850|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|104787.59|24722.24|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|104787.59|94308.82|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|104787.59|28044.45|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|104787.59|27388.79|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|104787.59|54489.55|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|104787.59|13760.59|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|104787.59|24189.7|94308.82|850|||| MS657|DRG||Kidney And Ureter Procedures For Neoplasm With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|104787.59|94308.82|94308.82|850|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|111042.49||||||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111042.49|109047.67|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111042.49|23312.53|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111042.49|23312.53|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111042.49|23312.53|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111042.49|109047.67|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111042.49|109047.67|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111042.49|68178.19|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111042.49|850|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|111042.49|392.95|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111042.49|9200.2|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111042.49|109047.67|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111042.49|2175|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111042.49|109047.67|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111042.49|109047.67|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111042.49|70880.99|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|||111042.49|33312.75|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111042.49|63345.79|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111042.49|11148.3|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111042.49|9200.2|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111042.49|19633.66|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111042.49|68178.19|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|GEHA [1415]|GEHA [141500]|111042.49|98142.9|109047.67|392.95|||| MS658|DRG||Kidney And Ureter Procedures For Neoplasm Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111042.49|98142.9|109047.67|392.95|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|GEHA [1415]|GEHA [141500]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|CORESOURCE [1315]|CORESOURCE [131500]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|CHAMPVA [1240]|CHAMP VA [124000]|96258.17|34107.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|96258.17|18215.16|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|96258.17|40373.12|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|||96258.17|28877.45|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|96258.17|45175.62|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|96258.17|46142.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|UMR [2035]|UMR OPTIONS [203501]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|96258.17|27304|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|96258.17|18215.16|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MULTIPLAN [1680]|IHC HS [168011]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MULTIPLAN [1680]|HMA [168003]|96258.17|528.37|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|HEALTHNET [1495]|HEALTHNET [149500]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|96258.17|31166.07|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|TRUSTMARK [2030]|STARMARK [203000]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|AETNA [1015]|AETNA ACO WILCO [101532]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|96258.17|2900|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|96258.17|3400|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|96258.17|42562.38|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|96258.17|42562.38|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|96258.17|62550.86|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|96258.17|38639.6|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|96258.17|37736.23|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|96258.17|27304|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|96258.17|16773.28|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|96258.17|33514.41|62550.86|528.37|||| MS659|DRG||Kidney And Ureter Procedures For Non-Neoplasm With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|96258.17|62550.86|62550.86|528.37|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|CHAMPVA [1240]|CHAMP VA [124000]|60120.86||||||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60120.86|2550|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|TRUSTMARK [2030]|STARMARK [203000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|HEALTHNET [1495]|HEALTHNET [149500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MULTIPLAN [1680]|IHC HS [168011]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MULTIPLAN [1680]|HMA [168003]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60120.86|9734.73|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|UMR [2035]|UMR OPTIONS [203501]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60120.86|35878.61|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|||60120.86|18036.26|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60120.86|10261.74|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60120.86|9734.73|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|CORESOURCE [1315]|CORESOURCE [131500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60120.86|35878.61|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|GEHA [1415]|GEHA [141500]|60120.86|21096.95|35878.61|2550|||| MS660|DRG||Kidney And Ureter Procedures For Non-Neoplasm With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60120.86|21096.95|35878.61|2550|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|GEHA [1415]|GEHA [141500]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54077.76|28585.55|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|54077.76|30436.62|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54077.76|7173.6|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54077.76|31862.31|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|||54077.76|16223.33|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54077.76|35652.45|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54077.76|12677.86|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54077.76|19658.08|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54077.76|10896.41|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54077.76|7173.6|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|54077.76|98.95|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54077.76|725|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54077.76|850|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54077.76|28585.55|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54077.76|49364.91|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54077.76|15433.8|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54077.76|15072.97|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54077.76|10896.41|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54077.76|16187.65|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54077.76|16187.65|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54077.76|13633.13|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54077.76|7785.68|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54077.76|14963.12|49364.91|98.95|||| MS661|DRG||Kidney And Ureter Procedures For Non-Neoplasm Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54077.76|49364.91|49364.91|98.95|||| MS662|DRG||Minor Bladder Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77034.53|56784|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77034.53|41488.9|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77034.53|42482.1|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77034.53|1450|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|MULTIPLAN [1680]|HMA [168003]|77034.53|741.98|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77034.53|56784|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77034.53|41176.51|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77034.53||||||| MS662|DRG||Minor Bladder Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77034.53|36805.46|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77034.53|70980|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|||77034.53|23110.36|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77034.53|63434.29|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77034.53|32594.23|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|GEHA [1415]|GEHA [141500]|77034.53|98280.01|98280.01|741.98|||| MS662|DRG||Minor Bladder Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77034.53|98280.01|98280.01|741.98|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|100811.65||||||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|100811.65||||||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|100811.65||||||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100811.65||||||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100811.65||||||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100811.65|41167.92|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|||100811.65|30243.49|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100811.65|12869.76|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100811.65|17396.18|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100811.65|10017.85|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100811.65|46064.99|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|100811.65|334.41|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|100811.65|2175|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100811.65||||||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100811.65|63782.29|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100811.65|17170.9|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100811.65|16769.46|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100811.65|10017.85|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100811.65|14697.02|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100811.65|16432.67|63782.29|334.41|||| MS664|DRG||Minor Bladder Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100811.65|63782.29|63782.29|334.41|||| MS665|DRG||Prostatectomy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|80950.50||||||| MS665|DRG||Prostatectomy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|80950.50||||||| MS665|DRG||Prostatectomy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|80950.50||||||| MS665|DRG||Prostatectomy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|80950.50||||||| MS665|DRG||Prostatectomy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|80950.50||||||| MS665|DRG||Prostatectomy With McC|TRUSTMARK [2030]|STARMARK [203000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|HEALTHNET [1495]|HEALTHNET [149500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MULTIPLAN [1680]|HMA [168003]|80950.50||||||| MS665|DRG||Prostatectomy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|80950.50||||||| MS665|DRG||Prostatectomy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|UMR [2035]|UMR OPTIONS [203501]|80950.50||||||| MS665|DRG||Prostatectomy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|80950.50||||||| MS665|DRG||Prostatectomy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|80950.50||||||| MS665|DRG||Prostatectomy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|80950.50||||||| MS665|DRG||Prostatectomy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|80950.50||||||| MS665|DRG||Prostatectomy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|80950.50||||||| MS665|DRG||Prostatectomy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MULTIPLAN [1680]|IHC HS [168011]|80950.50||||||| MS665|DRG||Prostatectomy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|80950.50||||||| MS665|DRG||Prostatectomy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|80950.50||||||| MS665|DRG||Prostatectomy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|80950.50||||||| MS665|DRG||Prostatectomy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|CHAMPVA [1240]|CHAMP VA [124000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|CORESOURCE [1315]|CORESOURCE [131500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|80950.50||||||| MS665|DRG||Prostatectomy With McC|GEHA [1415]|GEHA [141500]|80950.50||||||| MS665|DRG||Prostatectomy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|80950.50||||||| MS665|DRG||Prostatectomy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|80950.50||||||| MS665|DRG||Prostatectomy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|80950.50||||||| MS665|DRG||Prostatectomy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|||80950.50|24285.15|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|80950.50|19084.48|24285.15|19084.48|||| MS665|DRG||Prostatectomy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|80950.50|19084.48|24285.15|19084.48|||| MS666|DRG||Prostatectomy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MULTIPLAN [1680]|IHC HS [168011]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MULTIPLAN [1680]|HMA [168003]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|TRUSTMARK [2030]|STARMARK [203000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|||67445.98|20233.79|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67445.98|11886.27|20233.79|11886.27|||| MS666|DRG||Prostatectomy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|UMR [2035]|UMR OPTIONS [203501]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|GEHA [1415]|GEHA [141500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67445.98||||||| MS666|DRG||Prostatectomy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67445.98||||||| MS667|DRG||Prostatectomy Without Cc/McC|GEHA [1415]|GEHA [141500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|||69590.70|20877.21|20877.21|20877.21|||| MS667|DRG||Prostatectomy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69590.70||||||| MS667|DRG||Prostatectomy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|69590.70||||||| MS668|DRG||Transurethral Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|MULTIPLAN [1680]|HMA [168003]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|||120423.08|36126.92|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|GEHA [1415]|GEHA [141500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|120423.08|142740.93|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|120423.08|17334.45|142740.93|17334.45|||| MS668|DRG||Transurethral Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|120423.08||||||| MS668|DRG||Transurethral Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|120423.08|17334.45|142740.93|17334.45|||| MS669|DRG||Transurethral Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67007.04|1700|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67007.04|7173.97|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|GEHA [1415]|GEHA [141500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|||67007.04|20102.11|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67007.04|7173.97|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67007.04|36996.83|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67007.04|36996.83|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67007.04|9732.78|36996.83|1700|||| MS669|DRG||Transurethral Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67007.04||||||| MS669|DRG||Transurethral Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67007.04|9732.78|36996.83|1700|||| MS670|DRG||Transurethral Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|||54457.87|16337.36|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54457.87|7211.41|16337.36|7211.41|||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54457.87||||||| MS670|DRG||Transurethral Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|54457.87||||||| MS671|DRG||Urethral Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|105404.32|7221.77|61229.39|5100|||| MS671|DRG||Urethral Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|105404.32|61229.39|61229.39|5100|||| MS671|DRG||Urethral Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|105404.32|5100|61229.39|5100|||| MS671|DRG||Urethral Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|||105404.32|31621.3|61229.39|5100|||| MS671|DRG||Urethral Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|105404.32|61229.39|61229.39|5100|||| MS671|DRG||Urethral Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|105404.32|7221.77|61229.39|5100|||| MS671|DRG||Urethral Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|105404.32||||||| MS671|DRG||Urethral Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|105404.32||||||| MS672|DRG||Urethral Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|||90626.66|27188|27188|27188|||| MS672|DRG||Urethral Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90626.66||||||| MS672|DRG||Urethral Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|90626.66||||||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|191679.59|63293.17|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|191679.59||||||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|191679.59|5100|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|191679.59|49753.68|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|191679.59|49040.96|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MULTIPLAN [1680]|HMA [168003]|191679.59|1749.51|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|191679.59|4350|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|191679.59|63293.17|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|||191679.59|57503.88|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|191679.59|14631.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|191679.59|41572.6|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|191679.59|50214.95|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|191679.59|70705.78|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|191679.59|49753.68|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|191679.59|45522.53|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|191679.59|14631.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|191679.59|21734.38|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|GEHA [1415]|GEHA [141500]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|191679.59|47647.18|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|191679.59|109545.87|109545.87|1749.51|||| MS673|DRG||Other Kidney And Urinary Tract Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|191679.59|79116.46|109545.87|1749.51|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|133140.93|18249.5|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|133140.93|33708.84|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|133140.93|34515.8|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|133140.93|85148.79|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|133140.93||||||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|GEHA [1415]|GEHA [141500]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|133140.93|85148.79|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|133140.93|28426.05|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|133140.93|15992.51|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|||133140.93|39942.28|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|133140.93|15992.51|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|133140.93|18249.5|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|133140.93|770.04|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|133140.93|2175|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|133140.93|61454.73|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|133140.93|15005.85|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|133140.93|54921.63|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|133140.93|36295.61|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|133140.93|6800|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|133140.93|85091.16|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|133140.93|31319.08|85148.79|770.04|||| MS674|DRG||Other Kidney And Urinary Tract Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|133140.93|36295.61|85148.79|770.04|||| MS682|DRG||Renal Failure With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|66556.01|21947.84|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|66556.01|3400|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|66556.01|30831.48|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|66556.01|12269.16|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|66556.01|21947.84|49051.64|2175|||| MS682|DRG||Renal Failure With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66556.01|2175|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|66556.01|21947.84|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|66556.01|20819.5|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MULTIPLAN [1680]|HMA [168003]|66556.01|3774.55|49051.64|2175|||| MS682|DRG||Renal Failure With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MULTIPLAN [1680]|IHC HS [168011]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|TRUSTMARK [2030]|STARMARK [203000]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|66556.01|17951.96|49051.64|2175|||| MS682|DRG||Renal Failure With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66556.01|12269.16|49051.64|2175|||| MS682|DRG||Renal Failure With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|UMR [2035]|UMR OPTIONS [203501]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|HEALTHNET [1495]|HEALTHNET [149500]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|66556.01|35426.19|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66556.01|17189.14|49051.64|2175|||| MS682|DRG||Renal Failure With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|66556.01|31660.11|49051.64|2175|||| MS682|DRG||Renal Failure With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|66556.01|21317.9|49051.64|2175|||| MS682|DRG||Renal Failure With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|66556.01|17951.96|49051.64|2175|||| MS682|DRG||Renal Failure With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|CHAMPVA [1240]|CHAMP VA [124000]|66556.01|30360.31|49051.64|2175|||| MS682|DRG||Renal Failure With McC|CORESOURCE [1315]|CORESOURCE [131500]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|GEHA [1415]|GEHA [141500]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|66556.01|49051.64|49051.64|2175|||| MS682|DRG||Renal Failure With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|66556.01|30831.48|49051.64|2175|||| MS682|DRG||Renal Failure With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66556.01|9349.34|49051.64|2175|||| MS682|DRG||Renal Failure With McC|AETNA [1015]|AETNA ACO WILCO [101532]|66556.01|20067.74|49051.64|2175|||| MS682|DRG||Renal Failure With McC|||66556.01|19966.8|49051.64|2175|||| MS682|DRG||Renal Failure With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|66556.01|49051.64|49051.64|2175|||| MS683|DRG||Renal Failure With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|CHAMPVA [1240]|CHAMP VA [124000]|39091.29||||||| MS683|DRG||Renal Failure With Cc|GEHA [1415]|GEHA [141500]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|CORESOURCE [1315]|CORESOURCE [131500]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39091.29|5702.45|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39091.29|11141.21|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39091.29|27161.43|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|||39091.29|11727.39|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39091.29|24273.95|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39091.29|10435.6|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39091.29|12562.78|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|UMR [2035]|UMR OPTIONS [203501]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39091.29|11141.21|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39091.29|7680.94|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MULTIPLAN [1680]|IHC HS [168011]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|HEALTHNET [1495]|HEALTHNET [149500]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MULTIPLAN [1680]|HMA [168003]|39091.29|616.63|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39091.29|2900|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39091.29|1700|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39091.29|22616.15|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39091.29|5702.45|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39091.29|7680.94|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39091.29|22616.15|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39091.29|13324.63|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39091.29|12434.77|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39091.29|13324.63|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39091.29|12732.45|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|TRUSTMARK [2030]|STARMARK [203000]|39091.29|37608.13|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39091.29|11221.91|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39091.29|5669.68|37608.13|616.63|||| MS683|DRG||Renal Failure With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39091.29|11221.91|37608.13|616.63|||| MS684|DRG||Renal Failure Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30994.34|8602.81|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30994.34|4913.64|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30994.34|8808.75|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30994.34|1450|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30994.34|15414.09|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30994.34|2550|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|30994.34|146.3|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30994.34|6961.61|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30994.34|4913.64|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30994.34|7155.94|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30994.34|8495.97|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|||30994.34|9298.3|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30994.34|6961.61|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30994.34|7695.13|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30994.34|15414.09|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|GEHA [1415]|GEHA [141500]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|30994.34||||||| MS684|DRG||Renal Failure Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30994.34|17705.7|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30994.34|11428.05|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30994.34|12787.45|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30994.34|4065.48|17705.7|146.3|||| MS684|DRG||Renal Failure Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30994.34|7695.13|17705.7|146.3|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|GEHA [1415]|GEHA [141500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|CORESOURCE [1315]|CORESOURCE [131500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|TRUSTMARK [2030]|STARMARK [203000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|HEALTHNET [1495]|HEALTHNET [149500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MULTIPLAN [1680]|HMA [168003]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|UMR [2035]|UMR OPTIONS [203501]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|AETNA [1015]|AETNA ACO WILCO [101532]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MULTIPLAN [1680]|IHC HS [168011]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|CHAMPVA [1240]|CHAMP VA [124000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|||28758.00|8627.4|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28758.00||||||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28758.00|11853.8|11853.8|8627.4|||| MS686|DRG||Kidney And Urinary Tract Neoplasms With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|28758.00||||||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70632.66|15193.1|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70632.66|14837.9|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70632.66|14295.98|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70632.66|725|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|CHAMPVA [1240]|CHAMP VA [124000]|70632.66||||||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|TRUSTMARK [2030]|STARMARK [203000]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70632.66|53494.53|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MULTIPLAN [1680]|IHC HS [168011]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MULTIPLAN [1680]|HMA [168003]|70632.66|236.39|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70632.66|9649.26|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70632.66|53494.53|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70632.66|66868.17|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70632.66|14853.07|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70632.66|59759.57|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|CORESOURCE [1315]|CORESOURCE [131500]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|GEHA [1415]|GEHA [141500]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|HEALTHNET [1495]|HEALTHNET [149500]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|UMR [2035]|UMR OPTIONS [203501]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70632.66|9649.26|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70632.66|92586.69|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|||70632.66|21189.8|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70632.66|12241.74|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70632.66|14295.98|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70632.66|6724.29|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70632.66|13164.14|92586.69|236.39|||| MS687|DRG||Kidney And Urinary Tract Neoplasms With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70632.66|1700|92586.69|236.39|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|GEHA [1415]|GEHA [141500]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28723.45|53312.03|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28723.45|11508.22|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|||28723.45|8617.03|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28723.45|8970.22|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28723.45|5580.63|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28723.45|7652.25|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28723.45|47644.55|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28723.45|7652.25|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|28723.45|141.11|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28723.45|1450|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28723.45|1700|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28723.45|11833.3|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28723.45|11833.3|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28723.45|5580.63|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28723.45|11453.57|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28723.45|9936.85|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28723.45|9704.53|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28723.45|73816.65|73816.65|141.11|||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28723.45||||||| MS688|DRG||Kidney And Urinary Tract Neoplasms Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28723.45|11453.57|73816.65|141.11|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52552.40|20036.42|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52552.40|1700|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|AETNA [1015]|AETNA ACO WILCO [101532]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52552.40|7099.72|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|HEALTHNET [1495]|HEALTHNET [149500]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MULTIPLAN [1680]|HMA [168003]|52552.40|302.75|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52552.40|9021.39|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|TRUSTMARK [2030]|STARMARK [203000]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MULTIPLAN [1680]|IHC HS [168011]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52552.40|14592.14|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52552.40|13009.32|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|||52552.40|15765.72|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52552.40|1450|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|CORESOURCE [1315]|CORESOURCE [131500]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|GEHA [1415]|GEHA [141500]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52552.40|20036.42|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|UMR [2035]|UMR OPTIONS [203501]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52552.40|16113.85|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52552.40|32320.39|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52552.40|7099.72|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52552.40|28884.52|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|CHAMPVA [1240]|CHAMP VA [124000]|52552.40||||||| MS689|DRG||Kidney And Urinary Tract Infections With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52552.40|44751.31|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52552.40|7118.91|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52552.40|9021.39|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52552.40|4679.12|44751.31|302.75|||| MS689|DRG||Kidney And Urinary Tract Infections With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52552.40|15737.12|44751.31|302.75|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|CHAMPVA [1240]|CHAMP VA [124000]|36410.91|21430.24|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36410.91|24219.59|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|CORESOURCE [1315]|CORESOURCE [131500]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36410.91|4655.04|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|||36410.91|10923.27|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36410.91|9197|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36410.91|10741.64|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|UMR [2035]|UMR OPTIONS [203501]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36410.91|6293.66|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36410.91|4655.04|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MULTIPLAN [1680]|IHC HS [168011]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MULTIPLAN [1680]|HMA [168003]|36410.91|223.32|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|HEALTHNET [1495]|HEALTHNET [149500]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36410.91|25895.26|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|TRUSTMARK [2030]|STARMARK [203000]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36410.91|23142.41|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36410.91|6293.66|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|GEHA [1415]|GEHA [141500]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36410.91|11218.34|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36410.91|11743.13|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36410.91|24219.59|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36410.91|11486.9|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36410.91|5135.84|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36410.91|35854.97|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36410.91|2550|35854.97|223.32|||| MS690|DRG||Kidney And Urinary Tract Infections Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36410.91|1450|35854.97|223.32|||| MS693|DRG||Urinary Stones With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36001.05||||||| MS693|DRG||Urinary Stones With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36001.05||||||| MS693|DRG||Urinary Stones With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36001.05||||||| MS693|DRG||Urinary Stones With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36001.05||||||| MS693|DRG||Urinary Stones With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36001.05||||||| MS693|DRG||Urinary Stones With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36001.05||||||| MS693|DRG||Urinary Stones With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36001.05||||||| MS693|DRG||Urinary Stones With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36001.05||||||| MS693|DRG||Urinary Stones With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36001.05||||||| MS693|DRG||Urinary Stones With McC|TRUSTMARK [2030]|STARMARK [203000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MULTIPLAN [1680]|IHC HS [168011]|36001.05||||||| MS693|DRG||Urinary Stones With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|UMR [2035]|UMR OPTIONS [203501]|36001.05||||||| MS693|DRG||Urinary Stones With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36001.05||||||| MS693|DRG||Urinary Stones With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36001.05||||||| MS693|DRG||Urinary Stones With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36001.05||||||| MS693|DRG||Urinary Stones With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36001.05||||||| MS693|DRG||Urinary Stones With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36001.05||||||| MS693|DRG||Urinary Stones With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MULTIPLAN [1680]|HMA [168003]|36001.05||||||| MS693|DRG||Urinary Stones With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36001.05||||||| MS693|DRG||Urinary Stones With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36001.05||||||| MS693|DRG||Urinary Stones With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|HEALTHNET [1495]|HEALTHNET [149500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|AETNA [1015]|AETNA ACO WILCO [101532]|36001.05||||||| MS693|DRG||Urinary Stones With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36001.05||||||| MS693|DRG||Urinary Stones With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36001.05||||||| MS693|DRG||Urinary Stones With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|CHAMPVA [1240]|CHAMP VA [124000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36001.05||||||| MS693|DRG||Urinary Stones With McC|CORESOURCE [1315]|CORESOURCE [131500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|GEHA [1415]|GEHA [141500]|36001.05||||||| MS693|DRG||Urinary Stones With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36001.05||||||| MS693|DRG||Urinary Stones With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|||36001.05|10800.31|11866.36|850|||| MS693|DRG||Urinary Stones With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36001.05|5252.65|11866.36|850|||| MS693|DRG||Urinary Stones With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36001.05|11866.36|11866.36|850|||| MS693|DRG||Urinary Stones With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36001.05|5252.65|11866.36|850|||| MS693|DRG||Urinary Stones With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36001.05|11866.36|11866.36|850|||| MS693|DRG||Urinary Stones With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36001.05|850|11866.36|850|||| MS693|DRG||Urinary Stones With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36001.05|8097.7|11866.36|850|||| MS693|DRG||Urinary Stones With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36001.05||||||| MS694|DRG||Urinary Stones Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23231.02|7398.93|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|CHAMPVA [1240]|CHAMP VA [124000]|23231.02||||||| MS694|DRG||Urinary Stones Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|GEHA [1415]|GEHA [141500]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|CORESOURCE [1315]|CORESOURCE [131500]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23231.02|13494.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|||23231.02|6969.31|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23231.02|8610.85|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23231.02|5538.64|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|UMR [2035]|UMR OPTIONS [203501]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23231.02|3346.32|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23231.02|11007.98|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MULTIPLAN [1680]|IHC HS [168011]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MULTIPLAN [1680]|HMA [168003]|23231.02|292.43|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|HEALTHNET [1495]|HEALTHNET [149500]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|TRUSTMARK [2030]|STARMARK [203000]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23231.02|15100.17|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23231.02|1450|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23231.02|1700|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23231.02|7398.93|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23231.02|10327.62|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23231.02|3346.32|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23231.02|10994.71|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23231.02|5538.64|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23231.02|10574.85|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23231.02|4744.94|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23231.02|9558.56|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23231.02|10994.71|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23231.02|20907.92|20907.92|292.43|||| MS694|DRG||Urinary Stones Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23231.02|10994.71|20907.92|292.43|||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|HEALTHNET [1495]|HEALTHNET [149500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MULTIPLAN [1680]|IHC HS [168011]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MULTIPLAN [1680]|HMA [168003]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|AETNA [1015]|AETNA ACO WILCO [101532]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|TRUSTMARK [2030]|STARMARK [203000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|UMR [2035]|UMR OPTIONS [203501]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|CORESOURCE [1315]|CORESOURCE [131500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|GEHA [1415]|GEHA [141500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|CHAMPVA [1240]|CHAMP VA [124000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|||69162.46|20748.74|20748.74|20748.74|||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|69162.46||||||| MS695|DRG||Kidney And Urinary Tract Signs And Symptoms With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|69162.46||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|CORESOURCE [1315]|CORESOURCE [131500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|UMR [2035]|UMR OPTIONS [203501]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MULTIPLAN [1680]|HMA [168003]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|TRUSTMARK [2030]|STARMARK [203000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|HEALTHNET [1495]|HEALTHNET [149500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MULTIPLAN [1680]|IHC HS [168011]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|20323.59|6874.26|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20323.59|850|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|GEHA [1415]|GEHA [141500]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20323.59|6874.26|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|20323.59|4279.08|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20323.59||||||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20323.59|5337.7|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20323.59|4279.08|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|||20323.59|6097.08|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|CHAMPVA [1240]|CHAMP VA [124000]|20323.59|12004.59|12004.59|850|||| MS696|DRG||Kidney And Urinary Tract Signs And Symptoms Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20323.59|5337.7|12004.59|850|||| MS697|DRG||Urethral Stricture|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28938.64||||||| MS697|DRG||Urethral Stricture|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28938.64||||||| MS697|DRG||Urethral Stricture|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28938.64||||||| MS697|DRG||Urethral Stricture|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28938.64||||||| MS697|DRG||Urethral Stricture|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28938.64||||||| MS697|DRG||Urethral Stricture|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28938.64||||||| MS697|DRG||Urethral Stricture|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28938.64||||||| MS697|DRG||Urethral Stricture|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28938.64||||||| MS697|DRG||Urethral Stricture|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28938.64||||||| MS697|DRG||Urethral Stricture|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28938.64||||||| MS697|DRG||Urethral Stricture|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28938.64||||||| MS697|DRG||Urethral Stricture|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28938.64||||||| MS697|DRG||Urethral Stricture|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28938.64||||||| MS697|DRG||Urethral Stricture|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28938.64||||||| MS697|DRG||Urethral Stricture|TRUSTMARK [2030]|STARMARK [203000]|28938.64||||||| MS697|DRG||Urethral Stricture|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28938.64||||||| MS697|DRG||Urethral Stricture|HEALTHNET [1495]|HEALTHNET [149500]|28938.64||||||| MS697|DRG||Urethral Stricture|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28938.64||||||| MS697|DRG||Urethral Stricture|MULTIPLAN [1680]|HMA [168003]|28938.64||||||| MS697|DRG||Urethral Stricture|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28938.64||||||| MS697|DRG||Urethral Stricture|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28938.64||||||| MS697|DRG||Urethral Stricture|FMH BENEFIT SERVICES [1390]|FMH [139000]|28938.64||||||| MS697|DRG||Urethral Stricture|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28938.64||||||| MS697|DRG||Urethral Stricture|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28938.64||||||| MS697|DRG||Urethral Stricture|FIRST HEALTH [1375]|QUALCHOICE [137513]|28938.64||||||| MS697|DRG||Urethral Stricture|MULTIPLAN [1680]|IHC HS [168011]|28938.64||||||| MS697|DRG||Urethral Stricture|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28938.64||||||| MS697|DRG||Urethral Stricture|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28938.64||||||| MS697|DRG||Urethral Stricture|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28938.64||||||| MS697|DRG||Urethral Stricture|UMR [2035]|UMR OPTIONS [203501]|28938.64||||||| MS697|DRG||Urethral Stricture|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28938.64||||||| MS697|DRG||Urethral Stricture|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28938.64||||||| MS697|DRG||Urethral Stricture|AETNA [1015]|AETNA ACO WILCO [101532]|28938.64||||||| MS697|DRG||Urethral Stricture|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28938.64||||||| MS697|DRG||Urethral Stricture|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28938.64||||||| MS697|DRG||Urethral Stricture|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28938.64||||||| MS697|DRG||Urethral Stricture|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28938.64||||||| MS697|DRG||Urethral Stricture|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28938.64||||||| MS697|DRG||Urethral Stricture|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28938.64||||||| MS697|DRG||Urethral Stricture|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28938.64||||||| MS697|DRG||Urethral Stricture|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28938.64||||||| MS697|DRG||Urethral Stricture|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28938.64||||||| MS697|DRG||Urethral Stricture|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28938.64||||||| MS697|DRG||Urethral Stricture|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28938.64||||||| MS697|DRG||Urethral Stricture|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28938.64||||||| MS697|DRG||Urethral Stricture|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28938.64||||||| MS697|DRG||Urethral Stricture|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28938.64||||||| MS697|DRG||Urethral Stricture|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28938.64||||||| MS697|DRG||Urethral Stricture|CORESOURCE [1315]|CORESOURCE [131500]|28938.64||||||| MS697|DRG||Urethral Stricture|GEHA [1415]|GEHA [141500]|28938.64||||||| MS697|DRG||Urethral Stricture|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28938.64|8378.66|16810.47|1700|||| MS697|DRG||Urethral Stricture|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28938.64||||||| MS697|DRG||Urethral Stricture|||28938.64|8681.59|16810.47|1700|||| MS697|DRG||Urethral Stricture|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28938.64|16810.47|16810.47|1700|||| MS697|DRG||Urethral Stricture|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28938.64|8378.66|16810.47|1700|||| MS697|DRG||Urethral Stricture|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28938.64|1700|16810.47|1700|||| MS697|DRG||Urethral Stricture|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28938.64||||||| MS697|DRG||Urethral Stricture|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28938.64|16810.47|16810.47|1700|||| MS697|DRG||Urethral Stricture|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28938.64||||||| MS697|DRG||Urethral Stricture|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28938.64||||||| MS697|DRG||Urethral Stricture|CHAMPVA [1240]|CHAMP VA [124000]|28938.64||||||| MS697|DRG||Urethral Stricture|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28938.64||||||| MS697|DRG||Urethral Stricture|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28938.64||||||| MS697|DRG||Urethral Stricture|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28938.64||||||| MS697|DRG||Urethral Stricture|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28938.64||||||| MS697|DRG||Urethral Stricture|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28938.64||||||| MS697|DRG||Urethral Stricture|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28938.64||||||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|GEHA [1415]|GEHA [141500]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63954.17|37150.98|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|63954.17|21256.42|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63954.17|34421.33|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|||63954.17|19186.25|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63954.17|18824.32|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63954.17|12617.19|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63954.17|11402.15|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63954.17|21468.41|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|63954.17|992.76|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63954.17|38515.86|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63954.17|5950|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63954.17|37150.98|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63954.17|22752.48|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63954.17|11402.15|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63954.17|12617.19|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63954.17|23297.15|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63954.17|10197.62|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63954.17|10110|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63954.17|24035.71|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63954.17|53329.67|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63954.17|2900|53329.67|992.76|||| MS698|DRG||Other Kidney And Urinary Tract Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63954.17|53329.67|53329.67|992.76|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|CHAMPVA [1240]|CHAMP VA [124000]|33143.50||||||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|33143.50|8212.28|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33143.50|14517.86|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|33143.50|15578.91|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|33143.50|3400|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33143.50|1450|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|TRUSTMARK [2030]|STARMARK [203000]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MULTIPLAN [1680]|HMA [168003]|33143.50|282.1|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|33143.50|6681.09|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33143.50|8212.28|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|HEALTHNET [1495]|HEALTHNET [149500]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|UMR [2035]|UMR OPTIONS [203501]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|33143.50|14148.68|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33143.50|12010.3|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|||33143.50|9943.05|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|33143.50|14865.4|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33143.50|15578.91|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MULTIPLAN [1680]|IHC HS [168011]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|GEHA [1415]|GEHA [141500]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|33143.50|6681.09|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|33143.50|6592.29|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|33143.50|15283.86|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33143.50|23679.59|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33143.50|17101.93|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|33143.50|15335.27|23679.59|282.1|||| MS699|DRG||Other Kidney And Urinary Tract Diagnoses With Cc|CORESOURCE [1315]|CORESOURCE [131500]|33143.50|23679.59|23679.59|282.1|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|45292.62||||||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|GEHA [1415]|GEHA [141500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45292.62|44890.11|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45292.62|4518.49|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|||45292.62|13587.79|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45292.62|10498.28|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45292.62|5741.33|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45292.62|8625.97|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45292.62|4518.49|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|45292.62|173.61|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45292.62|17166.66|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45292.62|15341.7|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45292.62|10799.6|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45292.62|44890.11|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45292.62|4896.06|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45292.62|10547.11|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45292.62|4250|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45292.62|1450|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45292.62|23769.22|44890.11|173.61|||| MS700|DRG||Other Kidney And Urinary Tract Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45292.62|5741.33|44890.11|173.61|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|118226.08||||||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|118226.08||||||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|118226.08||||||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|118226.08||||||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|118226.08||||||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|118226.08||||||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|118226.08|60828.19|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|118226.08|26610.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|118226.08|26610.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|118226.08|27197.62|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|118226.08|27848.7|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|118226.08|375.94|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|118226.08|1450|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|118226.08|60828.19|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|118226.08|21746.94|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|118226.08|76035.24|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|||118226.08|35467.82|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|118226.08|26610.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|118226.08|12148.38|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|118226.08|23385.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|118226.08|24364.39|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|118226.08|105279.55|105279.55|375.94|||| MS707|DRG||Major Male Pelvic Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|118226.08|67952.1|105279.55|375.94|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111526.83|67857.58|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|111526.83|133367.4|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111526.83|8762.95|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111526.83|60220.3|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|||111526.83|33458.05|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111526.83|16886.76|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111526.83|53906.96|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111526.83|8762.95|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111526.83|18719.79|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|111526.83|118.89|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111526.83|67383.7|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111526.83|850|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111526.83|67857.58|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111526.83|21625.3|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111526.83|21119.72|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111526.83|53906.96|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111526.83|10575.34|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111526.83|21561.75|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111526.83|725|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111526.83|93300.51|133367.4|118.89|||| MS708|DRG||Major Male Pelvic Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111526.83|93300.51|133367.4|118.89|||| MS709|DRG||Penis Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|||44060.43|13218.13|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44060.43|15935.8|15935.8|13218.13|||| MS709|DRG||Penis Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44060.43||||||| MS709|DRG||Penis Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|44060.43||||||| MS710|DRG||Penis Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|||63908.87|19172.66|19172.66|19172.66|||| MS710|DRG||Penis Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63908.87||||||| MS710|DRG||Penis Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63908.87||||||| MS711|DRG||Testes Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75701.69|43975.13|43975.13|1700|||| MS711|DRG||Testes Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75701.69|1700|43975.13|1700|||| MS711|DRG||Testes Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75701.69|8001.36|43975.13|1700|||| MS711|DRG||Testes Procedures With Cc/McC|||75701.69|22710.51|43975.13|1700|||| MS711|DRG||Testes Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75701.69|8001.36|43975.13|1700|||| MS711|DRG||Testes Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75701.69|43975.13|43975.13|1700|||| MS711|DRG||Testes Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75701.69||||||| MS711|DRG||Testes Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75701.69||||||| MS712|DRG||Testes Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|||64874.08|19462.22|19462.22|19462.22|||| MS712|DRG||Testes Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64874.08||||||| MS712|DRG||Testes Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64874.08||||||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|GEHA [1415]|GEHA [141500]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77176.51||||||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77176.51||||||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77176.51||||||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|77176.51||||||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77176.51||||||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77176.51|21628.2|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77176.51|4350|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MULTIPLAN [1680]|HMA [168003]|77176.51|1067.97|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77176.51|21122.55|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77176.51|11973.61|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77176.51|11973.61|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77176.51||||||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77176.51|19253.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77176.51|10576.65|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77176.51|17003.06|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77176.51|89632.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77176.51|21710.25|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77176.51|64734.83|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|||77176.51|23152.95|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77176.51|57853.01|89632.83|1067.97|||| MS713|DRG||Transurethral Prostatectomy With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77176.51|10576.65|89632.83|1067.97|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55003.58||||||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55003.58||||||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55003.58||||||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55003.58||||||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|GEHA [1415]|GEHA [141500]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55003.58|31951.57|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55003.58|35752.33|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55003.58|11917.88|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55003.58|6405.9|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55003.58|10646.1|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|55003.58|238.7|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|||55003.58|16501.07|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55003.58|725|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55003.58||||||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|55003.58||||||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55003.58|49503.22|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55003.58|13463.25|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55003.58|13148.49|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55003.58|6405.9|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55003.58|6897.83|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55003.58|13593.41|49503.22|238.7|||| MS714|DRG||Transurethral Prostatectomy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55003.58|49503.22|49503.22|238.7|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136931.93||||||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|136931.93||||||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136931.93||||||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|136931.93||||||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MULTIPLAN [1680]|HMA [168003]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|136931.93||||||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|||136931.93|41079.58|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136931.93||||||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136931.93|12759.28|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|GEHA [1415]|GEHA [141500]|136931.93|41153.1|41153.1|12759.28|||| MS715|DRG||Other Male Reproductive System O.R. Procedures For Malignancy With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136931.93|41153.1|41153.1|12759.28|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|81378.26|47272.64|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|81378.26|52895.87|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|81378.26|17043.77|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|81378.26|19286.28|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|||81378.26|24413.48|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|81378.26|9574.53|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|81378.26|145.08|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|81378.26||||||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|81378.26|725|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|81378.26|73240.43|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|81378.26|18509.25|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|81378.26|18076.52|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|81378.26|9574.53|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|81378.26|21762.22|73240.43|145.08|||| MS716|DRG||Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|81378.26|73240.43|73240.43|145.08|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|67563.85||||||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67563.85|14306.48|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67563.85|25468.56|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67563.85|74004.47|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67563.85|9350|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67563.85|2175|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MULTIPLAN [1680]|HMA [168003]|67563.85|1483.83|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67563.85|2397.17|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67563.85|14306.48|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67563.85|26078.25|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67563.85|26082.78|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67563.85|20518.81|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67563.85|48548.73|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|||67563.85|20269.15|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67563.85|43387.63|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67563.85|12581.67|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67563.85|2397.17|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67563.85|26199.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67563.85|74004.47|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|GEHA [1415]|GEHA [141500]|67563.85|67221.31|74004.47|1483.83|||| MS717|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67563.85|67221.31|74004.47|1483.83|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63887.40||||||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63887.40||||||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63887.40||||||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63887.40||||||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63887.40||||||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63887.40|8868.98|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63887.40|9923.99|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63887.40|14181.62|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63887.40|15267.67|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63887.40|8154.94|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|||63887.40|19166.22|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|63887.40|358.98|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63887.40|1450|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|63887.40||||||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63887.40|15267.67|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63887.40|15267.67|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63887.40|8154.94|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63887.40|8081.14|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63887.40|13740.9|19166.22|358.98|||| MS718|DRG||Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63887.40|13740.9|19166.22|358.98|||| MS722|DRG||Malignancy, Male Reproductive System With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|AETNA [1015]|AETNA ACO WILCO [101532]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|TRUSTMARK [2030]|STARMARK [203000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MULTIPLAN [1680]|IHC HS [168011]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MULTIPLAN [1680]|HMA [168003]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|UMR [2035]|UMR OPTIONS [203501]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|HEALTHNET [1495]|HEALTHNET [149500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|CHAMPVA [1240]|CHAMP VA [124000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|CORESOURCE [1315]|CORESOURCE [131500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|GEHA [1415]|GEHA [141500]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|37599.13||||||| MS722|DRG||Malignancy, Male Reproductive System With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|||37599.13|11279.74|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|37599.13|11681.52|11681.52|11279.74|||| MS722|DRG||Malignancy, Male Reproductive System With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|37599.13|11681.52|11681.52|11279.74|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|GEHA [1415]|GEHA [141500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|CHAMPVA [1240]|CHAMP VA [124000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MULTIPLAN [1680]|IHC HS [168011]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MULTIPLAN [1680]|HMA [168003]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|HEALTHNET [1495]|HEALTHNET [149500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|TRUSTMARK [2030]|STARMARK [203000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|UMR [2035]|UMR OPTIONS [203501]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|CORESOURCE [1315]|CORESOURCE [131500]|24559.00||||||| MS723|DRG||Malignancy, Male Reproductive System With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|||24559.00|7367.7|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24559.00|6980.95|7367.7|6980.95|||| MS723|DRG||Malignancy, Male Reproductive System With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24559.00|6980.95|7367.7|6980.95|||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|GEHA [1415]|GEHA [141500]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10588.70||||||| MS724|DRG||Malignancy, Male Reproductive System Without Cc/McC|||10588.70|3176.61|3176.61|3176.61|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|GEHA [1415]|GEHA [141500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|CORESOURCE [1315]|CORESOURCE [131500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|CHAMPVA [1240]|CHAMP VA [124000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MULTIPLAN [1680]|IHC HS [168011]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|HEALTHNET [1495]|HEALTHNET [149500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|TRUSTMARK [2030]|STARMARK [203000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MULTIPLAN [1680]|HMA [168003]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|UMR [2035]|UMR OPTIONS [203501]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13822.00|17287.32|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13822.00|6964.43|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13822.00||||||| MS725|DRG||Benign Prostatic Hypertrophy With McC|||13822.00|4146.6|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13822.00|6964.43|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13822.00|1700|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13822.00|17287.32|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13822.00|9206.65|17287.32|1700|||| MS725|DRG||Benign Prostatic Hypertrophy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13822.00|9206.65|17287.32|1700|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26357.10||||||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26357.10||||||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26357.10||||||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|CHAMPVA [1240]|CHAMP VA [124000]|26357.10||||||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26357.10||||||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26357.10|5675.92|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26357.10|10525.87|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26357.10|10777.85|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26357.10|725|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|TRUSTMARK [2030]|STARMARK [203000]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|HEALTHNET [1495]|HEALTHNET [149500]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MULTIPLAN [1680]|IHC HS [168011]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MULTIPLAN [1680]|HMA [168003]|26357.10|83.3|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26357.10|5675.92|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|UMR [2035]|UMR OPTIONS [203501]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26357.10|9969.65|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26357.10|8893.46|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26357.10|16147.73|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|||26357.10|7907.13|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26357.10||||||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26357.10|14431.09|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26357.10|4831.95|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26357.10|10294.58|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|CORESOURCE [1315]|CORESOURCE [131500]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|GEHA [1415]|GEHA [141500]|26357.10|22358.39|22358.39|83.3|||| MS726|DRG||Benign Prostatic Hypertrophy Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26357.10|22358.39|22358.39|83.3|||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|GEHA [1415]|GEHA [141500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|CORESOURCE [1315]|CORESOURCE [131500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|CHAMPVA [1240]|CHAMP VA [124000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|UMR [2035]|UMR OPTIONS [203501]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MULTIPLAN [1680]|IHC HS [168011]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MULTIPLAN [1680]|HMA [168003]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|HEALTHNET [1495]|HEALTHNET [149500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|TRUSTMARK [2030]|STARMARK [203000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|AETNA [1015]|AETNA ACO WILCO [101532]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|64710.40||||||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|64710.40|21668.79|21668.79|2550|||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|64710.40|5973.12|21668.79|2550|||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|||64710.40|19413.12|21668.79|2550|||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|64710.40|5973.12|21668.79|2550|||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|64710.40|2550|21668.79|2550|||| MS727|DRG||Inflammation Of The Male Reproductive System With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|64710.40|21668.79|21668.79|2550|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|CHAMPVA [1240]|CHAMP VA [124000]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45461.22|6464.85|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45461.22|11378.36|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45461.22|11650.75|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45461.22|2550|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45461.22|1450|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|TRUSTMARK [2030]|STARMARK [203000]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|HEALTHNET [1495]|HEALTHNET [149500]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MULTIPLAN [1680]|IHC HS [168011]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MULTIPLAN [1680]|HMA [168003]|45461.22|229.6|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45461.22|26454.22|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45461.22|3780.53|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45461.22|6464.85|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|UMR [2035]|UMR OPTIONS [203501]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45461.22|10972.83|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45461.22|9333.08|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45461.22||||||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45461.22|20925.82|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|||45461.22|13638.37|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45461.22|18701.24|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45461.22|3780.53|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45461.22|11916.88|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|CORESOURCE [1315]|CORESOURCE [131500]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45461.22|26454.22|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|GEHA [1415]|GEHA [141500]|45461.22|28974.2|28974.2|229.6|||| MS728|DRG||Inflammation Of The Male Reproductive System Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45461.22|28974.2|28974.2|229.6|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MULTIPLAN [1680]|HMA [168003]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|||56621.09|16986.33|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|GEHA [1415]|GEHA [141500]|56621.09||||||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56621.09|7396.3|16986.33|7396.3|||| MS729|DRG||Other Male Reproductive System Diagnoses With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56621.09|7396.3|16986.33|7396.3|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82405.90|8202.65|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82405.90|725|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82405.90|8010.88|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|82405.90|1555.81|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82405.90|5377.95|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82405.90|5377.95|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82405.90|8628.46|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82405.90||||||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82405.90|7345.51|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82405.90|52689.59|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|||82405.90|24721.77|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82405.90|47088.28|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82405.90|10724.06|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|GEHA [1415]|GEHA [141500]|82405.90|72954.8|72954.8|725|||| MS730|DRG||Other Male Reproductive System Diagnoses Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82405.90|72954.8|72954.8|725|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|GEHA [1415]|GEHA [141500]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119433.28|12888.44|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|||119433.28|35829.98|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119433.28|59651.14|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119433.28|25491.8|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119433.28|29410.87|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119433.28|20755.98|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119433.28|12888.44|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119433.28|53309.76|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119433.28|35816.87|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MULTIPLAN [1680]|HMA [168003]|119433.28|413.14|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119433.28||||||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119433.28|2175|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119433.28|850|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119433.28|35816.87|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119433.28|82593.89|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119433.28|32230.6|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119433.28|31477.07|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119433.28|20755.98|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119433.28|32549.04|82593.89|413.14|||| MS734|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119433.28|82593.89|82593.89|413.14|||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|GEHA [1415]|GEHA [141500]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88371.04||||||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88371.04|58695.54|58695.54|2550|||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88371.04|2550|58695.54|2550|||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|88371.04|10874.85|58695.54|2550|||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|||88371.04|26511.31|58695.54|2550|||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88371.04|10874.85|58695.54|2550|||| MS735|DRG||Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|88371.04|58695.54|58695.54|2550|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|CORESOURCE [1315]|CORESOURCE [131500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|UMR [2035]|UMR OPTIONS [203501]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MULTIPLAN [1680]|IHC HS [168011]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MULTIPLAN [1680]|HMA [168003]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|HEALTHNET [1495]|HEALTHNET [149500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|TRUSTMARK [2030]|STARMARK [203000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|CHAMPVA [1240]|CHAMP VA [124000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|GEHA [1415]|GEHA [141500]|187726.62||||||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|||187726.62|56317.99|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|187726.62|28651.31|56317.99|28651.31|||| MS736|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|187726.62|28651.31|56317.99|28651.31|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|109804.63|60915.8|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|109804.63|29146.17|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|109804.63|29843.9|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|109804.63|56262.54|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|109804.63|4250|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|109804.63|5800|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MULTIPLAN [1680]|IHC HS [168011]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MULTIPLAN [1680]|HMA [168003]|109804.63|468.71|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|TRUSTMARK [2030]|STARMARK [203000]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|109804.63|12429.43|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|109804.63|60915.8|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|UMR [2035]|UMR OPTIONS [203501]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|109804.63|26495.14|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|109804.63|23109.97|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|109804.63|76144.75|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|||109804.63|32941.39|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|109804.63|68049.99|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|109804.63||||||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|109804.63|14278.33|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|109804.63|12429.43|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|109804.63|24851.29|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|109804.63|56262.54|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|GEHA [1415]|GEHA [141500]|109804.63|105431.19|105431.19|468.71|||| MS737|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|109804.63|105431.19|105431.19|468.71|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82771.13||||||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|||82771.13|24831.34|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82771.13|10478.65|24831.34|10478.65|||| MS738|DRG||Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82771.13|10478.65|24831.34|10478.65|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|CHAMPVA [1240]|CHAMP VA [124000]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|124423.93|64700.44|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|124423.93|54119.09|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|124423.93|55414.65|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|124423.93|2900|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|TRUSTMARK [2030]|STARMARK [203000]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|HEALTHNET [1495]|HEALTHNET [149500]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MULTIPLAN [1680]|IHC HS [168011]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MULTIPLAN [1680]|HMA [168003]|124423.93|2727.96|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124423.93|64700.44|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|UMR [2035]|UMR OPTIONS [203501]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|124423.93|47878.38|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124423.93|43548.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|124423.93||||||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|124423.93|80875.56|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|||124423.93|37327.18|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|124423.93|72277.85|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|124423.93|55604.66|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|CORESOURCE [1315]|CORESOURCE [131500]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|GEHA [1415]|GEHA [141500]|124423.93|111981.54|111981.54|2727.96|||| MS739|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|124423.93|111981.54|111981.54|2727.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|102400.16||||||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102400.16||||||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|102400.16||||||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102400.16||||||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102400.16||||||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|GEHA [1415]|GEHA [141500]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102400.16|59484.25|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102400.16|66560.11|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102400.16|20758.39|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102400.16|23273.33|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|UMR [2035]|UMR OPTIONS [203501]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102400.16|53248.08|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MULTIPLAN [1680]|IHC HS [168011]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|||102400.16|30720.05|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MULTIPLAN [1680]|HMA [168003]|102400.16|816.96|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|TRUSTMARK [2030]|STARMARK [203000]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|102400.16|1450|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102400.16|92160.15|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|102400.16||||||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102400.16|26100|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102400.16|25489.8|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102400.16|53248.08|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102400.16|11398.91|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102400.16|26505.21|92160.15|816.96|||| MS740|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102400.16|92160.15|92160.15|816.96|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70193.39|9565.65|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70193.39|18119|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70193.39|18552.75|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70193.39|32375.43|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70193.39|850|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70193.39|725|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|70193.39|196|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70193.39|6717.83|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70193.39|9565.65|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70193.39|17094.69|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70193.39|15462.09|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70193.39|41085.33|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|||70193.39|21058.02|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70193.39|36717.64|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70193.39|9190.97|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|70193.39||||||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70193.39|6717.83|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70193.39|16627.14|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70193.39|32375.43|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|70193.39|56887.38|56887.38|196|||| MS741|DRG||Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70193.39|56887.38|56887.38|196|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|GEHA [1415]|GEHA [141500]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|83670.94|39904.03|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|83670.94|98693.42|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83670.94|42266.04|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|||83670.94|25101.28|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83670.94|19648.89|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83670.94|22157.93|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83670.94|12464.57|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|83670.94|7845.67|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MULTIPLAN [1680]|HMA [168003]|83670.94|210.6|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83670.94|47293.72|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|83670.94|1450|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83670.94|2550|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83670.94|7845.67|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83670.94|39904.03|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83670.94|65483.62|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83670.94|24896.5|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83670.94|24314.44|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83670.94|12464.57|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83670.94|12049.22|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83670.94|21129.41|98693.42|210.6|||| MS742|DRG||Uterine And Adnexa Procedures For Non-Malignancy With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83670.94|65483.62|98693.42|210.6|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62116.75|8037.86|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62116.75|17054.87|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62116.75|7864.91|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62116.75|16034.5|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62116.75|16418.35|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62116.75|33906.96|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62116.75|1700|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|62116.75|1513.53|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62116.75|7411.59|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62116.75|8037.86|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62116.75|1450|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62116.75|14527.24|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62116.75|13357.06|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62116.75|17054.87|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62116.75|40375.89|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|||62116.75|18635.02|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62116.75|36083.61|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62116.75|8229.27|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62116.75|7411.59|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|62116.75|50047.36|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62116.75|14827.14|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62116.75|33906.96|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|GEHA [1415]|GEHA [141500]|62116.75|55905.07|55905.07|1450|||| MS743|DRG||Uterine And Adnexa Procedures For Non-Malignancy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62116.75|55905.07|55905.07|1450|||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|GEHA [1415]|GEHA [141500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MULTIPLAN [1680]|HMA [168003]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82561.58||||||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82561.58|47815.97|47815.97|2550|||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82561.58|7380.07|47815.97|2550|||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|||82561.58|24768.47|47815.97|2550|||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82561.58|7380.07|47815.97|2550|||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82561.58|2550|47815.97|2550|||| MS744|DRG||D&C, Conization, Laparoscopy And Tubal Interruption With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82561.58|47815.97|47815.97|2550|||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|GEHA [1415]|GEHA [141500]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46935.05||||||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46935.05|27264.59|27264.59|2550|||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46935.05|2550|27264.59|2550|||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46935.05|4533.57|27264.59|2550|||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|||46935.05|14080.51|27264.59|2550|||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46935.05|4533.57|27264.59|2550|||| MS745|DRG||D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46935.05|27264.59|27264.59|2550|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|52032.56|24766.73|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|52032.56|6672.36|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|52032.56||||||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|||52032.56|15609.77|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|52032.56|6672.36|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|52032.56|850|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|52032.56|24766.73|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52032.56|10214.41|24766.73|850|||| MS746|DRG||Vagina, Cervix And Vulva Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52032.56|10214.41|24766.73|850|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|63389.91||||||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63389.91|7180.29|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63389.91|13283.02|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63389.91|13601|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63389.91|38681.58|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63389.91|2550|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63389.91|1450|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|63389.91|1492.4|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63389.91|3899.75|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63389.91|7180.29|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63389.91|12468.14|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63389.91|10841.49|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63389.91|37282.97|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|||63389.91|19016.97|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63389.91|33319.49|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63389.91|6959.88|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63389.91|3899.75|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63389.91|6383.69|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63389.91|38681.58|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|63389.91|51622.57|51622.57|1450|||| MS747|DRG||Vagina, Cervix And Vulva Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63389.91|51622.57|51622.57|1450|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|UMR [2035]|UMR OPTIONS [203501]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MULTIPLAN [1680]|IHC HS [168011]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MULTIPLAN [1680]|HMA [168003]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|TRUSTMARK [2030]|STARMARK [203000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|HEALTHNET [1495]|HEALTHNET [149500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|||59971.25|17991.37|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59971.25|9640.45|17991.37|9640.45|||| MS748|DRG||Female Reproductive System Reconstructive Procedures|CORESOURCE [1315]|CORESOURCE [131500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|CHAMPVA [1240]|CHAMP VA [124000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|GEHA [1415]|GEHA [141500]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59971.25||||||| MS748|DRG||Female Reproductive System Reconstructive Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59971.25||||||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|172894.63|13361.65|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|172894.63|110979.78|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|172894.63|20624.36|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|172894.63|13361.65|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|172894.63||||||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|172894.63|30147.29|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|172894.63|110979.78|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|||172894.63|51868.39|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|172894.63|62774.97|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|172894.63|1949.11|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|172894.63|4350|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|172894.63|39257.3|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|172894.63|56101.5|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|172894.63|34842.39|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|172894.63|38339.49|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|172894.63|18519.67|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|172894.63|7650|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|172894.63|20624.36|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|172894.63|38493.37|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|172894.63|86919.18|110979.78|1949.11|||| MS749|DRG||Other Female Reproductive System O.R. Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|172894.63|18519.67|110979.78|1949.11|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56160.69|50415.99|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56160.69|8058.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56160.69|15481.86|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56160.69|17573.3|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|56160.69|638.35|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56160.69|9612.48|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56160.69|45056.39|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|||56160.69|16848.21|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56160.69|4350|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56160.69|8058.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56160.69|9612.48|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56160.69|21255.55|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56160.69|27269.39|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56160.69|20758.61|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56160.69|27269.39|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56160.69||||||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56160.69|850|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56160.69|69806.75|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56160.69|18479.76|69806.75|638.35|||| MS750|DRG||Other Female Reproductive System O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|56160.69|69806.75|69806.75|638.35|||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93354.22|15848|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|HEALTHNET [1495]|HEALTHNET [149500]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|AETNA [1015]|AETNA ACO WILCO [101532]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|CHAMPVA [1240]|CHAMP VA [124000]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93354.22|25787.18|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|TRUSTMARK [2030]|STARMARK [203000]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MULTIPLAN [1680]|IHC HS [168011]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93354.22|54229.48|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93354.22|20490.9|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|||93354.22|28006.27|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93354.22||||||| MS754|DRG||Malignancy, Female Reproductive System With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93354.22|15848|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|CORESOURCE [1315]|CORESOURCE [131500]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|GEHA [1415]|GEHA [141500]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93354.22|22437.8|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93354.22|60680.24|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MULTIPLAN [1680]|HMA [168003]|93354.22|1963.65|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93354.22|24207.56|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93354.22|26404.5|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|93354.22|5800|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|UMR [2035]|UMR OPTIONS [203501]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93354.22|84018.79|84018.79|1963.65|||| MS754|DRG||Malignancy, Female Reproductive System With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93354.22|84018.79|84018.79|1963.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|||31282.76|9384.83|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|UMR [2035]|UMR OPTIONS [203501]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31282.76|14839.55|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31282.76|15295.77|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31282.76|2550|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31282.76|15198.53|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|HEALTHNET [1495]|HEALTHNET [149500]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31282.76|725|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MULTIPLAN [1680]|HMA [168003]|31282.76|20.65|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|TRUSTMARK [2030]|STARMARK [203000]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31282.76|15967.94|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31282.76|8935.8|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31282.76|11906.79|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MULTIPLAN [1680]|IHC HS [168011]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31282.76|16350.2|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31282.76|8935.8|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31282.76|17115.27|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31282.76|10427.1|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31282.76|10427.1|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31282.76|12803.96|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|CORESOURCE [1315]|CORESOURCE [131500]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|CHAMPVA [1240]|CHAMP VA [124000]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31282.76||||||| MS755|DRG||Malignancy, Female Reproductive System With Cc|GEHA [1415]|GEHA [141500]|31282.76|23698.06|23698.06|20.65|||| MS755|DRG||Malignancy, Female Reproductive System With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31282.76|15198.53|23698.06|20.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34624.00|12972.89|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34624.00|5371.49|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34624.00|20113.09|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34624.00|13283.45|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34624.00||||||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|34624.00|230.65|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34624.00|28704.65|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34624.00|2175|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34624.00|3718.68|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34624.00|2550|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34624.00|5371.49|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34624.00|25653.12|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34624.00|10197.18|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34624.00|8586.55|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34624.00|20113.09|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|||34624.00|10387.2|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34624.00|10965.53|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34624.00|3718.68|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|GEHA [1415]|GEHA [141500]|34624.00|39744.9|39744.9|230.65|||| MS756|DRG||Malignancy, Female Reproductive System Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34624.00|39744.9|39744.9|230.65|||| MS757|DRG||Infections, Female Reproductive System With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|CHAMPVA [1240]|CHAMP VA [124000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|CORESOURCE [1315]|CORESOURCE [131500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|GEHA [1415]|GEHA [141500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MULTIPLAN [1680]|HMA [168003]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|UMR [2035]|UMR OPTIONS [203501]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MULTIPLAN [1680]|IHC HS [168011]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|HEALTHNET [1495]|HEALTHNET [149500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|TRUSTMARK [2030]|STARMARK [203000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|AETNA [1015]|AETNA ACO WILCO [101532]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|||31141.93|9342.58|9342.58|9342.58|||| MS757|DRG||Infections, Female Reproductive System With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31141.93||||||| MS757|DRG||Infections, Female Reproductive System With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31141.93||||||| MS758|DRG||Infections, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|35924.22|18798.68|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|HEALTHNET [1495]|HEALTHNET [149500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|TRUSTMARK [2030]|STARMARK [203000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MULTIPLAN [1680]|HMA [168003]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|UMR [2035]|UMR OPTIONS [203501]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MULTIPLAN [1680]|IHC HS [168011]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|35924.22|1700|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|CHAMPVA [1240]|CHAMP VA [124000]|35924.22||||||| MS758|DRG||Infections, Female Reproductive System With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|CORESOURCE [1315]|CORESOURCE [131500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|35924.22|3794.01|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|||35924.22|10777.27|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35924.22|18798.68|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|GEHA [1415]|GEHA [141500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|35924.22|3794.01|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|35924.22|20620.94|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|35924.22|7149.36|20620.94|1700|||| MS758|DRG||Infections, Female Reproductive System With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|35924.22|20620.94|20620.94|1700|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28347.62|9623.4|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28347.62|14404.18|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28347.62|725|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|28347.62|282.72|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28347.62|850|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28347.62|9623.4|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28347.62|5596.78|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28347.62|14404.18|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|GEHA [1415]|GEHA [141500]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|28347.62||||||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28347.62|2747.23|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28347.62|5590.24|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28347.62|6255.21|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|||28347.62|8504.29|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28347.62|9623.4|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28347.62|9805.25|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28347.62|2747.23|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28347.62|7679.29|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28347.62|4458.45|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28347.62|5596.78|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28347.62|8661.06|14404.18|282.72|||| MS759|DRG||Infections, Female Reproductive System Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28347.62|4458.45|14404.18|282.72|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30632.76|6421.25|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30632.76|3934.62|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MULTIPLAN [1680]|HMA [168003]|30632.76|78.84|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30632.76|7157.95|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30632.76|6421.25|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30632.76|23950.38|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|GEHA [1415]|GEHA [141500]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30632.76|3730.1|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30632.76|725|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30632.76|1700|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30632.76|4173.81|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30632.76|6421.25|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|||30632.76|9189.83|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30632.76|6421.25|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30632.76|7157.95|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|30632.76|5592.75|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30632.76|6421.25|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30632.76|23950.38|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30632.76|5779.13|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30632.76|5846.23|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30632.76|3436.37|23950.38|78.84|||| MS760|DRG||Menstrual And Other Female Reproductive System Disorders With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30632.76|5779.13|23950.38|78.84|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|22880.50||||||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22880.50|13061.23|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22880.50|3297.67|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22880.50|8751.97|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22880.50|6575.6|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22880.50|8686.6|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|||22880.50|6864.15|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22880.50|4027.81|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22880.50|3297.67|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22880.50|9793.06|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22880.50|850|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22880.50|13061.23|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22880.50|8555|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22880.50|4027.81|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22880.50|725|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22880.50|4686.34|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|22880.50|279.83|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22880.50|8396.01|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|22880.50|13559.62|13559.62|279.83|||| MS761|DRG||Menstrual And Other Female Reproductive System Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22880.50|8354.99|13559.62|279.83|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27258.46|9031.08|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27258.46|12600.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|FMH BENEFIT SERVICES [1390]|FMH [139000]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|FIRST HEALTH [1375]|QUALCHOICE [137513]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27258.46|2175|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MULTIPLAN [1680]|HMA [168003]|27258.46|339.98|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27258.46|16391.76|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|AETNA [1015]|AETNA ACO WILCO [101532]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|HEALTHNET [1495]|HEALTHNET [149500]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27258.46|14861.06|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MULTIPLAN [1680]|IHC HS [168011]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|TRUSTMARK [2030]|STARMARK [203000]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27258.46||||||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27258.46|5459.95|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27258.46|15834.44|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|UMR [2035]|UMR OPTIONS [203501]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27258.46|16976.6|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27258.46|16001.32|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27258.46|16579.7|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27258.46|11717.23|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|||27258.46|8177.54|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27258.46|1700|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27258.46|9031.08|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27258.46|15327.62|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|CHAMPVA [1240]|CHAMP VA [124000]|27258.46|20583.53|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27258.46|17718|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|CORESOURCE [1315]|CORESOURCE [131500]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|GEHA [1415]|GEHA [141500]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27258.46|16001.32|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27258.46|13132.11|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27258.46|24532.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27258.46|4882.61|24532.61|339.98|||| MS768|DRG||Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27258.46|24532.61|24532.61|339.98|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|CORESOURCE [1315]|CORESOURCE [131500]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70345.43|36278.19|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|GEHA [1415]|GEHA [141500]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|CHAMPVA [1240]|CHAMP VA [124000]|70345.43||||||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70345.43|16782.09|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70345.43|23307.13|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MULTIPLAN [1680]|IHC HS [168011]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70345.43|43890.13|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70345.43|4543.31|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70345.43|15285.98|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70345.43|4543.31|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70345.43|49111.02|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|UMR [2035]|UMR OPTIONS [203501]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70345.43|36278.19|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|||70345.43|21103.63|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70345.43|1450|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|HEALTHNET [1495]|HEALTHNET [149500]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70345.43|23495.8|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70345.43|22946.48|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70345.43|2550|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70345.43|10282.75|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70345.43|67999.88|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MULTIPLAN [1680]|HMA [168003]|70345.43|218.4|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70345.43|21428.1|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70345.43|15285.98|67999.88|218.4|||| MS769|DRG||Postpartum And Post Abortion Diagnoses With O.R. Procedures|TRUSTMARK [2030]|STARMARK [203000]|70345.43|67999.88|67999.88|218.4|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40010.00|8633.12|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MULTIPLAN [1680]|HMA [168003]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MULTIPLAN [1680]|IHC HS [168011]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|AETNA [1015]|AETNA ACO WILCO [101532]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|HEALTHNET [1495]|HEALTHNET [149500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|TRUSTMARK [2030]|STARMARK [203000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|FMH BENEFIT SERVICES [1390]|FMH [139000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|40010.00|3130.38|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|UMR [2035]|UMR OPTIONS [203501]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40010.00||||||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|||40010.00|12003|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|CHAMPVA [1240]|CHAMP VA [124000]|40010.00|39599.69|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|40010.00|8633.12|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|GEHA [1415]|GEHA [141500]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|FIRST HEALTH [1375]|QUALCHOICE [137513]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40010.00|850|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40010.00|3130.38|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40010.00|11676.31|39599.69|850|||| MS770|DRG||Abortion With D&C, Aspiration Curettage Or Hysterotomy|CORESOURCE [1315]|CORESOURCE [131500]|40010.00|11676.31|39599.69|850|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|GEHA [1415]|GEHA [141500]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|CORESOURCE [1315]|CORESOURCE [131500]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19381.16|2947.59|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19381.16|11227.63|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19381.16|12563.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|UMR [2035]|UMR OPTIONS [203501]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19381.16|10914.7|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19381.16|2947.59|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|CHAMPVA [1240]|CHAMP VA [124000]|19381.16|16551.33|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19381.16|13418.35|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|||19381.16|5814.35|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19381.16||||||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19381.16|6554.48|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|FIRST HEALTH [1375]|QUALCHOICE [137513]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|FMH BENEFIT SERVICES [1390]|FMH [139000]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19381.16|1700|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MULTIPLAN [1680]|IHC HS [168011]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|TRUSTMARK [2030]|STARMARK [203000]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|AETNA [1015]|AETNA ACO WILCO [101532]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19381.16|8256.14|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19381.16|1450|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19381.16|13418.35|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19381.16|10886.98|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19381.16|11147.6|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|MULTIPLAN [1680]|HMA [168003]|19381.16|473.55|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19381.16|8878.23|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|HEALTHNET [1495]|HEALTHNET [149500]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19381.16|6554.48|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19381.16|17395.2|17395.2|473.55|||| MS776|DRG||Postpartum And Post Abortion Diagnoses Without O.R. Procedures|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19381.16|8878.23|17395.2|473.55|||| MS779|DRG||Abortion Without D&C|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17030.91||||||| MS779|DRG||Abortion Without D&C|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17030.91||||||| MS779|DRG||Abortion Without D&C|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17030.91||||||| MS779|DRG||Abortion Without D&C|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17030.91||||||| MS779|DRG||Abortion Without D&C|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17030.91||||||| MS779|DRG||Abortion Without D&C|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17030.91||||||| MS779|DRG||Abortion Without D&C|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17030.91||||||| MS779|DRG||Abortion Without D&C|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17030.91|15085.8|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17030.91||||||| MS779|DRG||Abortion Without D&C|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17030.91||||||| MS779|DRG||Abortion Without D&C|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17030.91|7735.63|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17030.91||||||| MS779|DRG||Abortion Without D&C|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17030.91|850|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|TRUSTMARK [2030]|STARMARK [203000]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17030.91||||||| MS779|DRG||Abortion Without D&C|MULTIPLAN [1680]|IHC HS [168011]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|HEALTHNET [1495]|HEALTHNET [149500]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17030.91||||||| MS779|DRG||Abortion Without D&C|AETNA [1015]|AETNA ACO WILCO [101532]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|CHAMPVA [1240]|CHAMP VA [124000]|17030.91||||||| MS779|DRG||Abortion Without D&C|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17030.91|725|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|MULTIPLAN [1680]|HMA [168003]|17030.91|40.6|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17030.91|14733.1|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|FMH BENEFIT SERVICES [1390]|FMH [139000]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17030.91|5159.12|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17030.91|2430.11|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|UMR [2035]|UMR OPTIONS [203501]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17030.91|13279.13|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17030.91|9105.72|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17030.91|12395.4|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|||17030.91|5109.27|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17030.91|11077.67|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|CORESOURCE [1315]|CORESOURCE [131500]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|GEHA [1415]|GEHA [141500]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17030.91|10299|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17030.91|2430.11|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|FIRST HEALTH [1375]|QUALCHOICE [137513]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17030.91|7735.63|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17030.91|5159.12|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17030.91|17162.87|17162.87|40.6|||| MS779|DRG||Abortion Without D&C|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17030.91|17162.87|17162.87|40.6|||| MS783|DRG||Cesarean Section With Sterilization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51687.03|27154.15|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51687.03|17319.26|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51687.03|26519.3|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51687.03|30023.05|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|GEHA [1415]|GEHA [141500]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|CHAMPVA [1240]|CHAMP VA [124000]|51687.03|34822.57|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51687.03|27306.71|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51687.03|6825.27|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|||51687.03|15506.11|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51687.03|30554.93|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51687.03|24944.02|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|CORESOURCE [1315]|CORESOURCE [131500]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|UMR [2035]|UMR OPTIONS [203501]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51687.03|17319.26|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MULTIPLAN [1680]|IHC HS [168011]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MULTIPLAN [1680]|HMA [168003]|51687.03|189.21|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|HEALTHNET [1495]|HEALTHNET [149500]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|TRUSTMARK [2030]|STARMARK [203000]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51687.03||||||| MS783|DRG||Cesarean Section With Sterilization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51687.03|2900|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51687.03|4250|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51687.03|42306.82|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51687.03|6825.27|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51687.03|31849.62|42306.82|189.21|||| MS783|DRG||Cesarean Section With Sterilization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51687.03|30023.05|42306.82|189.21|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48131.68|13071.6|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48131.68|15504.88|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48131.68|1700|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48131.68|1450|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|TRUSTMARK [2030]|STARMARK [203000]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|HEALTHNET [1495]|HEALTHNET [149500]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MULTIPLAN [1680]|IHC HS [168011]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|MULTIPLAN [1680]|HMA [168003]|48131.68|167.86|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48131.68|5262.1|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48131.68|15876.05|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48131.68|27910.37|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48131.68|12155.68|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48131.68|8439.99|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|||48131.68|14439.5|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48131.68|27959.67|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48131.68|31285.59|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|UMR [2035]|UMR OPTIONS [203501]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48131.68|5262.1|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48131.68||||||| MS784|DRG||Cesarean Section With Sterilization With Cc|CHAMPVA [1240]|CHAMP VA [124000]|48131.68|32723.89|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|CORESOURCE [1315]|CORESOURCE [131500]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48131.68|15520.9|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48131.68|27910.37|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|GEHA [1415]|GEHA [141500]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48131.68|8439.99|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48131.68|43318.51|43318.51|167.86|||| MS784|DRG||Cesarean Section With Sterilization With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48131.68|15520.9|43318.51|167.86|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|GEHA [1415]|GEHA [141500]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42538.11|24693.83|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|42538.11|37936.24|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42538.11|5131.97|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42538.11|27062.53|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42538.11|9983.19|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42538.11|6931.58|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42538.11|5131.97|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42538.11|24185.57|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|||42538.11|12761.43|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42538.11|11081.94|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42538.11|24693.83|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42538.11|2550|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42538.11|13271.85|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42538.11|12961.56|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42538.11|1450|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42538.11|6931.58|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42538.11|12746.97|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42538.11|12746.97|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42538.11|10735.42|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42538.11|7315.74|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|42538.11|274.73|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42538.11|4249.12|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42538.11|37471.2|37936.24|274.73|||| MS785|DRG||Cesarean Section With Sterilization Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42538.11|11081.94|37936.24|274.73|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55283.74|13844.59|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55283.74|21442.07|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55283.74|22531.57|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55283.74|23070.95|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55283.74|3400|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55283.74|25459.79|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55283.74|2900|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|AETNA [1015]|AETNA ACO WILCO [101532]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|TRUSTMARK [2030]|STARMARK [203000]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|HEALTHNET [1495]|HEALTHNET [149500]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MULTIPLAN [1680]|IHC HS [168011]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MULTIPLAN [1680]|HMA [168003]|55283.74|124.5|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|UMR [2035]|UMR OPTIONS [203501]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55283.74|25359.79|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55283.74|32161.42|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55283.74|19939.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55283.74|34043.12|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|||55283.74|16585.12|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55283.74|30424.06|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55283.74|7378.8|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|CHAMPVA [1240]|CHAMP VA [124000]|55283.74|39009.6|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55283.74|25234.98|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|CORESOURCE [1315]|CORESOURCE [131500]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55283.74|32161.42|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55283.74||||||| MS786|DRG||Cesarean Section Without Sterilization With McC|GEHA [1415]|GEHA [141500]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|55283.74|47136.64|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55283.74|11782.34|47136.64|124.5|||| MS786|DRG||Cesarean Section Without Sterilization With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55283.74|13844.59|47136.64|124.5|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|GEHA [1415]|GEHA [141500]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49627.02|29261.52|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|CORESOURCE [1315]|CORESOURCE [131500]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|CHAMPVA [1240]|CHAMP VA [124000]|49627.02|35361.1|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|||49627.02|14888.11|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49627.02|28172.59|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49627.02|31523.83|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49627.02|12159.17|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|UMR [2035]|UMR OPTIONS [203501]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49627.02|7503.55|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49627.02|5471.83|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49627.02|8442.41|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|HEALTHNET [1495]|HEALTHNET [149500]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|TRUSTMARK [2030]|STARMARK [203000]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49627.02|2175|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49627.02|29261.52|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49627.02|15409.15|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49627.02|15048.89|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49627.02|8442.41|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49627.02|3400|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49627.02|15525.35|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49627.02|13075.35|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49627.02|13075.35|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49627.02|7774.56|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MULTIPLAN [1680]|HMA [168003]|49627.02|710.66|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49627.02|14878.24|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49627.02|43648.38|43648.38|710.66|||| MS787|DRG||Cesarean Section Without Sterilization With Cc|MULTIPLAN [1680]|IHC HS [168011]|49627.02|43648.38|43648.38|710.66|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45721.17|7317.57|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45721.17|11497.22|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45721.17|11333.22|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45721.17|12562.22|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45721.17|12862.95|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45721.17|26734.35|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45721.17|3400|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|45721.17|220.89|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45721.17|13456.79|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45721.17|6393.55|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45721.17|7317.57|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45721.17|1450|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45721.17|29044.12|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45721.17|10539.11|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|||45721.17|13716.35|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45721.17|25956.51|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45721.17|6647.17|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45721.17|5322.59|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|45721.17|37221.47|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45721.17|11399.04|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45721.17|26734.35|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|GEHA [1415]|GEHA [141500]|45721.17|40214.93|40214.93|220.89|||| MS788|DRG||Cesarean Section Without Sterilization Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45721.17|40214.93|40214.93|220.89|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|CORESOURCE [1315]|CORESOURCE [131500]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21343.19|13866.67|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21343.19|10909.29|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21343.19|12207|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|CHAMPVA [1240]|CHAMP VA [124000]|21343.19|12049.43|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21343.19|13934.96|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21343.19|18780|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21343.19|18780|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|UMR [2035]|UMR OPTIONS [203501]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21343.19|12554.2|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|FIRST HEALTH [1375]|QUALCHOICE [137513]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|FMH BENEFIT SERVICES [1390]|FMH [139000]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MULTIPLAN [1680]|IHC HS [168011]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|||21343.19|6402.96|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MULTIPLAN [1680]|HMA [168003]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|HEALTHNET [1495]|HEALTHNET [149500]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|TRUSTMARK [2030]|STARMARK [203000]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21343.19|725|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|AETNA [1015]|AETNA ACO WILCO [101532]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21343.19|5100|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21343.19|13934.96|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21343.19|18780|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21343.19|18780|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21343.19|12554.2|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21343.19||||||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21343.19|2799.43|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21343.19|2799.43|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21343.19|11573.09|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21343.19|6875.66|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|GEHA [1415]|GEHA [141500]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21343.19|16902|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21343.19|7713.85|18780|725|||| MS789|DRG||Neonates, Died Or Transferred To Another Acute Care Facility|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21343.19|16902|18780|725|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|974924.26|732613.87|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|974924.26|441563.92|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|974924.26|633992.77|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|974924.26|511030.34|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|974924.26|33150|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|974924.26|40600|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|AETNA [1015]|COVENTRY HEALTHCARE [101502]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|AETNA [1015]|AETNA ACO WILCO [101532]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|HEALTHNET [1495]|HEALTHNET [149500]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|TRUSTMARK [2030]|STARMARK [203000]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MULTIPLAN [1680]|IHC HS [168011]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MULTIPLAN [1680]|HMA [168003]|974924.26|2009.6|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|FMH BENEFIT SERVICES [1390]|FMH [139000]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|974924.26|441563.92|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|974924.26|633992.77|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|974924.26|226342.74|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|UMR [2035]|UMR OPTIONS [203501]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|974924.26|441563.92|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|974924.26|64813.99|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|||974924.26|292477.28|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|974924.26|818414.21|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|974924.26|915767.33|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|974924.26||||||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|974924.26|226342.74|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|974924.26|704436.41|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|974924.26|314633.97|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|CHAMPVA [1240]|CHAMP VA [124000]|974924.26|359281.94|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|974924.26|82757.32|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|CORESOURCE [1315]|CORESOURCE [131500]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|974924.26|511030.34|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|GEHA [1415]|GEHA [141500]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|974924.26|732613.87|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|974924.26|1267985.54|1267985.54|2009.6|||| MS790|DRG||Extreme Immaturity Or Respiratory Distress Syndrome, Neonate|FIRST HEALTH [1375]|QUALCHOICE [137513]|974924.26|1267985.54|1267985.54|2009.6|||| MS791|DRG||Prematurity With Major Problems|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|283242.60|181860.26|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|GEHA [1415]|GEHA [141500]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|CORESOURCE [1315]|CORESOURCE [131500]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|CHAMPVA [1240]|CHAMP VA [124000]|283242.60|70863.44|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|283242.60|150986.48|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|283242.60|98662.22|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|||283242.60|84972.78|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|283242.60|168946.85|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|283242.60|2692.8|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|283242.60|129959.11|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|283242.60|44266.11|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|UMR [2035]|UMR OPTIONS [203501]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|283242.60|135157.47|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|FMH BENEFIT SERVICES [1390]|FMH [139000]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MULTIPLAN [1680]|IHC HS [168011]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MULTIPLAN [1680]|HMA [168003]|283242.60|1479.28|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|AETNA [1015]|COVENTRY HEALTHCARE [101502]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|283242.60|6525|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|283242.60|14450|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|283242.60|181860.26|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|TRUSTMARK [2030]|STARMARK [203000]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|283242.60|116963.2|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|HEALTHNET [1495]|HEALTHNET [149500]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|283242.60|116963.2|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|283242.60|135157.47|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|283242.60|56520.89|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|283242.60|56520.89|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|283242.60||||||| MS791|DRG||Prematurity With Major Problems|AETNA [1015]|AETNA ACO WILCO [101532]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|283242.60|47601.52|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|283242.60|49138.04|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|FIRST HEALTH [1375]|QUALCHOICE [137513]|283242.60|233926.4|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|283242.60|72756.3|233926.4|1479.28|||| MS791|DRG||Prematurity With Major Problems|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|283242.60|233926.4|233926.4|1479.28|||| MS792|DRG||Prematurity Without Major Problems|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65865.38|17060.05|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65865.38|33070.18|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65865.38|33861.85|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65865.38|5100|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65865.38|2175|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|AETNA [1015]|AETNA ACO WILCO [101532]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|TRUSTMARK [2030]|STARMARK [203000]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|HEALTHNET [1495]|HEALTHNET [149500]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|MULTIPLAN [1680]|IHC HS [168011]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65865.38||||||| MS792|DRG||Prematurity Without Major Problems|MULTIPLAN [1680]|HMA [168003]|65865.38|31.5|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65865.38|28720.74|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65865.38|34059.17|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|FMH BENEFIT SERVICES [1390]|FMH [139000]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65865.38|3764.18|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|UMR [2035]|UMR OPTIONS [203501]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65865.38|30152.3|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65865.38|26708.3|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|||65865.38|19759.61|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65865.38|38261.19|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65865.38|42812.5|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65865.38|5040.72|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|CHAMPVA [1240]|CHAMP VA [124000]|65865.38|119786.26|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|CORESOURCE [1315]|CORESOURCE [131500]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65865.38|34102.31|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65865.38|34059.17|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|GEHA [1415]|GEHA [141500]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65865.38|17060.05|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|FIRST HEALTH [1375]|QUALCHOICE [137513]|65865.38|59278.84|119786.26|31.5|||| MS792|DRG||Prematurity Without Major Problems|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65865.38|59278.84|119786.26|31.5|||| MS793|DRG||Full Term Neonate With Major Problems|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|CHAMPVA [1240]|CHAMP VA [124000]|62931.91|50128.04|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62931.91|45481.21|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|CORESOURCE [1315]|CORESOURCE [131500]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62931.91|4307.12|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62931.91|28380.21|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62931.91|31756.13|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62931.91|48895.92|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62931.91|56547.71|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62931.91|48855.58|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62931.91|46105.79|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62931.91|45469.81|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|GEHA [1415]|GEHA [141500]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62931.91|45709.87|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|||62931.91|18879.57|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|UMR [2035]|UMR OPTIONS [203501]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62931.91|29044.16|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62931.91|6298.72|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|FIRST HEALTH [1375]|QUALCHOICE [137513]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|FMH BENEFIT SERVICES [1390]|FMH [139000]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MULTIPLAN [1680]|IHC HS [168011]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|HEALTHNET [1495]|HEALTHNET [149500]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|TRUSTMARK [2030]|STARMARK [203000]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62931.91|2550|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62931.91|48895.92|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|AETNA [1015]|AETNA ACO WILCO [101532]|62931.91|48895.92|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62931.91|45709.87|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62931.91|48895.92|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62931.91|48855.58|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62931.91|48855.58|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62931.91||||||| MS793|DRG||Full Term Neonate With Major Problems|MULTIPLAN [1680]|HMA [168003]|62931.91|10.15|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62931.91|29044.16|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62931.91|2900|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62931.91|48895.92|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62931.91|58057.83|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62931.91|55762.98|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62931.91|48895.92|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62931.91|43970.02|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62931.91|47106|58057.83|10.15|||| MS793|DRG||Full Term Neonate With Major Problems|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62931.91|43970.02|58057.83|10.15|||| MS794|DRG||Neonate With Other Significant Problems|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|13845.47|10280.28|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13845.47|12491.71|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13845.47|12491.71|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|13845.47|8843.85|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|13845.47|1700|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13845.47|725|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|AETNA [1015]|COVENTRY HEALTHCARE [101502]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|AETNA [1015]|AETNA ACO WILCO [101532]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|HEALTHNET [1495]|HEALTHNET [149500]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|MULTIPLAN [1680]|IHC HS [168011]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|TRUSTMARK [2030]|STARMARK [203000]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13845.47||||||| MS794|DRG||Neonate With Other Significant Problems|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|MULTIPLAN [1680]|HMA [168003]|13845.47|31.5|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|FMH BENEFIT SERVICES [1390]|FMH [139000]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13845.47|10280.28|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|UMR [2035]|UMR OPTIONS [203501]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13845.47|12491.71|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|13845.47|8119.61|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|||13845.47|4153.64|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|13845.47|7256.43|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|13845.47|1228.13|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|13845.47|12491.71|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|CHAMPVA [1240]|CHAMP VA [124000]|13845.47|15110.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|CORESOURCE [1315]|CORESOURCE [131500]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|13845.47|8843.85|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|13845.47|1228.13|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|GEHA [1415]|GEHA [141500]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|13845.47|17306.23|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|FIRST HEALTH [1375]|QUALCHOICE [137513]|13845.47|11242.54|17306.23|31.5|||| MS794|DRG||Neonate With Other Significant Problems|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|13845.47|17306.23|17306.23|31.5|||| MS795|DRG||Normal Newborn|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6429.86||||||| MS795|DRG||Normal Newborn|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6429.86||||||| MS795|DRG||Normal Newborn|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6429.86||||||| MS795|DRG||Normal Newborn|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6429.86||||||| MS795|DRG||Normal Newborn|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6429.86||||||| MS795|DRG||Normal Newborn|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6429.86||||||| MS795|DRG||Normal Newborn|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6429.86||||||| MS795|DRG||Normal Newborn|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6429.86||||||| MS795|DRG||Normal Newborn|GEHA [1415]|GEHA [141500]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|CORESOURCE [1315]|CORESOURCE [131500]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|CHAMPVA [1240]|CHAMP VA [124000]|6429.86|7443.29|7443.29|31.5|||| MS795|DRG||Normal Newborn|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6429.86|3676.74|7443.29|31.5|||| MS795|DRG||Normal Newborn|||6429.86|1928.96|7443.29|31.5|||| MS795|DRG||Normal Newborn|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6429.86|4114.1|7443.29|31.5|||| MS795|DRG||Normal Newborn|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6429.86|3496.67|7443.29|31.5|||| MS795|DRG||Normal Newborn|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6429.86|2178.3|7443.29|31.5|||| MS795|DRG||Normal Newborn|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6429.86||||||| MS795|DRG||Normal Newborn|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6429.86||||||| MS795|DRG||Normal Newborn|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6429.86|2459.29|7443.29|31.5|||| MS795|DRG||Normal Newborn|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|UMR [2035]|UMR OPTIONS [203501]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6429.86|1392.13|7443.29|31.5|||| MS795|DRG||Normal Newborn|FMH BENEFIT SERVICES [1390]|FMH [139000]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|MULTIPLAN [1680]|HMA [168003]|6429.86|31.5|7443.29|31.5|||| MS795|DRG||Normal Newborn|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6429.86|729.03|7443.29|31.5|||| MS795|DRG||Normal Newborn|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6429.86|1450|7443.29|31.5|||| MS795|DRG||Normal Newborn|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6429.86|1700|7443.29|31.5|||| MS795|DRG||Normal Newborn|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6429.86|3582.63|7443.29|31.5|||| MS795|DRG||Normal Newborn|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|TRUSTMARK [2030]|STARMARK [203000]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6429.86|2762.25|7443.29|31.5|||| MS795|DRG||Normal Newborn|MULTIPLAN [1680]|IHC HS [168011]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|AETNA [1015]|AETNA ACO WILCO [101532]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6429.86|2697.67|7443.29|31.5|||| MS795|DRG||Normal Newborn|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6429.86|1392.13|7443.29|31.5|||| MS795|DRG||Normal Newborn|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6429.86||||||| MS795|DRG||Normal Newborn|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6429.86||||||| MS795|DRG||Normal Newborn|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6429.86|2342.43|7443.29|31.5|||| MS795|DRG||Normal Newborn|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|FIRST HEALTH [1375]|QUALCHOICE [137513]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6429.86|729.03|7443.29|31.5|||| MS795|DRG||Normal Newborn|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6429.86|5696.44|7443.29|31.5|||| MS795|DRG||Normal Newborn|HEALTHNET [1495]|HEALTHNET [149500]|6429.86|5696.44|7443.29|31.5|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|CHAMPVA [1240]|CHAMP VA [124000]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56839.10|15926.32|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56839.10|15122.53|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56839.10|15484.55|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56839.10|33017.87|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|AETNA [1015]|AETNA ACO WILCO [101532]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|TRUSTMARK [2030]|STARMARK [203000]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|HEALTHNET [1495]|HEALTHNET [149500]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MULTIPLAN [1680]|IHC HS [168011]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MULTIPLAN [1680]|HMA [168003]|56839.10|174.6|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56839.10|725|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56839.10|1700|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56839.10|4035.26|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56839.10|19553.6|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|||56839.10|17051.73|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56839.10|17474.91|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56839.10|4035.26|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56839.10|24738.94|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56839.10|22937.85|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|CORESOURCE [1315]|CORESOURCE [131500]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56839.10|33017.87|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|GEHA [1415]|GEHA [141500]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56839.10|27074.21|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56839.10||||||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56839.10|15926.32|33017.87|174.6|||| MS796|DRG||Vaginal Delivery With Sterilization And/Or D&C With McC|UMR [2035]|UMR OPTIONS [203501]|56839.10|27074.21|33017.87|174.6|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|CHAMPVA [1240]|CHAMP VA [124000]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26139.21|17014.31|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|CORESOURCE [1315]|CORESOURCE [131500]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26139.21|3765.16|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26139.21|14494.82|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26139.21|16219.03|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|GEHA [1415]|GEHA [141500]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26139.21||||||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26139.21|10034.36|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|||26139.21|7841.76|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|UMR [2035]|UMR OPTIONS [203501]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26139.21|6967.11|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MULTIPLAN [1680]|IHC HS [168011]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MULTIPLAN [1680]|HMA [168003]|26139.21|607.22|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|HEALTHNET [1495]|HEALTHNET [149500]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|TRUSTMARK [2030]|STARMARK [203000]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26139.21|1450|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26139.21|1700|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26139.21|17014.31|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26139.21|13338.55|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26139.21|13026.7|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26139.21|6967.11|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26139.21|8692.14|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26139.21|22457.12|22457.12|607.22|||| MS797|DRG||Vaginal Delivery With Sterilization And/Or D&C With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26139.21|3765.16|22457.12|607.22|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49937.09|3171|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49937.09|6967.11|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49937.09|10034.36|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49937.09|16095.78|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|||49937.09|14981.13|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49937.09|14384.66|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49937.09|3171|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49937.09|34915.8|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|GEHA [1415]|GEHA [141500]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49937.09|6967.11|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49937.09|11715.4|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49937.09|11995.85|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49937.09|34915.8|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49937.09||||||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49937.09|2550|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49937.09|1450|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49937.09|7015.54|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|49937.09|456.33|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49937.09|22286.46|34915.8|456.33|||| MS798|DRG||Vaginal Delivery With Sterilization And/Or D&C Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|49937.09|22286.46|34915.8|456.33|||| MS799|DRG||Splenectomy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|233993.70||||||| MS799|DRG||Splenectomy With McC|GEHA [1415]|GEHA [141500]|233993.70||||||| MS799|DRG||Splenectomy With McC|CORESOURCE [1315]|CORESOURCE [131500]|233993.70||||||| MS799|DRG||Splenectomy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|233993.70||||||| MS799|DRG||Splenectomy With McC|CHAMPVA [1240]|CHAMP VA [124000]|233993.70||||||| MS799|DRG||Splenectomy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|233993.70||||||| MS799|DRG||Splenectomy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|233993.70||||||| MS799|DRG||Splenectomy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|233993.70||||||| MS799|DRG||Splenectomy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|233993.70||||||| MS799|DRG||Splenectomy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|233993.70||||||| MS799|DRG||Splenectomy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|233993.70||||||| MS799|DRG||Splenectomy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|233993.70||||||| MS799|DRG||Splenectomy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|233993.70||||||| MS799|DRG||Splenectomy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|233993.70||||||| MS799|DRG||Splenectomy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|233993.70||||||| MS799|DRG||Splenectomy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|233993.70||||||| MS799|DRG||Splenectomy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|233993.70||||||| MS799|DRG||Splenectomy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|233993.70||||||| MS799|DRG||Splenectomy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|233993.70||||||| MS799|DRG||Splenectomy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|233993.70||||||| MS799|DRG||Splenectomy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|233993.70||||||| MS799|DRG||Splenectomy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|233993.70||||||| MS799|DRG||Splenectomy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|233993.70||||||| MS799|DRG||Splenectomy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|233993.70||||||| MS799|DRG||Splenectomy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|233993.70||||||| MS799|DRG||Splenectomy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|233993.70||||||| MS799|DRG||Splenectomy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|233993.70||||||| MS799|DRG||Splenectomy With McC|UMR [2035]|UMR OPTIONS [203501]|233993.70||||||| MS799|DRG||Splenectomy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|233993.70||||||| MS799|DRG||Splenectomy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|233993.70||||||| MS799|DRG||Splenectomy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|233993.70||||||| MS799|DRG||Splenectomy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|233993.70||||||| MS799|DRG||Splenectomy With McC|MULTIPLAN [1680]|HMA [168003]|233993.70||||||| MS799|DRG||Splenectomy With McC|MULTIPLAN [1680]|IHC HS [168011]|233993.70||||||| MS799|DRG||Splenectomy With McC|HEALTHNET [1495]|HEALTHNET [149500]|233993.70||||||| MS799|DRG||Splenectomy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|233993.70||||||| MS799|DRG||Splenectomy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|233993.70||||||| MS799|DRG||Splenectomy With McC|TRUSTMARK [2030]|STARMARK [203000]|233993.70||||||| MS799|DRG||Splenectomy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|233993.70||||||| MS799|DRG||Splenectomy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|233993.70||||||| MS799|DRG||Splenectomy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|233993.70||||||| MS799|DRG||Splenectomy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|233993.70||||||| MS799|DRG||Splenectomy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|233993.70||||||| MS799|DRG||Splenectomy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|233993.70||||||| MS799|DRG||Splenectomy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|233993.70||||||| MS799|DRG||Splenectomy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|233993.70||||||| MS799|DRG||Splenectomy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|233993.70||||||| MS799|DRG||Splenectomy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|233993.70||||||| MS799|DRG||Splenectomy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|233993.70||||||| MS799|DRG||Splenectomy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|233993.70||||||| MS799|DRG||Splenectomy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|233993.70||||||| MS799|DRG||Splenectomy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|233993.70||||||| MS799|DRG||Splenectomy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|233993.70||||||| MS799|DRG||Splenectomy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|233993.70||||||| MS799|DRG||Splenectomy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|233993.70||||||| MS799|DRG||Splenectomy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|233993.70||||||| MS799|DRG||Splenectomy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|233993.70||||||| MS799|DRG||Splenectomy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|233993.70||||||| MS799|DRG||Splenectomy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|233993.70||||||| MS799|DRG||Splenectomy With McC|||233993.70|70198.11|70198.11|70198.11|||| MS800|DRG||Splenectomy With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136836.76||||||| MS800|DRG||Splenectomy With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136836.76||||||| MS800|DRG||Splenectomy With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136836.76||||||| MS800|DRG||Splenectomy With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136836.76||||||| MS800|DRG||Splenectomy With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|136836.76||||||| MS800|DRG||Splenectomy With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136836.76||||||| MS800|DRG||Splenectomy With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136836.76||||||| MS800|DRG||Splenectomy With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|136836.76||||||| MS800|DRG||Splenectomy With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|HEALTHNET [1495]|HEALTHNET [149500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MULTIPLAN [1680]|IHC HS [168011]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MULTIPLAN [1680]|HMA [168003]|136836.76||||||| MS800|DRG||Splenectomy With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|136836.76||||||| MS800|DRG||Splenectomy With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136836.76||||||| MS800|DRG||Splenectomy With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|UMR [2035]|UMR OPTIONS [203501]|136836.76||||||| MS800|DRG||Splenectomy With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136836.76||||||| MS800|DRG||Splenectomy With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136836.76||||||| MS800|DRG||Splenectomy With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136836.76||||||| MS800|DRG||Splenectomy With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136836.76||||||| MS800|DRG||Splenectomy With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136836.76||||||| MS800|DRG||Splenectomy With Cc|TRUSTMARK [2030]|STARMARK [203000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136836.76||||||| MS800|DRG||Splenectomy With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|136836.76||||||| MS800|DRG||Splenectomy With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136836.76||||||| MS800|DRG||Splenectomy With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136836.76||||||| MS800|DRG||Splenectomy With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136836.76||||||| MS800|DRG||Splenectomy With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|CHAMPVA [1240]|CHAMP VA [124000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|CORESOURCE [1315]|CORESOURCE [131500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|GEHA [1415]|GEHA [141500]|136836.76||||||| MS800|DRG||Splenectomy With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136836.76||||||| MS800|DRG||Splenectomy With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136836.76|79277.72|79277.72|3400|||| MS800|DRG||Splenectomy With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136836.76|3400|79277.72|3400|||| MS800|DRG||Splenectomy With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|136836.76|55379.2|79277.72|3400|||| MS800|DRG||Splenectomy With Cc|||136836.76|41051.03|79277.72|3400|||| MS800|DRG||Splenectomy With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136836.76|55379.2|79277.72|3400|||| MS800|DRG||Splenectomy With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|136836.76|79277.72|79277.72|3400|||| MS801|DRG||Splenectomy Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|GEHA [1415]|GEHA [141500]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60930.17|34379.48|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60930.17|13130.66|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60930.17|41399.04|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60930.17|46323.59|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60930.17|21785.32|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60930.17|23021.86|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|||60930.17|18279.05|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60930.17|12497.68|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60930.17|13130.66|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|60930.17|524.55|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60930.17|725|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60930.17|850|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|60930.17||||||| MS801|DRG||Splenectomy Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60930.17|34379.48|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60930.17|64140.36|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60930.17|24410.75|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60930.17|23840.04|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60930.17|12497.68|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60930.17|27816.44|64140.36|524.55|||| MS801|DRG||Splenectomy Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60930.17|64140.36|64140.36|524.55|||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|AETNA [1015]|AETNA ACO WILCO [101532]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|TRUSTMARK [2030]|STARMARK [203000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MULTIPLAN [1680]|IHC HS [168011]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MULTIPLAN [1680]|HMA [168003]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|UMR [2035]|UMR OPTIONS [203501]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|HEALTHNET [1495]|HEALTHNET [149500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|CHAMPVA [1240]|CHAMP VA [124000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|CORESOURCE [1315]|CORESOURCE [131500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|GEHA [1415]|GEHA [141500]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|93974.46||||||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|93974.46|54589.76|54589.76|4250|||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|93974.46|4250|54589.76|4250|||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|93974.46|16786.54|54589.76|4250|||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|||93974.46|28192.34|54589.76|4250|||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|93974.46|16786.54|54589.76|4250|||| MS802|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|93974.46|54589.76|54589.76|4250|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|CHAMPVA [1240]|CHAMP VA [124000]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|GEHA [1415]|GEHA [141500]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|CORESOURCE [1315]|CORESOURCE [131500]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|||74307.96|22292.39|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74307.96|48300.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74307.96|20720.01|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74307.96|25151.26|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74307.96|43165.5|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|UMR [2035]|UMR OPTIONS [203501]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74307.96|14890.3|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MULTIPLAN [1680]|IHC HS [168011]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MULTIPLAN [1680]|HMA [168003]|74307.96|2652.65|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|HEALTHNET [1495]|HEALTHNET [149500]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|TRUSTMARK [2030]|STARMARK [203000]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74307.96||||||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74307.96|1450|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74307.96|66877.17|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74307.96|27329.6|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74307.96|26690.65|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74307.96|14890.3|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74307.96|1848.27|66877.17|1450|||| MS803|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74307.96|66877.17|66877.17|1450|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|50561.20|9903.99|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|50561.20|19318.44|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|50561.20|725|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|50561.20|19780.9|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|50561.20|635.92|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|50561.20|9903.99|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|50561.20|16205.07|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|50561.20|15847.04|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|50561.20|32864.79|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|50561.20||||||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|||50561.20|15168.36|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|50561.20|29371.01|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|50561.20|20234.19|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|GEHA [1415]|GEHA [141500]|50561.20|45505.09|45505.09|635.92|||| MS804|DRG||Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|50561.20|45505.09|45505.09|635.92|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|GEHA [1415]|GEHA [141500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27883.62|16197.61|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|CORESOURCE [1315]|CORESOURCE [131500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|CHAMPVA [1240]|CHAMP VA [124000]|27883.62|24016.12|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27883.62|3144.51|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|||27883.62|8365.09|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|UMR [2035]|UMR OPTIONS [203501]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27883.62|3440.07|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MULTIPLAN [1680]|IHC HS [168011]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MULTIPLAN [1680]|HMA [168003]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|HEALTHNET [1495]|HEALTHNET [149500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|TRUSTMARK [2030]|STARMARK [203000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|AETNA [1015]|AETNA ACO WILCO [101532]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27883.62|2550|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27883.62|16197.61|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27883.62||||||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27883.62|8403.65|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27883.62|13015.32|24016.12|2550|||| MS805|DRG||Vaginal Delivery Without Sterilization Or D&C With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27883.62|13015.32|24016.12|2550|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25057.02|3407|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25057.02|5726.79|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25057.02|10531.4|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25057.02|10431.4|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25057.02|10392.76|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25057.02|10641.55|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25057.02|14536.85|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25057.02|9677.51|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25057.02|1700|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25057.02|1450|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25057.02|9677.51|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|25057.02|9677.51|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|HEALTHNET [1495]|HEALTHNET [149500]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MULTIPLAN [1680]|IHC HS [168011]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25057.02|9677.51|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MULTIPLAN [1680]|HMA [168003]|25057.02|329.83|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25057.02|2657.44|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25057.02|5726.79|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|TRUSTMARK [2030]|STARMARK [203000]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|UMR [2035]|UMR OPTIONS [203501]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25057.02|9677.51|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25057.02|9677.51|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25057.02|23988.52|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25057.02|8248|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25057.02|9677.51|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25057.02|8869.48|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25057.02|16191.2|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|||25057.02|7517.11|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25057.02|14469.96|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25057.02|5626.46|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25057.02|2432.32|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|CHAMPVA [1240]|CHAMP VA [124000]|25057.02|18845.28|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25057.02|9546.41|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|CORESOURCE [1315]|CORESOURCE [131500]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25057.02|14536.85|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|GEHA [1415]|GEHA [141500]|25057.02|22418.58|23988.52|329.83|||| MS806|DRG||Vaginal Delivery Without Sterilization Or D&C With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25057.02|22418.58|23988.52|329.83|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|GEHA [1415]|GEHA [141500]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|22814.09|17947.4|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|22814.09|1956.76|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|22814.09|13275.8|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|||22814.09|6844.23|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22814.09|14855.01|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22814.09|5061.41|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|22814.09|1956.76|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|22814.09|349.16|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22814.09|7289.68|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|22814.09|1450|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|22814.09|850|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22814.09|13216.41|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|22814.09|13216.41|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22814.09|20568.47|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22814.09|9295.95|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|22814.09|9078.62|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|22814.09|5061.41|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22814.09|5020.18|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|22814.09|7838.96|20568.47|349.16|||| MS807|DRG||Vaginal Delivery Without Sterilization Or D&C Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|22814.09|20568.47|20568.47|349.16|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|57021.07||||||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57021.07|8651.93|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57021.07|5100|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57021.07|1450|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MULTIPLAN [1680]|HMA [168003]|57021.07|1163.56|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57021.07|10980.17|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57021.07|17974.95|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57021.07|30743.34|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57021.07|28778.67|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57021.07|30841.24|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57021.07|24767.25|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57021.07|25502.26|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57021.07|17974.95|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|||57021.07|17106.32|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57021.07|22791.18|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57021.07|13747.39|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57021.07|10980.17|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57021.07|9511.94|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57021.07|30743.34|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|GEHA [1415]|GEHA [141500]|57021.07|35310.83|35310.83|1163.56|||| MS808|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57021.07|35310.83|35310.83|1163.56|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|65134.68||||||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|GEHA [1415]|GEHA [141500]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65134.68|39307.33|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65134.68|8672.23|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65134.68|37836.75|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|||65134.68|19540.4|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65134.68|42337.54|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65134.68|14140.92|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65134.68|16175.33|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65134.68|9719.88|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65134.68|8672.23|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|65134.68|2709.59|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65134.68|5800|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65134.68|2550|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65134.68|39307.33|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65134.68|58621.21|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65134.68|17714.65|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65134.68|17300.49|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65134.68|9719.88|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65134.68|7805.01|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65134.68|15206.42|58621.21|2550|||| MS809|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65134.68|58621.21|58621.21|2550|||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|65616.96||||||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|65616.96|33407.08|33407.08|4945.39|||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|65616.96|5950|33407.08|4945.39|||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|65616.96|4945.39|33407.08|4945.39|||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|||65616.96|19685.09|33407.08|4945.39|||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|65616.96|4945.39|33407.08|4945.39|||| MS810|DRG||Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|65616.96|33407.08|33407.08|4945.39|||| MS811|DRG||Red Blood Cell Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|70867.69||||||| MS811|DRG||Red Blood Cell Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|70867.69|31651.41|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|70867.69|7533.31|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|70867.69|46169.76|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|70867.69|51661.82|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|70867.69|18084.35|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|70867.69|10359.42|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|70867.69|7533.31|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MULTIPLAN [1680]|HMA [168003]|70867.69|411.73|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|70867.69|15587.69|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|||70867.69|21260.31|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|70867.69|2900|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|70867.69|2550|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|GEHA [1415]|GEHA [141500]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|70867.69|31651.41|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|70867.69|71531.74|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|70867.69|19975.2|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|70867.69|19508.19|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|70867.69|10359.42|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|70867.69|8773.86|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|70867.69|19903.04|71531.74|411.73|||| MS811|DRG||Red Blood Cell Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|70867.69|71531.74|71531.74|411.73|||| MS812|DRG||Red Blood Cell Disorders Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46738.10|6579|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46738.10|13148.39|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46738.10|850|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|TRUSTMARK [2030]|STARMARK [203000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MULTIPLAN [1680]|IHC HS [168011]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MULTIPLAN [1680]|HMA [168003]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46738.10|4471.42|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|HEALTHNET [1495]|HEALTHNET [149500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|UMR [2035]|UMR OPTIONS [203501]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46738.10|5712.13|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|||46738.10|14021.43|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46738.10|5779.61|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46738.10|4471.42|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|CHAMPVA [1240]|CHAMP VA [124000]|46738.10|15260.84|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|CORESOURCE [1315]|CORESOURCE [131500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46738.10|13148.39|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|GEHA [1415]|GEHA [141500]|46738.10|12929.63|15260.84|850|||| MS812|DRG||Red Blood Cell Disorders Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46738.10|12929.63|15260.84|850|||| MS813|DRG||Coagulation Disorders|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|GEHA [1415]|GEHA [141500]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|42459.16|16029.8|38213.24|725|||| MS813|DRG||Coagulation Disorders|CORESOURCE [1315]|CORESOURCE [131500]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|CHAMPVA [1240]|CHAMP VA [124000]|42459.16|30589.1|38213.24|725|||| MS813|DRG||Coagulation Disorders|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|42459.16|4695.1|38213.24|725|||| MS813|DRG||Coagulation Disorders|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|42459.16|24664.53|38213.24|725|||| MS813|DRG||Coagulation Disorders|||42459.16|12737.75|38213.24|725|||| MS813|DRG||Coagulation Disorders|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|42459.16|27598.46|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|42459.16|18435.88|38213.24|725|||| MS813|DRG||Coagulation Disorders|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|42459.16|23403.12|38213.24|725|||| MS813|DRG||Coagulation Disorders|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|UMR [2035]|UMR OPTIONS [203501]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|42459.16|13351.21|38213.24|725|||| MS813|DRG||Coagulation Disorders|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|42459.16|4695.1|38213.24|725|||| MS813|DRG||Coagulation Disorders|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|FIRST HEALTH [1375]|QUALCHOICE [137513]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|FMH BENEFIT SERVICES [1390]|FMH [139000]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|MULTIPLAN [1680]|IHC HS [168011]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|MULTIPLAN [1680]|HMA [168003]|42459.16|13479.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|HEALTHNET [1495]|HEALTHNET [149500]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|TRUSTMARK [2030]|STARMARK [203000]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|AETNA [1015]|COVENTRY HEALTHCARE [101502]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|AETNA [1015]|AETNA ACO WILCO [101532]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|42459.16|725|38213.24|725|||| MS813|DRG||Coagulation Disorders|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|42459.16|3400|38213.24|725|||| MS813|DRG||Coagulation Disorders|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|42459.16|16029.8|38213.24|725|||| MS813|DRG||Coagulation Disorders|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|42459.16|38213.24|38213.24|725|||| MS813|DRG||Coagulation Disorders|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|42459.16|22398.15|38213.24|725|||| MS813|DRG||Coagulation Disorders|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|42459.16|21874.5|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|42459.16|13351.21|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|42459.16|9812.32|38213.24|725|||| MS813|DRG||Coagulation Disorders|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|42459.16|19825|38213.24|725|||| MS813|DRG||Coagulation Disorders|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|42459.16|38213.24|38213.24|725|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|AETNA [1015]|AETNA ACO WILCO [101532]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|TRUSTMARK [2030]|STARMARK [203000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|HEALTHNET [1495]|HEALTHNET [149500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MULTIPLAN [1680]|IHC HS [168011]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MULTIPLAN [1680]|HMA [168003]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|UMR [2035]|UMR OPTIONS [203501]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|CHAMPVA [1240]|CHAMP VA [124000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|CORESOURCE [1315]|CORESOURCE [131500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|GEHA [1415]|GEHA [141500]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29174.75||||||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29174.75|16947.62|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29174.75|1700|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29174.75|10417.62|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|||29174.75|8752.42|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29174.75|12074.47|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29174.75|10417.62|16947.62|1700|||| MS814|DRG||Reticuloendothelial And Immunity Disorders With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29174.75|16947.62|16947.62|1700|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|CHAMPVA [1240]|CHAMP VA [124000]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46048.74|41024.72|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|CORESOURCE [1315]|CORESOURCE [131500]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46048.74|5215.25|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46048.74|16150.1|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|||46048.74|13814.62|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46048.74|18071.22|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46048.74|11778.86|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46048.74|13545.69|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|UMR [2035]|UMR OPTIONS [203501]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46048.74|8033.01|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46048.74|5215.25|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MULTIPLAN [1680]|IHC HS [168011]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|GEHA [1415]|GEHA [141500]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MULTIPLAN [1680]|HMA [168003]|46048.74|370.71|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|HEALTHNET [1495]|HEALTHNET [149500]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|TRUSTMARK [2030]|STARMARK [203000]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46048.74|1450|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46048.74|4250|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46048.74|41024.72|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46048.74||||||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46048.74|25021.68|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46048.74|14391.25|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46048.74|14054.79|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46048.74|8033.01|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46048.74|12666.39|41024.72|370.71|||| MS815|DRG||Reticuloendothelial And Immunity Disorders With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46048.74|25021.68|41024.72|370.71|||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|GEHA [1415]|GEHA [141500]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|20651.51||||||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|20651.51|11996.46|11996.46|2550|||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|20651.51|2550|11996.46|2550|||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|20651.51|4085.83|11996.46|2550|||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|||20651.51|6195.45|11996.46|2550|||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|20651.51|4085.83|11996.46|2550|||| MS816|DRG||Reticuloendothelial And Immunity Disorders Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|20651.51|11996.46|11996.46|2550|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|74385.30|27456.25|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|74385.30|6164.15|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|74385.30|43210.42|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|||74385.30|22315.59|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|74385.30|48350.45|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|74385.30|29263.41|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|74385.30|20318.32|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|74385.30|6164.15|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|74385.30|258.43|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|74385.30|725|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|74385.30|850|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|74385.30||||||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|74385.30|27456.25|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|74385.30|66946.77|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|74385.30|33376.1|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|74385.30|32595.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|74385.30|20318.32|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|74385.30|37364.79|66946.77|258.43|||| MS817|DRG||Other Antepartum Diagnoses With O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|74385.30|66946.77|66946.77|258.43|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|46964.28|10286.74|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46964.28|19089.25|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|46964.28|24974.81|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|46964.28|2550|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|46964.28|725|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|46964.28|186.9|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46964.28|18642.96|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|46964.28|4341.41|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46964.28|10286.74|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46964.28|14815.46|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|46964.28||||||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|46964.28|30526.77|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|||46964.28|14089.28|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|46964.28|27281.54|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|46964.28|4341.41|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|46964.28|16446.05|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|46964.28|24974.81|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|46964.28|42267.84|42267.84|186.9|||| MS818|DRG||Other Antepartum Diagnoses With O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|46964.28|42267.84|42267.84|186.9|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32720.24|31275.75|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32720.24|3610.84|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32720.24|19007.19|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|||32720.24|9816.07|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32720.24|21268.16|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32720.24|9279.58|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32720.24|6443.04|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32720.24|3610.84|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|32720.24|10.15|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32720.24||||||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32720.24|725|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32720.24|850|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32720.24|31275.75|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32720.24|29448.22|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32720.24|14469.55|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32720.24|14131.26|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32720.24|6443.04|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32720.24|9978.78|31275.75|10.15|||| MS819|DRG||Other Antepartum Diagnoses With O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32720.24|29448.22|31275.75|10.15|||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|223230.71||||||| MS820|DRG||Lymphoma And Leukemia With Major O.R. Procedures With McC|||223230.71|66969.21|66969.21|66969.21|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|144066.08||||||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|||144066.08|43219.82|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|144066.08|18991.7|43219.82|18991.7|||| MS821|DRG||Lymphoma And Leukemia With Major O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|144066.08|18991.7|43219.82|18991.7|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|186230.69||||||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|186230.69|183176.64|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|186230.69|158518.24|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|186230.69|158518.24|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|186230.69|38206.72|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|186230.69|2550|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MULTIPLAN [1680]|HMA [168003]|186230.69|7485.89|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|186230.69|35825.48|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|186230.69|183176.64|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|186230.69|18850|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|186230.69|176131.38|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|186230.69|27764.34|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|186230.69|49197.23|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|186230.69|228970.8|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|||186230.69|55869.21|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|186230.69|204629.44|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|186230.69|28160.27|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|186230.69|35825.48|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|186230.69|67999.19|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|186230.69|38206.72|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|GEHA [1415]|GEHA [141500]|186230.69|317036.49|317036.49|2550|||| MS823|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|186230.69|317036.49|317036.49|2550|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|106037.77||||||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|106037.77|27447.54|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|106037.77|13441.19|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|106037.77|55932.19|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|||106037.77|31811.33|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|106037.77|62585.49|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|106037.77|29542.55|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|106037.77|18532.93|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|106037.77|13441.19|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|106037.77|239.99|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|106037.77|27040.91|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|106037.77|2900|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|106037.77|2550|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|GEHA [1415]|GEHA [141500]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|106037.77|27447.54|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|106037.77|86656.84|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|106037.77|34259.15|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|106037.77|33458.19|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|106037.77|18532.93|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|106037.77|14895.85|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|106037.77|29078.42|86656.84|239.99|||| MS824|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|106037.77|86656.84|86656.84|239.99|||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|51563.37||||||| MS825|DRG||Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/McC|||51563.37|15469.01|15469.01|15469.01|||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99771.03||||||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|99771.03|359613.87|359613.87|29931.31|||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99771.03|256762.03|359613.87|29931.31|||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|||99771.03|29931.31|359613.87|29931.31|||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|99771.03|256762.03|359613.87|29931.31|||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99771.03|54400|359613.87|29931.31|||| MS826|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99771.03|359613.87|359613.87|29931.31|||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113344.40||||||| MS827|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc|||113344.40|34003.32|34003.32|34003.32|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|100858.49|141260.73|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|||100858.49|30257.55|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100858.49|158064.18|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|100858.49|19203.46|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|100858.49|21910.51|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|100858.49|126451.34|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|100858.49|1284.27|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|100858.49||||||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|100858.49|7250|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|100858.49|218858.1|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|100858.49|24326.65|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|100858.49|23757.91|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|100858.49|126451.34|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100858.49|20650.42|218858.1|1284.27|||| MS828|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|100858.49|218858.1|218858.1|1284.27|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|||60735.31|18220.59|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|GEHA [1415]|GEHA [141500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60735.31|20134.75|20134.75|18220.59|||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MULTIPLAN [1680]|HMA [168003]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60735.31||||||| MS829|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60735.31||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|||67095.49|20128.65|38876.95|2550|||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|67095.49|8111.06|38876.95|2550|||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|67095.49|2550|38876.95|2550|||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|67095.49|8111.06|38876.95|2550|||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|67095.49|38876.95|38876.95|2550|||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|67095.49|38876.95|38876.95|2550|||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|67095.49||||||| MS830|DRG||Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|67095.49||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|40694.44|33000.76|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|40694.44|8419.14|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|40694.44|5472.45|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|40694.44|3458.71|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|40694.44|3400|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|40694.44|8419.14|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|40694.44|3572.72|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|40694.44|8419.14|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|40694.44|725|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|40694.44|33000.76|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|||40694.44|12208.33|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|40694.44|24.03|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|40694.44|8419.14|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|40694.44|13488.06|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|40694.44||||||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|40694.44|15858.75|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|40694.44|3572.72|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|40694.44|4890.67|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|40694.44|7577.22|33000.76|24.03|||| MS831|DRG||Other Antepartum Diagnoses Without O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|40694.44|7577.22|33000.76|24.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|21120.22|13925.02|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|21120.22|8321.27|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|21120.22|13105.87|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|21120.22|11092.89|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|21120.22|12412.41|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|21120.22|1450|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|21120.22|13925.02|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|||21120.22|6336.07|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|21120.22|160.03|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|21120.22|5777.66|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|21120.22|2740.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|21120.22|1700|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|21120.22|5777.66|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|21120.22|11042.75|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|21120.22|2740.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|21120.22|8948.26|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|21120.22||||||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|21120.22|11307.1|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|21120.22|17186.42|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|21120.22|10394.95|17186.42|160.03|||| MS832|DRG||Other Antepartum Diagnoses Without O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|21120.22||||||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12823.22|7590.3|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|12823.22|4296.71|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|12823.22|850|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|12823.22|8995.43|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12823.22|1450|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12823.22|7772|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|12823.22|1773.14|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12823.22|4296.71|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|12823.22|7901.52|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|12823.22|7220.75|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|12823.22|6453.12|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|||12823.22|3846.97|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|12823.22|1773.14|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|12823.22|6654.61|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|12823.22|4345.53|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12823.22|6188.32|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|12823.22|29161.79|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12823.22|9997.96|29161.79|850|||| MS833|DRG||Other Antepartum Diagnoses Without O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|12823.22|8995.43|29161.79|850|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72094.08|48483.99|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|72094.08|59432.58|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72094.08|29687.53|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|||72094.08|21628.22|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72094.08|43329.77|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72094.08|67948.28|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72094.08|74277.53|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72094.08|42583.51|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|72094.08|1030.2|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72094.08|39728.6|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72094.08|2900|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72094.08|4250|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72094.08|42583.51|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72094.08|39728.6|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72094.08|21138.9|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72094.08|29687.53|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72094.08|7732.42|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72094.08|74590.74|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72094.08|32257.81|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72094.08|67131.67|74590.74|1030.2|||| MS834|DRG||Acute Leukemia Without Major O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72094.08|7732.42|74590.74|1030.2|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25240.86|4643.73|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25240.86|21421.27|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25240.86|13522.43|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25240.86|13522.43|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25240.86|16991.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|25240.86|2479.73|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25240.86||||||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25240.86|25240.86|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25240.86|16406.56|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25240.86|16991.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25240.86|1700|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25240.86|14662.41|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|||25240.86|7572.26|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25240.86|23587.97|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25240.86|25240.86|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|25240.86|5915.33|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25240.86|725|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25240.86|2511.42|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|25240.86|22716.78|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25240.86|21421.27|25240.86|725|||| MS835|DRG||Acute Leukemia Without Major O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|25240.86|22716.78|25240.86|725|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|||32622.55|9786.76|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32622.55|21204.66|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32622.55|9442.1|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32622.55|18612.98|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|32622.55|40.6|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32622.55|18950.43|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32622.55|1450|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32622.55|15323.69|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32622.55|13045.54|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32622.55|9442.1|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32622.55|29360.3|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32622.55|16562.71|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32622.55|3874.45|29360.3|40.6|||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32622.55||||||| MS836|DRG||Acute Leukemia Without Major O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32622.55||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|AETNA [1015]|AETNA ACO WILCO [101532]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|TRUSTMARK [2030]|STARMARK [203000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|HEALTHNET [1495]|HEALTHNET [149500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MULTIPLAN [1680]|IHC HS [168011]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|UMR [2035]|UMR OPTIONS [203501]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MULTIPLAN [1680]|HMA [168003]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|FMH BENEFIT SERVICES [1390]|FMH [139000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|CHAMPVA [1240]|CHAMP VA [124000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|FIRST HEALTH [1375]|QUALCHOICE [137513]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|CORESOURCE [1315]|CORESOURCE [131500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|GEHA [1415]|GEHA [141500]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44373.13||||||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44373.13|9939.92|25776.34|5100|||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44373.13|5100|25776.34|5100|||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44373.13|9939.92|25776.34|5100|||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44373.13|25776.34|25776.34|5100|||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|||44373.13|13311.94|25776.34|5100|||| MS838|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44373.13|25776.34|25776.34|5100|||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|GEHA [1415]|GEHA [141500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31818.16|18483.17|18483.17|4250|||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31818.16|5306.28|18483.17|4250|||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31818.16|18483.17|18483.17|4250|||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|31818.16||||||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31818.16|5306.28|18483.17|4250|||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|||31818.16|9545.45|18483.17|4250|||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31818.16|4250|18483.17|4250|||| MS839|DRG||Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31818.16||||||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|102881.66|54855.97|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|102881.66|45537.53|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|102881.66|5075|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|102881.66|46627.65|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|TRUSTMARK [2030]|STARMARK [203000]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|HEALTHNET [1495]|HEALTHNET [149500]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MULTIPLAN [1680]|IHC HS [168011]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|102881.66|54855.97|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|102881.66|15973.38|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|UMR [2035]|UMR OPTIONS [203501]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MULTIPLAN [1680]|HMA [168003]|102881.66|7457.97|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|102881.66|41632.14|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|102881.66|37160.18|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|102881.66|3400|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|||102881.66|30864.5|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|102881.66|68569.96|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|AETNA [1015]|AETNA ACO WILCO [101532]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|102881.66|38084.34|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|102881.66|61280.43|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|102881.66|25557.74|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|102881.66|15973.38|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|CHAMPVA [1240]|CHAMP VA [124000]|102881.66|77161.25|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|102881.66|47447.73|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|GEHA [1415]|GEHA [141500]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|102881.66|94943.02|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|102881.66|38084.34|94943.02|3400|||| MS840|DRG||Lymphoma And Non-Acute Leukemia With McC|CORESOURCE [1315]|CORESOURCE [131500]|102881.66|94943.02|94943.02|3400|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|HEALTHNET [1495]|HEALTHNET [149500]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60473.06||||||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60473.06||||||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|GEHA [1415]|GEHA [141500]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60473.06|32727.52|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60473.06|17052.78|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60473.06|36620.57|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|CHAMPVA [1240]|CHAMP VA [124000]|60473.06||||||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60473.06||||||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60473.06||||||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|||60473.06|18141.92|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|UMR [2035]|UMR OPTIONS [203501]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MULTIPLAN [1680]|HMA [168003]|60473.06|1142.81|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MULTIPLAN [1680]|IHC HS [168011]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|TRUSTMARK [2030]|STARMARK [203000]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|CORESOURCE [1315]|CORESOURCE [131500]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60473.06|15303.92|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60473.06|5075|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60473.06|9341.97|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60473.06||||||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60473.06|19360.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60473.06|18907.77|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60473.06|9341.97|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60473.06|12956.25|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60473.06|50705.4|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60473.06|19540.71|50705.4|1142.81|||| MS841|DRG||Lymphoma And Non-Acute Leukemia With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60473.06|19540.71|50705.4|1142.81|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|49117.63||||||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|49117.63||||||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|49117.63||||||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|49117.63||||||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49117.63|15510.54|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|49117.63||||||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49117.63|3625|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|49117.63||||||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|49117.63|15200.54|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|49117.63|36287.39|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|49117.63|8702.43|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|49117.63|15881.85|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49117.63|13334.96|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49117.63|8702.43|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|||49117.63|14735.29|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|49117.63|614.52|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|49117.63|17026.65|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|GEHA [1415]|GEHA [141500]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|49117.63|32429.76|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49117.63|6863.83|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|49117.63|50244.08|50244.08|614.52|||| MS842|DRG||Lymphoma And Non-Acute Leukemia Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|49117.63|17026.65|50244.08|614.52|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|GEHA [1415]|GEHA [141500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62850.39|16213.46|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62850.39|58378.62|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62850.39|16213.46|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|||62850.39|18855.12|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62850.39|5950|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62850.39|58378.62|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62850.39||||||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62850.39|12038.39|58378.62|5950|||| MS843|DRG||Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62850.39|12038.39|58378.62|5950|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|CHAMPVA [1240]|CHAMP VA [124000]|59950.99||||||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|59950.99||||||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|59950.99||||||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|59950.99|38713.55|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|59950.99|18785.68|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|59950.99||||||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MULTIPLAN [1680]|IHC HS [168011]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MULTIPLAN [1680]|HMA [168003]|59950.99|7508.56|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|59950.99|32072.94|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|59950.99||||||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|59950.99|35888.15|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|59950.99|30547.36|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|59950.99|37808.45|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|59950.99|3625|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|59950.99|18785.68|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|HEALTHNET [1495]|HEALTHNET [149500]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|59950.99|32183.01|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|||59950.99|17985.3|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|59950.99||||||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|TRUSTMARK [2030]|STARMARK [203000]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|GEHA [1415]|GEHA [141500]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|UMR [2035]|UMR OPTIONS [203501]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|59950.99|16804.96|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|59950.99|39004.2|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|CORESOURCE [1315]|CORESOURCE [131500]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|59950.99|49691.28|49691.28|3625|||| MS846|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|59950.99|49691.28|49691.28|3625|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MULTIPLAN [1680]|HMA [168003]|36278.70|777.97|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|TRUSTMARK [2030]|STARMARK [203000]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36278.70|2900|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36278.70|1700|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36278.70|19360.4|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36278.70|21074.29|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36278.70|18907.77|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36278.70|9341.97|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|36278.70||||||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|GEHA [1415]|GEHA [141500]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36278.70|17109.34|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|||36278.70|10883.61|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36278.70|15303.92|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36278.70|21074.29|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36278.70|19144.58|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36278.70|6322.18|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36278.70|17052.78|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36278.70|19540.71|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|UMR [2035]|UMR OPTIONS [203501]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36278.70|9341.97|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36278.70|6322.18|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36278.70|26507.87|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36278.70|8510.35|26507.87|777.97|||| MS847|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc|MULTIPLAN [1680]|IHC HS [168011]|36278.70|26507.87|26507.87|777.97|||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|||45434.80|13630.44|13630.44|13630.44|||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|45434.80||||||| MS848|DRG||Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/McC|GEHA [1415]|GEHA [141500]|45434.80||||||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|217871.52|85987.62|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|||217871.52|65361.46|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|217871.52|59296.72|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|217871.52|8070.7|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|217871.52|69329.21|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|217871.52|136767.76|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|217871.52|138400.84|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|217871.52|35653.64|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|217871.52|123687.77|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|217871.52|5800|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|217871.52|5100|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|217871.52|31041.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|217871.52|136767.76|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|217871.52|58205.04|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|217871.52|45885.89|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|217871.52|70020.48|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|217871.52|110720.68|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|217871.52|110720.68|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|217871.52|75712.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|217871.52|67980.67|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|217871.52|63764.67|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|217871.52|30941.29|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|217871.52|191631.94|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|217871.52|75542.63|191631.94|5100|||| MS853|DRG||Infectious And Parasitic Diseases With O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|217871.52|31417.29|191631.94|5100|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|103060.56|19280.68|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|103060.56|30368.8|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|103060.56|29658.8|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|103060.56|14335.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|103060.56|2900|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|103060.56|1930.91|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|103060.56|16143.66|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|103060.56|32329.02|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|103060.56|1700|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|103060.56|25134.76|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|103060.56|41951.88|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|103060.56|60860.85|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|||103060.56|30918.17|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|103060.56|54390.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|103060.56|19280.68|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|103060.56|13889.9|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|103060.56|16143.66|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|103060.56|78420.89|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|103060.56|27028.64|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|103060.56|84268.86|84268.86|1700|||| MS854|DRG||Infectious And Parasitic Diseases With O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|103060.56|41951.88|84268.86|1700|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|||90609.41|27182.82|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|90609.41|58760.26|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|90609.41|18646.38|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|90609.41|19280.68|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|90609.41|13109.56|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|90609.41|1179.98|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|90609.41|52513.61|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|90609.41|13109.56|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|90609.41|58692.13|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|90609.41||||||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|90609.41|5075|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|90609.41|5100|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|90609.41|32329.02|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|90609.41|58692.13|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|90609.41|30368.8|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|90609.41|29658.8|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|90609.41|13773.53|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|90609.41|81360.37|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|90609.41|24017.51|81360.37|1179.98|||| MS855|DRG||Infectious And Parasitic Diseases With O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|90609.41|81360.37|81360.37|1179.98|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|160883.89|65720.27|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|160883.89|65720.27|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|160883.89|65912.65|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|160883.89|88771.64|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|160883.89|3400|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|160883.89|64371.66|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|160883.89|2327.65|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|160883.89|60181.58|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|160883.89|51470.89|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|160883.89|7250|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|160883.89|84149.92|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|160883.89|65720.27|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|160883.89|105187.4|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|||160883.89|48265.17|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|160883.89|94005.18|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|160883.89|28462.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|160883.89|24682.39|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|160883.89|87015.54|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|160883.89|24682.39|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|160883.89|88771.64|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|160883.89|145644.1|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|160883.89|56361.29|145644.1|2327.65|||| MS856|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|160883.89|84149.92|145644.1|2327.65|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|CHAMPVA [1240]|CHAMP VA [124000]|84272.48|64523.99|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|CORESOURCE [1315]|CORESOURCE [131500]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|84272.48|9892.56|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|||84272.48|25281.74|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|84272.48|23647.28|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|GEHA [1415]|GEHA [141500]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|84272.48|26879.11|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|UMR [2035]|UMR OPTIONS [203501]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MULTIPLAN [1680]|HMA [168003]|84272.48|1930.11|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|TRUSTMARK [2030]|STARMARK [203000]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|HEALTHNET [1495]|HEALTHNET [149500]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|84272.48|2900|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|84272.48|4250|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|84272.48|54777.12|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|84272.48|48953.87|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|84272.48|44805.05|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MULTIPLAN [1680]|IHC HS [168011]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|84272.48|75845.24|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|84272.48|44805.05|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|84272.48|29503.15|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|84272.48|28813.39|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|84272.48|16553.75|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|84272.48|16553.75|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|84272.48|30193.87|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|84272.48|30193.87|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|84272.48|30193.87|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|84272.48|9892.56|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|84272.48|29434.08|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|84272.48|12414.17|75845.24|1930.11|||| MS857|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|84272.48|75845.24|75845.24|1930.11|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57244.86|10812.43|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57244.86|19094.69|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57244.86|5100|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57244.86|1450|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57244.86|10812.43|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57244.86|66051.09|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57244.86|19551.8|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57244.86|18235.78|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|57244.86||||||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57244.86|6472.2|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57244.86|16007.53|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57244.86|37209.17|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|57244.86|240.28|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|||57244.86|17173.46|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57244.86|20439.11|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57244.86|33253.55|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57244.86|6472.2|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|GEHA [1415]|GEHA [141500]|57244.86|51520.38|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57244.86|66051.09|66051.09|240.28|||| MS858|DRG||Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57244.86|20439.11|66051.09|240.28|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68411.55|35723.27|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|CHAMPVA [1240]|CHAMP VA [124000]|68411.55|19193.3|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68411.55|34505.14|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|||68411.55|20523.46|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68411.55|21522.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68411.55|9582.62|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68411.55|24778.1|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|UMR [2035]|UMR OPTIONS [203501]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68411.55|14943.6|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68411.55|9582.62|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MULTIPLAN [1680]|IHC HS [168011]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MULTIPLAN [1680]|HMA [168003]|68411.55|352.23|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|HEALTHNET [1495]|HEALTHNET [149500]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|AETNA [1015]|AETNA ACO WILCO [101532]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|GEHA [1415]|GEHA [141500]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|CORESOURCE [1315]|CORESOURCE [131500]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68411.55|38609.63|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68411.55|3625|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68411.55|3400|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|TRUSTMARK [2030]|STARMARK [203000]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68411.55|35723.27|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68411.55|27242.6|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68411.55|26605.69|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68411.55|14943.6|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68411.55|23144.18|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68411.55|53459.48|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68411.55|27480.84|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68411.55|11888.61|53459.48|352.23|||| MS862|DRG||Postoperative And Post-Traumatic Infections With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68411.55|11888.61|53459.48|352.23|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|CHAMPVA [1240]|CHAMP VA [124000]|39123.88||||||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39123.88|7942.57|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39123.88|13840.96|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39123.88|16680.86|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39123.88|1700|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39123.88|1450|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|TRUSTMARK [2030]|STARMARK [203000]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MULTIPLAN [1680]|IHC HS [168011]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MULTIPLAN [1680]|HMA [168003]|39123.88|432.26|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39123.88|7942.57|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|HEALTHNET [1495]|HEALTHNET [149500]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39123.88|13617.34|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|UMR [2035]|UMR OPTIONS [203501]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39123.88|11490.44|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39123.88|14172.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39123.88|4372.27|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39123.88|12582.18|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39123.88|28743.78|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|||39123.88|11737.16|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39123.88|25688.1|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39123.88|7217.3|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39123.88|4372.27|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|CORESOURCE [1315]|CORESOURCE [131500]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39123.88|16680.86|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|GEHA [1415]|GEHA [141500]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39123.88|39799.09|39799.09|432.26|||| MS863|DRG||Postoperative And Post-Traumatic Infections Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39123.88|12582.18|39799.09|432.26|||| MS864|DRG||Fever And Inflammatory Conditions|CHAMPVA [1240]|CHAMP VA [124000]|30250.73||||||| MS864|DRG||Fever And Inflammatory Conditions|GEHA [1415]|GEHA [141500]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|30250.73|17572.65|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|CORESOURCE [1315]|CORESOURCE [131500]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|||30250.73|9075.22|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|30250.73|9855.26|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|UMR [2035]|UMR OPTIONS [203501]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|FIRST HEALTH [1375]|QUALCHOICE [137513]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|FMH BENEFIT SERVICES [1390]|FMH [139000]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MULTIPLAN [1680]|IHC HS [168011]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MULTIPLAN [1680]|HMA [168003]|30250.73|516.25|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|HEALTHNET [1495]|HEALTHNET [149500]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|AETNA [1015]|COVENTRY HEALTHCARE [101502]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|30250.73|11763.75|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|AETNA [1015]|AETNA ACO WILCO [101532]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|TRUSTMARK [2030]|STARMARK [203000]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|30250.73|10593.7|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|30250.73|4223.43|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|30250.73|9467.52|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|30250.73|1450|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|30250.73|1700|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|30250.73|17572.65|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|30250.73|4223.43|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|30250.73|12687.5|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|30250.73|12390.88|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|30250.73|6798.34|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|30250.73|6798.34|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|30250.73|5650.4|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|30250.73|14668.2|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|30250.73|10597.85|17572.65|516.25|||| MS864|DRG||Fever And Inflammatory Conditions|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|30250.73|5650.4|17572.65|516.25|||| MS865|DRG||Viral Illness With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28117.99||||||| MS865|DRG||Viral Illness With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28117.99||||||| MS865|DRG||Viral Illness With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28117.99||||||| MS865|DRG||Viral Illness With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28117.99|20942.7|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28117.99|21444.05|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28117.99||||||| MS865|DRG||Viral Illness With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28117.99|3625|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|AETNA [1015]|AETNA ACO WILCO [101532]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|TRUSTMARK [2030]|STARMARK [203000]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|HEALTHNET [1495]|HEALTHNET [149500]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MULTIPLAN [1680]|IHC HS [168011]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MULTIPLAN [1680]|HMA [168003]|28117.99|322.69|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28117.99|12218.28|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28117.99|20298.93|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28117.99||||||| MS865|DRG||Viral Illness With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28117.99|12218.28|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28117.99|16204.08|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28117.99|55951.3|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|UMR [2035]|UMR OPTIONS [203501]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|||28117.99|8435.4|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28117.99|50003.24|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|CHAMPVA [1240]|CHAMP VA [124000]|28117.99|12446.3|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28117.99|16173.87|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28117.99|9403.41|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|GEHA [1415]|GEHA [141500]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28117.99|77471.03|77471.03|322.69|||| MS865|DRG||Viral Illness With McC|CORESOURCE [1315]|CORESOURCE [131500]|28117.99|77471.03|77471.03|322.69|||| MS866|DRG||Viral Illness Without McC|CHAMPVA [1240]|CHAMP VA [124000]|32175.17||||||| MS866|DRG||Viral Illness Without McC|GEHA [1415]|GEHA [141500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|||32175.17|9652.55|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|32175.17|9265.24|17217.98|850|||| MS866|DRG||Viral Illness Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|32175.17|3137.9|17217.98|850|||| MS866|DRG||Viral Illness Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MULTIPLAN [1680]|IHC HS [168011]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|HEALTHNET [1495]|HEALTHNET [149500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|UMR [2035]|UMR OPTIONS [203501]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|TRUSTMARK [2030]|STARMARK [203000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|32175.17|3137.9|17217.98|850|||| MS866|DRG||Viral Illness Without McC|CORESOURCE [1315]|CORESOURCE [131500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MULTIPLAN [1680]|HMA [168003]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|32175.17|850|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|32175.17|9265.24|17217.98|850|||| MS866|DRG||Viral Illness Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|32175.17|17217.98|17217.98|850|||| MS866|DRG||Viral Illness Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|32175.17|5766.28|17217.98|850|||| MS866|DRG||Viral Illness Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32175.17|5766.28|17217.98|850|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|135103.01||||||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|135103.01|22000.34|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|135103.01|31571.95|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|135103.01|149990.89|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|135103.01|8500|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|135103.01|1450|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|135103.01|1010.15|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|135103.01|22000.34|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|135103.01|28626.71|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|135103.01|25413.88|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|135103.01|12637.36|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|135103.01|7635.19|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|135103.01|34044.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|||135103.01|40530.9|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|135103.01|30425.2|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|135103.01|15397.47|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|135103.01|12637.36|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|135103.01|8507.3|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|GEHA [1415]|GEHA [141500]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|135103.01|149990.89|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|135103.01|47138.35|149990.89|1010.15|||| MS867|DRG||Other Infectious And Parasitic Diseases Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|135103.01|7635.19|149990.89|1010.15|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|CHAMPVA [1240]|CHAMP VA [124000]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|GEHA [1415]|GEHA [141500]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|78331.07|45235.9|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|CORESOURCE [1315]|CORESOURCE [131500]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78331.07|50114.23|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|||78331.07|23499.32|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|UMR [2035]|UMR OPTIONS [203501]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|78331.07|8661.73|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MULTIPLAN [1680]|HMA [168003]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78331.07|56075.5|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|HEALTHNET [1495]|HEALTHNET [149500]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|TRUSTMARK [2030]|STARMARK [203000]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MULTIPLAN [1680]|IHC HS [168011]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78331.07|8661.73|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78331.07|14820|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|78331.07|9425|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78331.07|4250|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|78331.07||||||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78331.07|45235.9|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78331.07|14325.79|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78331.07|15346.8|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78331.07|12441|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78331.07|14820|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|78331.07|10357.49|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78331.07|30280.77|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|78331.07|8723|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78331.07|77643|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78331.07|12758.11|77643|4250|||| MS868|DRG||Other Infectious And Parasitic Diseases Diagnoses With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|78331.07|77643|77643|4250|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|AETNA [1015]|COVENTRY HEALTHCARE [101502]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|AETNA [1015]|AETNA ACO WILCO [101532]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|HEALTHNET [1495]|HEALTHNET [149500]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MULTIPLAN [1680]|IHC HS [168011]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MULTIPLAN [1680]|HMA [168003]|383195.88|8573.92|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|FMH BENEFIT SERVICES [1390]|FMH [139000]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|FIRST HEALTH [1375]|QUALCHOICE [137513]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|383195.88|213146.41|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|UMR [2035]|UMR OPTIONS [203501]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|383195.88|43872.3|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|383195.88|204948.47|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|383195.88|43412.02|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|383195.88|73551.61|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|||383195.88|114958.76|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|383195.88|238109.13|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|383195.88|266433|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|TRUSTMARK [2030]|STARMARK [203000]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|383195.88|42915.28|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|383195.88|43872.3|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|CORESOURCE [1315]|CORESOURCE [131500]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|GEHA [1415]|GEHA [141500]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|383195.88|232907.06|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|CHAMPVA [1240]|CHAMP VA [124000]|383195.88||||||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|383195.88|40203.12|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|383195.88|213146.41|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|383195.88|93913.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|383195.88|93913.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|383195.88|93913.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|383195.88|184453.62|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|383195.88|184453.62|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|383195.88|232907.06|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|383195.88|42806.08|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|383195.88|94285.89|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|383195.88|17850|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|383195.88|368907.24|368907.24|8573.92|||| MS870|DRG||Septicemia Or Severe Sepsis With Mv >96 Hours|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|383195.88|12325|368907.24|8573.92|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|GEHA [1415]|GEHA [141500]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77065.92|49220.42|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|CORESOURCE [1315]|CORESOURCE [131500]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|CHAMPVA [1240]|CHAMP VA [124000]|77065.92|52289.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77065.92|42146.11|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|||77065.92|23119.78|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77065.92|21705.07|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77065.92|24645.61|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77065.92|14593.14|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77065.92|13783.36|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|UMR [2035]|UMR OPTIONS [203501]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MULTIPLAN [1680]|IHC HS [168011]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MULTIPLAN [1680]|HMA [168003]|77065.92|1425.08|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|HEALTHNET [1495]|HEALTHNET [149500]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77065.92|47159.55|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|TRUSTMARK [2030]|STARMARK [203000]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|AETNA [1015]|AETNA ACO WILCO [101532]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77065.92|13783.36|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77065.92|2900|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77065.92|3400|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77065.92|49220.42|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77065.92|65297.83|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77065.92|27088.9|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77065.92|26455.58|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77065.92|14593.14|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77065.92|11822.74|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77065.92|27713.98|65297.83|1425.08|||| MS871|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77065.92|65297.83|65297.83|1425.08|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48609.64|8501.36|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48609.64|12997.81|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48609.64|14466.88|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48609.64|14813.2|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48609.64|27010.41|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48609.64|6561.47|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48609.64|1700|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|TRUSTMARK [2030]|STARMARK [203000]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|HEALTHNET [1495]|HEALTHNET [149500]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MULTIPLAN [1680]|HMA [168003]|48609.64|1593.4|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MULTIPLAN [1680]|IHC HS [168011]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48609.64|8514.84|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48609.64|8501.36|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|UMR [2035]|UMR OPTIONS [203501]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48609.64|2175|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48609.64|11285.73|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48609.64|14258.19|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48609.64|6561.47|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48609.64|12087.06|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48609.64|15433.28|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48609.64|29851.32|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|||48609.64|14582.89|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48609.64|26677.9|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48609.64|6570.53|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48609.64|7429.39|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|CHAMPVA [1240]|CHAMP VA [124000]|48609.64|34334.29|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48609.64|11148.22|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|CORESOURCE [1315]|CORESOURCE [131500]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48609.64|27010.41|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|GEHA [1415]|GEHA [141500]|48609.64|41332.6|41332.6|1593.4|||| MS872|DRG||Septicemia Or Severe Sepsis Without Mv >96 Hours Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48609.64|41332.6|41332.6|1593.4|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|CHAMPVA [1240]|CHAMP VA [124000]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|GEHA [1415]|GEHA [141500]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|85418.88|47384.17|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|CORESOURCE [1315]|CORESOURCE [131500]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|85418.88|19489.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|85418.88|49619.86|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|||85418.88|25625.66|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|85418.88|55522.27|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|85418.88|42333.2|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|85418.88|47447.09|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|UMR [2035]|UMR OPTIONS [203501]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|85418.88|27077.9|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|85418.88|19489.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|FIRST HEALTH [1375]|QUALCHOICE [137513]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|FMH BENEFIT SERVICES [1390]|FMH [139000]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MULTIPLAN [1680]|IHC HS [168011]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MULTIPLAN [1680]|HMA [168003]|85418.88|223.02|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|HEALTHNET [1495]|HEALTHNET [149500]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|TRUSTMARK [2030]|STARMARK [203000]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|AETNA [1015]|COVENTRY HEALTHCARE [101502]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|AETNA [1015]|AETNA ACO WILCO [101532]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|85418.88|2175|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|85418.88|11900|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|85418.88||||||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|85418.88|108100.7|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|85418.88|76876.99|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|85418.88|47288.85|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|85418.88|46183.27|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|85418.88|27077.9|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|85418.88|45522.97|108100.7|223.02|||| MS876|DRG||O.R. Procedures With Principal Diagnosis Of Mental Illness|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|85418.88|76876.99|108100.7|223.02|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|23869.00|3135|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|23869.00|12229.44|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|23869.00|12522.2|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|23869.00|16863.66|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|23869.00|2550|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|AETNA [1015]|COVENTRY HEALTHCARE [101502]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|AETNA [1015]|AETNA ACO WILCO [101532]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|TRUSTMARK [2030]|STARMARK [203000]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|HEALTHNET [1495]|HEALTHNET [149500]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MULTIPLAN [1680]|IHC HS [168011]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MULTIPLAN [1680]|HMA [168003]|23869.00|93.78|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|FMH BENEFIT SERVICES [1390]|FMH [139000]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|FIRST HEALTH [1375]|QUALCHOICE [137513]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|23869.00|4427.15|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23869.00|3135|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23869.00|794|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|UMR [2035]|UMR OPTIONS [203501]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|23869.00|10930.92|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23869.00|9965.75|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23869.00|11061.65|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|||23869.00|7160.7|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|23869.00|9885.72|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|CHAMPVA [1240]|CHAMP VA [124000]|23869.00||||||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|23869.00|5579.58|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|23869.00|4427.15|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|23869.00|7532.43|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|CORESOURCE [1315]|CORESOURCE [131500]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23869.00|16863.66|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|GEHA [1415]|GEHA [141500]|23869.00|15316.14|16863.66|93.78|||| MS880|DRG||Acute Adjustment Reaction And Psychosocial Dysfunction|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|23869.00|15316.14|16863.66|93.78|||| MS881|DRG||Depressive Neuroses|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19049.00||||||| MS881|DRG||Depressive Neuroses|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19049.00||||||| MS881|DRG||Depressive Neuroses|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19049.00||||||| MS881|DRG||Depressive Neuroses|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19049.00||||||| MS881|DRG||Depressive Neuroses|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19049.00||||||| MS881|DRG||Depressive Neuroses|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19049.00||||||| MS881|DRG||Depressive Neuroses|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19049.00||||||| MS881|DRG||Depressive Neuroses|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19049.00||||||| MS881|DRG||Depressive Neuroses|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19049.00||||||| MS881|DRG||Depressive Neuroses|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|GEHA [1415]|GEHA [141500]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19049.00|3000|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|CORESOURCE [1315]|CORESOURCE [131500]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|CHAMPVA [1240]|CHAMP VA [124000]|19049.00|18483.34|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|||19049.00|5714.7|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19049.00|13920.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19049.00|11018.75|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19049.00|10734.54|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|UMR [2035]|UMR OPTIONS [203501]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19049.00|11070.12|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19049.00|4471.44|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19049.00|2267.66|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19049.00|2267.66|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|FIRST HEALTH [1375]|QUALCHOICE [137513]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|FMH BENEFIT SERVICES [1390]|FMH [139000]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MULTIPLAN [1680]|IHC HS [168011]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MULTIPLAN [1680]|HMA [168003]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|HEALTHNET [1495]|HEALTHNET [149500]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19049.00||||||| MS881|DRG||Depressive Neuroses|TRUSTMARK [2030]|STARMARK [203000]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|AETNA [1015]|AETNA ACO WILCO [101532]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19049.00||||||| MS881|DRG||Depressive Neuroses|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19049.00||||||| MS881|DRG||Depressive Neuroses|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19049.00|3400|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19049.00|11286.79|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19049.00|19274.4|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19049.00|13485.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19049.00|12604.23|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19049.00|4471.44|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19049.00|4084.1|19274.4|2267.66|||| MS881|DRG||Depressive Neuroses|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19049.00|19274.4|19274.4|2267.66|||| MS882|DRG||Neuroses Except Depressive|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|CHAMPVA [1240]|CHAMP VA [124000]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|26989.41|5225|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|26989.41|11654.5|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|26989.41|11933.5|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|26989.41|1700|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|AETNA [1015]|COVENTRY HEALTHCARE [101502]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|AETNA [1015]|AETNA ACO WILCO [101532]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|TRUSTMARK [2030]|STARMARK [203000]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|HEALTHNET [1495]|HEALTHNET [149500]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|MULTIPLAN [1680]|IHC HS [168011]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|MULTIPLAN [1680]|HMA [168003]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|26989.41|11858.99|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|FMH BENEFIT SERVICES [1390]|FMH [139000]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|FIRST HEALTH [1375]|QUALCHOICE [137513]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|26989.41|4534.44|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|26989.41|5225|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|UMR [2035]|UMR OPTIONS [203501]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|26989.41|10533.43|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|26989.41||||||| MS882|DRG||Neuroses Except Depressive|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|26989.41|9185.37|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|26989.41|17543.12|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|||26989.41|8096.82|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|26989.41|15678.15|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|26989.41|4534.44|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|26989.41|4584.85|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|CORESOURCE [1315]|CORESOURCE [131500]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|26989.41|11858.99|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|GEHA [1415]|GEHA [141500]|26989.41|24290.47|24290.47|1700|||| MS882|DRG||Neuroses Except Depressive|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|26989.41|24290.47|24290.47|1700|||| MS883|DRG||Disorders Of Personality And Impulse Control|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|GEHA [1415]|GEHA [141500]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|CORESOURCE [1315]|CORESOURCE [131500]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17427.96|10123.9|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|||17427.96|5228.39|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17427.96|11328.17|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17427.96|15544.66|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17427.96|15910.34|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|UMR [2035]|UMR OPTIONS [203501]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17427.96|4180|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|FIRST HEALTH [1375]|QUALCHOICE [137513]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|FMH BENEFIT SERVICES [1390]|FMH [139000]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|MULTIPLAN [1680]|IHC HS [168011]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|MULTIPLAN [1680]|HMA [168003]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|HEALTHNET [1495]|HEALTHNET [149500]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|TRUSTMARK [2030]|STARMARK [203000]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|AETNA [1015]|AETNA ACO WILCO [101532]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|CHAMPVA [1240]|CHAMP VA [124000]|17427.96||||||| MS883|DRG||Disorders Of Personality And Impulse Control|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17427.96|15685.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17427.96|17427.96|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17427.96|17427.96|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17427.96|4180|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17427.96|4355.16|17427.96|4180|||| MS883|DRG||Disorders Of Personality And Impulse Control|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17427.96|15685.16|17427.96|4180|||| MS884|DRG||Organic Disturbances And Intellectual Disability|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|AETNA [1015]|COVENTRY HEALTHCARE [101502]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|TRUSTMARK [2030]|STARMARK [203000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|HEALTHNET [1495]|HEALTHNET [149500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MULTIPLAN [1680]|IHC HS [168011]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MULTIPLAN [1680]|HMA [168003]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|FMH BENEFIT SERVICES [1390]|FMH [139000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|FIRST HEALTH [1375]|QUALCHOICE [137513]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|UMR [2035]|UMR OPTIONS [203501]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|AETNA [1015]|AETNA ACO WILCO [101532]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|CORESOURCE [1315]|CORESOURCE [131500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|GEHA [1415]|GEHA [141500]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|48214.40|28026.05|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|48214.40|1700|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|48214.40||||||| MS884|DRG||Organic Disturbances And Intellectual Disability|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|48214.40|7772.92|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|48214.40|1588|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|48214.40|15607|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|||48214.40|14464.32|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|48214.40|9185.28|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|48214.40|7772.92|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|CHAMPVA [1240]|CHAMP VA [124000]|48214.40|11705.25|28026.05|1588|||| MS884|DRG||Organic Disturbances And Intellectual Disability|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|48214.40|28026.05|28026.05|1588|||| MS885|DRG||Psychoses|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|GEHA [1415]|GEHA [141500]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|28755.00|4202.13|21214.27|3970|||| MS885|DRG||Psychoses|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|CHAMPVA [1240]|CHAMP VA [124000]|28755.00|13455.75|21214.27|3970|||| MS885|DRG||Psychoses|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|28755.00|10323.11|21214.27|3970|||| MS885|DRG||Psychoses|||28755.00|8626.5|21214.27|3970|||| MS885|DRG||Psychoses|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|28755.00|17546.75|21214.27|3970|||| MS885|DRG||Psychoses|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|28755.00|17359.87|21214.27|3970|||| MS885|DRG||Psychoses|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|UMR [2035]|UMR OPTIONS [203501]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|28755.00|3970|21214.27|3970|||| MS885|DRG||Psychoses|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|28755.00|4892.89|21214.27|3970|||| MS885|DRG||Psychoses|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|28755.00|4668.96|21214.27|3970|||| MS885|DRG||Psychoses|FIRST HEALTH [1375]|QUALCHOICE [137513]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|FMH BENEFIT SERVICES [1390]|FMH [139000]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|MULTIPLAN [1680]|IHC HS [168011]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|MULTIPLAN [1680]|HMA [168003]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|HEALTHNET [1495]|HEALTHNET [149500]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|TRUSTMARK [2030]|STARMARK [203000]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|AETNA [1015]|COVENTRY HEALTHCARE [101502]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|AETNA [1015]|AETNA ACO WILCO [101532]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|28755.00|15321.42|21214.27|3970|||| MS885|DRG||Psychoses|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|28755.00|4670.15|21214.27|3970|||| MS885|DRG||Psychoses|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|28755.00|4668.96|21214.27|3970|||| MS885|DRG||Psychoses|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|28755.00|15512.25|21214.27|3970|||| MS885|DRG||Psychoses|CORESOURCE [1315]|CORESOURCE [131500]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|28755.00|21214.27|21214.27|3970|||| MS885|DRG||Psychoses|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|28755.00|20725.41|21214.27|3970|||| MS885|DRG||Psychoses|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|28755.00|19619.62|21214.27|3970|||| MS885|DRG||Psychoses|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|28755.00|4892.89|21214.27|3970|||| MS885|DRG||Psychoses|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|28755.00|8380.94|21214.27|3970|||| MS885|DRG||Psychoses|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|28755.00|4355.16|21214.27|3970|||| MS885|DRG||Psychoses|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|28755.00|21214.27|21214.27|3970|||| MS886|DRG||Behavioral And Developmental Disorders|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|CHAMPVA [1240]|CHAMP VA [124000]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17445.00|1045|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17445.00|6743|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17445.00|6743|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17445.00|58650|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|AETNA [1015]|AETNA ACO WILCO [101532]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|TRUSTMARK [2030]|STARMARK [203000]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|HEALTHNET [1495]|HEALTHNET [149500]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MULTIPLAN [1680]|IHC HS [168011]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MULTIPLAN [1680]|HMA [168003]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17445.00|291664.02|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|FMH BENEFIT SERVICES [1390]|FMH [139000]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|FIRST HEALTH [1375]|QUALCHOICE [137513]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17445.00|7510.4|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17445.00|1045|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|UMR [2035]|UMR OPTIONS [203501]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17445.00|6743|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17445.00|6743|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17445.00||||||| MS886|DRG||Behavioral And Developmental Disorders|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17445.00|4382.95|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|||17445.00|5233.5|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17445.00|3917.01|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17445.00|7510.4|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17445.00|3266.37|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|CORESOURCE [1315]|CORESOURCE [131500]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17445.00|291664.02|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|GEHA [1415]|GEHA [141500]|17445.00|6068.7|291664.02|1045|||| MS886|DRG||Behavioral And Developmental Disorders|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17445.00|6068.7|291664.02|1045|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|CHAMPVA [1240]|CHAMP VA [124000]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|GEHA [1415]|GEHA [141500]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24964.97|17424.95|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|CORESOURCE [1315]|CORESOURCE [131500]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24964.97|3576.82|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24964.97|12593.3|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|||24964.97|7489.49|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24964.97|6750.05|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24964.97|7088.54|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|UMR [2035]|UMR OPTIONS [203501]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24964.97|14091.31|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24964.97|3593.38|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24964.97|3576.82|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|FIRST HEALTH [1375]|QUALCHOICE [137513]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|FMH BENEFIT SERVICES [1390]|FMH [139000]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MULTIPLAN [1680]|IHC HS [168011]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MULTIPLAN [1680]|HMA [168003]|24964.97|98.99|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|HEALTHNET [1495]|HEALTHNET [149500]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|TRUSTMARK [2030]|STARMARK [203000]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|AETNA [1015]|AETNA ACO WILCO [101532]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24964.97||||||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24964.97|725|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24964.97|1700|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24964.97|17424.95|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24964.97|19511.06|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24964.97|7938.75|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24964.97|7753.15|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24964.97|3593.38|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24964.97|5977.72|19511.06|98.99|||| MS894|DRG||Alcohol, Drug Abuse Or Dependence, Left Ama|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24964.97|19511.06|19511.06|98.99|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|47061.86|4180|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|47061.86|25164.1|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|47061.86|25766.5|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|47061.86|27066.02|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|47061.86|2550|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|47061.86|1450|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|AETNA [1015]|AETNA ACO WILCO [101532]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|HEALTHNET [1495]|HEALTHNET [149500]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MULTIPLAN [1680]|IHC HS [168011]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MULTIPLAN [1680]|HMA [168003]|47061.86|457.1|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|TRUSTMARK [2030]|STARMARK [203000]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|47061.86|8305.98|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|47061.86|4180|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|47061.86|3176|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|UMR [2035]|UMR OPTIONS [203501]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|47061.86|22114.66|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|47061.86|20000.11|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|47061.86|35908.91|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|||47061.86|14118.56|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|47061.86|32091.52|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|CHAMPVA [1240]|CHAMP VA [124000]|47061.86||||||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|47061.86|11818.78|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|47061.86|7308.69|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|47061.86|25537.01|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|CORESOURCE [1315]|CORESOURCE [131500]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|47061.86|27066.02|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|GEHA [1415]|GEHA [141500]|47061.86|49720.03|49720.03|457.1|||| MS896|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|47061.86|49720.03|49720.03|457.1|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|CHAMPVA [1240]|CHAMP VA [124000]|34798.00||||||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|GEHA [1415]|GEHA [141500]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|CORESOURCE [1315]|CORESOURCE [131500]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|34798.00|4891.7|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|34798.00|19627.16|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|||34798.00|10439.4|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34798.00|9557.53|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|34798.00|10675.39|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34798.00|1588|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34798.00|5575.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|34798.00|4891.7|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|UMR [2035]|UMR OPTIONS [203501]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MULTIPLAN [1680]|IHC HS [168011]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MULTIPLAN [1680]|HMA [168003]|34798.00|576.84|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|HEALTHNET [1495]|HEALTHNET [149500]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34798.00|21961.87|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|TRUSTMARK [2030]|STARMARK [203000]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|34798.00|1450|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|34798.00|1700|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34798.00|17866.65|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|34798.00|17866.65|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|34798.00|30408.74|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|34798.00|11969.75|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|34798.00|11689.91|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|34798.00|5575.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|34798.00|12203.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|34798.00|12203.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|34798.00|12203.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34798.00|5342.79|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|34798.00|12433.48|30408.74|576.84|||| MS897|DRG||Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|34798.00|30408.74|30408.74|576.84|||| MS901|DRG||Wound Debridements For Injuries With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|CHAMPVA [1240]|CHAMP VA [124000]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|137657.73|71582.02|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|137657.73|60357.01|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|137657.73|61801.9|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|137657.73|6525|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|AETNA [1015]|AETNA ACO WILCO [101532]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|TRUSTMARK [2030]|STARMARK [203000]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|HEALTHNET [1495]|HEALTHNET [149500]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MULTIPLAN [1680]|IHC HS [168011]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MULTIPLAN [1680]|HMA [168003]|137657.73|2116.65|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|137657.73|71582.02|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|UMR [2035]|UMR OPTIONS [203501]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|137657.73|56163.43|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|137657.73|50325.34|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|137657.73||||||| MS901|DRG||Wound Debridements For Injuries With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|137657.73|89477.53|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|||137657.73|41297.32|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|137657.73|79965.39|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|137657.73|64257.58|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|CORESOURCE [1315]|CORESOURCE [131500]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|GEHA [1415]|GEHA [141500]|137657.73|123891.97|123891.97|2116.65|||| MS901|DRG||Wound Debridements For Injuries With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|137657.73|123891.97|123891.97|2116.65|||| MS902|DRG||Wound Debridements For Injuries With Cc|CHAMPVA [1240]|CHAMP VA [124000]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|GEHA [1415]|GEHA [141500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|83659.58|48597.84|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|CORESOURCE [1315]|CORESOURCE [131500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|83659.58|10206.39|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|||83659.58|25097.87|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|UMR [2035]|UMR OPTIONS [203501]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|83659.58|10206.39|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MULTIPLAN [1680]|IHC HS [168011]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MULTIPLAN [1680]|HMA [168003]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|HEALTHNET [1495]|HEALTHNET [149500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|TRUSTMARK [2030]|STARMARK [203000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|83659.58|5950|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|83659.58||||||| MS902|DRG||Wound Debridements For Injuries With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|83659.58|48597.84|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|83659.58|29207.86|48597.84|5950|||| MS902|DRG||Wound Debridements For Injuries With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|83659.58|29207.86|48597.84|5950|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|GEHA [1415]|GEHA [141500]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82243.45||||||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82243.45|46442.27|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82243.45|5100|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82243.45|5419.27|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|||82243.45|24673.03|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82243.45|7262.48|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82243.45|5419.27|46442.27|5100|||| MS903|DRG||Wound Debridements For Injuries Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82243.45|46442.27|46442.27|5100|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|GEHA [1415]|GEHA [141500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MULTIPLAN [1680]|HMA [168003]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101654.03||||||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|||101654.03|30496.21|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101654.03|24797.61|30496.21|24797.61|||| MS904|DRG||Skin Grafts For Injuries With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101654.03|24797.61|30496.21|24797.61|||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|GEHA [1415]|GEHA [141500]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|44769.05||||||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|44769.05|25955.44|25955.44|850|||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|44769.05|850|25955.44|850|||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|44769.05|6764.98|25955.44|850|||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|||44769.05|13430.71|25955.44|850|||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|44769.05|6764.98|25955.44|850|||| MS905|DRG||Skin Grafts For Injuries Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|44769.05|25955.44|25955.44|850|||| MS906|DRG||Hand Procedures For Injuries|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|CORESOURCE [1315]|CORESOURCE [131500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|CHAMPVA [1240]|CHAMP VA [124000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|UMR [2035]|UMR OPTIONS [203501]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|FIRST HEALTH [1375]|QUALCHOICE [137513]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|FMH BENEFIT SERVICES [1390]|FMH [139000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MULTIPLAN [1680]|IHC HS [168011]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MULTIPLAN [1680]|HMA [168003]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|HEALTHNET [1495]|HEALTHNET [149500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|TRUSTMARK [2030]|STARMARK [203000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|AETNA [1015]|AETNA ACO WILCO [101532]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|GEHA [1415]|GEHA [141500]|72915.82||||||| MS906|DRG||Hand Procedures For Injuries|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|||72915.82|21874.75|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72915.82|11360.37|21874.75|11360.37|||| MS906|DRG||Hand Procedures For Injuries|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72915.82|11360.37|21874.75|11360.37|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|165654.96|110608.52|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|165654.96|56036.49|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|165654.96|57377.95|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|165654.96|78009.01|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|165654.96|850|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|165654.96|5075|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|AETNA [1015]|AETNA ACO WILCO [101532]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|HEALTHNET [1495]|HEALTHNET [149500]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MULTIPLAN [1680]|IHC HS [168011]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MULTIPLAN [1680]|HMA [168003]|165654.96|5522.65|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|TRUSTMARK [2030]|STARMARK [203000]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|165654.96|21298.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|165654.96|110608.52|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|UMR [2035]|UMR OPTIONS [203501]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|165654.96|56406.79|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|165654.96|46399.05|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|165654.96|138260.66|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|||165654.96|49696.49|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|165654.96|123562.47|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|CHAMPVA [1240]|CHAMP VA [124000]|165654.96||||||| MS907|DRG||Other O.R. Procedures For Injuries With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|165654.96|24804.38|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|165654.96|21298.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|165654.96|47051.86|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|CORESOURCE [1315]|CORESOURCE [131500]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|165654.96|78009.01|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|GEHA [1415]|GEHA [141500]|165654.96|191437.84|191437.84|850|||| MS907|DRG||Other O.R. Procedures For Injuries With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|165654.96|191437.84|191437.84|850|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|CHAMPVA [1240]|CHAMP VA [124000]|86099.96||||||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|GEHA [1415]|GEHA [141500]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|CORESOURCE [1315]|CORESOURCE [131500]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|86099.96|44650.29|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|||86099.96|25829.99|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|86099.96|49961.58|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86099.96|23993.85|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|86099.96|27383.41|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86099.96|15806.81|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|86099.96|8800.78|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|UMR [2035]|UMR OPTIONS [203501]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MULTIPLAN [1680]|IHC HS [168011]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MULTIPLAN [1680]|HMA [168003]|86099.96|687.01|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|HEALTHNET [1495]|HEALTHNET [149500]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|TRUSTMARK [2030]|STARMARK [203000]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86099.96|1450|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|86099.96|850|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|86099.96|8800.78|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|86099.96|26797.91|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|86099.96|26797.91|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|86099.96|69177.56|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|86099.96|29585.8|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|86099.96|28894.1|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|86099.96|15806.81|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86099.96|12892.88|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|86099.96|30636.4|69177.56|687.01|||| MS908|DRG||Other O.R. Procedures For Injuries With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|86099.96|69177.56|69177.56|687.01|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56385.74||||||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56385.74||||||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56385.74||||||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56385.74||||||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|56385.74||||||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56385.74||||||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56385.74|19936.05|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|56385.74|362.26|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56385.74|2900|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56385.74|54514.1|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56385.74|19469.96|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56385.74|54514.1|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56385.74|19021.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56385.74|15336.48|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56385.74|68142.62|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|||56385.74|16915.72|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56385.74|60898.55|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56385.74|7332.73|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56385.74|19582.29|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|GEHA [1415]|GEHA [141500]|56385.74|94351.32|94351.32|362.26|||| MS909|DRG||Other O.R. Procedures For Injuries Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56385.74|94351.32|94351.32|362.26|||| MS913|DRG||Traumatic Injury With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|CORESOURCE [1315]|CORESOURCE [131500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|CHAMPVA [1240]|CHAMP VA [124000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|UMR [2035]|UMR OPTIONS [203501]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MULTIPLAN [1680]|IHC HS [168011]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MULTIPLAN [1680]|HMA [168003]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|HEALTHNET [1495]|HEALTHNET [149500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|TRUSTMARK [2030]|STARMARK [203000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|AETNA [1015]|AETNA ACO WILCO [101532]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|GEHA [1415]|GEHA [141500]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|71857.33||||||| MS913|DRG||Traumatic Injury With McC|||71857.33|21557.2|21557.2|21557.2|||| MS914|DRG||Traumatic Injury Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|25996.76|5659.77|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|25996.76|12583.46|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|25996.76|12815.76|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|25996.76|3068.28|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25996.76|1450|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|TRUSTMARK [2030]|STARMARK [203000]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|HEALTHNET [1495]|HEALTHNET [149500]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MULTIPLAN [1680]|IHC HS [168011]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MULTIPLAN [1680]|HMA [168003]|25996.76|63|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25996.76|12884.7|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|25996.76|3045.27|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25996.76|5659.77|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|UMR [2035]|UMR OPTIONS [203501]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|CHAMPVA [1240]|CHAMP VA [124000]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|25996.76|11224.3|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25996.76|10021.57|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|25996.76|16897.89|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|||25996.76|7799.03|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|25996.76|15101.53|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25996.76||||||| MS914|DRG||Traumatic Injury Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|25996.76|3045.27|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|25996.76|12795.98|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|CORESOURCE [1315]|CORESOURCE [131500]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|25996.76|2807.71|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|GEHA [1415]|GEHA [141500]|25996.76|23397.08|23397.08|63|||| MS914|DRG||Traumatic Injury Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|25996.76|23397.08|23397.08|63|||| MS915|DRG||Allergic Reactions With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|36792.61||||||| MS915|DRG||Allergic Reactions With McC|CHAMPVA [1240]|CHAMP VA [124000]|36792.61||||||| MS915|DRG||Allergic Reactions With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|36792.61||||||| MS915|DRG||Allergic Reactions With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|36792.61||||||| MS915|DRG||Allergic Reactions With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|36792.61||||||| MS915|DRG||Allergic Reactions With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|CORESOURCE [1315]|CORESOURCE [131500]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|36792.61|71878.53|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|||36792.61|11037.78|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|36792.61|80428.72|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|36792.61|19760.53|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|36792.61|21872.66|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|UMR [2035]|UMR OPTIONS [203501]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|36792.61|64342.97|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MULTIPLAN [1680]|IHC HS [168011]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MULTIPLAN [1680]|HMA [168003]|36792.61|1599.03|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|HEALTHNET [1495]|HEALTHNET [149500]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|TRUSTMARK [2030]|STARMARK [203000]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|AETNA [1015]|AETNA ACO WILCO [101532]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|GEHA [1415]|GEHA [141500]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|36792.61|3625|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|36792.61||||||| MS915|DRG||Allergic Reactions With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|36792.61|111362.83|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|36792.61|24615.2|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|36792.61|24039.71|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|36792.61|64342.97|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|36792.61|10659.89|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|36792.61|21249.47|111362.83|1599.03|||| MS915|DRG||Allergic Reactions With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|36792.61|111362.83|111362.83|1599.03|||| MS916|DRG||Allergic Reactions Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|17599.27||||||| MS916|DRG||Allergic Reactions Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|17599.27||||||| MS916|DRG||Allergic Reactions Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|17599.27||||||| MS916|DRG||Allergic Reactions Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|17599.27||||||| MS916|DRG||Allergic Reactions Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|17599.27|4148.13|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|17599.27|9308.03|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|17599.27|9530.85|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17599.27|725|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|HEALTHNET [1495]|HEALTHNET [149500]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MULTIPLAN [1680]|IHC HS [168011]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MULTIPLAN [1680]|HMA [168003]|17599.27|28.24|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|TRUSTMARK [2030]|STARMARK [203000]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17599.27|4148.13|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|UMR [2035]|UMR OPTIONS [203501]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|17599.27|8114.7|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17599.27|7364.12|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|17599.27|8333.45|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|17599.27||||||| MS916|DRG||Allergic Reactions Without McC|||17599.27|5279.78|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|17599.27|7447.54|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17599.27|4297.5|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|CHAMPVA [1240]|CHAMP VA [124000]|17599.27|9417.81|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|17599.27|7919|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|CORESOURCE [1315]|CORESOURCE [131500]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|GEHA [1415]|GEHA [141500]|17599.27|11538.62|11538.62|28.24|||| MS916|DRG||Allergic Reactions Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|17599.27|11538.62|11538.62|28.24|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|GEHA [1415]|GEHA [141500]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|55773.25|23372.39|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|CORESOURCE [1315]|CORESOURCE [131500]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|55773.25|6106.02|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|||55773.25|16731.97|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|55773.25|38927.33|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|55773.25|17017.02|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|UMR [2035]|UMR OPTIONS [203501]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|55773.25|11346.18|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|55773.25|6106.02|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|55773.25|18955.04|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MULTIPLAN [1680]|IHC HS [168011]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MULTIPLAN [1680]|HMA [168003]|55773.25|251.37|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|HEALTHNET [1495]|HEALTHNET [149500]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|TRUSTMARK [2030]|STARMARK [203000]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|55773.25|34789.06|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|AETNA [1015]|AETNA ACO WILCO [101532]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|55773.25|5075|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|55773.25|3400|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|CHAMPVA [1240]|CHAMP VA [124000]|55773.25|22836.86|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|55773.25|9328.42|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|55773.25|26718.85|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|55773.25|53899.38|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|55773.25|21423.75|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|55773.25|20922.88|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|55773.25|11346.18|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|55773.25|9394.7|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|55773.25|18299.23|53899.38|251.37|||| MS917|DRG||Poisoning And Toxic Effects Of Drugs With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|55773.25|53899.38|53899.38|251.37|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31179.87|5177.69|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31179.87|9804.95|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31179.87|9804.95|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31179.87|9804.95|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31179.87|11470.95|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31179.87|1450|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|TRUSTMARK [2030]|STARMARK [203000]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|HEALTHNET [1495]|HEALTHNET [149500]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MULTIPLAN [1680]|IHC HS [168011]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MULTIPLAN [1680]|HMA [168003]|31179.87|382.9|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31179.87|5438.43|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31179.87|5177.69|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|UMR [2035]|UMR OPTIONS [203501]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31179.87|850|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31179.87|10142.7|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31179.87|19296.05|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31179.87|11202.77|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31179.87|9117.92|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31179.87|14649.92|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|||31179.87|9353.96|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31179.87|13092.53|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31179.87|5129.01|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31179.87|4668.96|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|CHAMPVA [1240]|CHAMP VA [124000]|31179.87|34037.1|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31179.87|11642.16|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|CORESOURCE [1315]|CORESOURCE [131500]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31179.87|19296.05|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|GEHA [1415]|GEHA [141500]|31179.87|20284.51|34037.1|382.9|||| MS918|DRG||Poisoning And Toxic Effects Of Drugs Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31179.87|20284.51|34037.1|382.9|||| MS919|DRG||Complications Of Treatment With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|GEHA [1415]|GEHA [141500]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|56513.61|26338.89|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|CHAMPVA [1240]|CHAMP VA [124000]|56513.61|16509.76|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|56513.61|7343.76|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|56513.61|32651.63|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|||56513.61|16954.08|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|56513.61|21228.24|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|56513.61|23669.46|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|56513.61|13525.63|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|56513.61|7343.76|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|UMR [2035]|UMR OPTIONS [203501]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MULTIPLAN [1680]|IHC HS [168011]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MULTIPLAN [1680]|HMA [168003]|56513.61|604.6|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|HEALTHNET [1495]|HEALTHNET [149500]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|56513.61|36535.64|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|TRUSTMARK [2030]|STARMARK [203000]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|AETNA [1015]|AETNA ACO WILCO [101532]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|56513.61|1450|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|56513.61|1700|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|CORESOURCE [1315]|CORESOURCE [131500]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|56513.61|26338.89|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|56513.61|50587.82|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|56513.61|26598.8|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|56513.61|25976.94|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|56513.61|13525.63|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|56513.61|11612.69|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|56513.61|27105.14|50587.82|604.6|||| MS919|DRG||Complications Of Treatment With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|56513.61|50587.82|50587.82|604.6|||| MS920|DRG||Complications Of Treatment With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|UMR [2035]|UMR OPTIONS [203501]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39122.18|11717.23|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|39122.18|13510.54|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39122.18|16379.43|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|||39122.18|11736.65|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|39122.18|14638.19|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|39122.18|4747.67|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|CORESOURCE [1315]|CORESOURCE [131500]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39122.18|15416.1|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|GEHA [1415]|GEHA [141500]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|HEALTHNET [1495]|HEALTHNET [149500]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|TRUSTMARK [2030]|STARMARK [203000]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|39122.18|7953.88|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|39122.18|4747.67|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|39122.18|15416.1|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MULTIPLAN [1680]|HMA [168003]|39122.18|871.55|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|39122.18|1700|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|39122.18|2175|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39122.18|7953.88|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|39122.18|14895.85|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MULTIPLAN [1680]|IHC HS [168011]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|CHAMPVA [1240]|CHAMP VA [124000]|39122.18||||||| MS920|DRG||Complications Of Treatment With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|39122.18|22679.22|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|39122.18|6596.9|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|39122.18|14961.06|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|39122.18|14547.6|22679.22|871.55|||| MS920|DRG||Complications Of Treatment With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|39122.18|22679.22|22679.22|871.55|||| MS921|DRG||Complications Of Treatment Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|24164.41|317.8|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24164.41|1450|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|24164.41|2550|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|24164.41|15824.1|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|24164.41|10025.3|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24164.41|8031.68|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|24164.41|15824.1|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24164.41|9790.92|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|24164.41||||||| MS921|DRG||Complications Of Treatment Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|24164.41|9589.74|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|24164.41|14685.39|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|24164.41|5331.12|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|24164.41|3359.98|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|24164.41|13124.23|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|24164.41|3359.98|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24164.41|5331.12|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|||24164.41|7249.32|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24164.41|4509.42|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|GEHA [1415]|GEHA [141500]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|24164.41|8636.86|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|24164.41|20333.62|20333.62|317.8|||| MS921|DRG||Complications Of Treatment Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|24164.41|20333.62|20333.62|317.8|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|||60961.12|18288.34|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|GEHA [1415]|GEHA [141500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|CHAMPVA [1240]|CHAMP VA [124000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|TRUSTMARK [2030]|STARMARK [203000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MULTIPLAN [1680]|IHC HS [168011]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60961.12|9398.92|18288.34|9398.92|||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MULTIPLAN [1680]|HMA [168003]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|UMR [2035]|UMR OPTIONS [203501]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|CORESOURCE [1315]|CORESOURCE [131500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|HEALTHNET [1495]|HEALTHNET [149500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|AETNA [1015]|AETNA ACO WILCO [101532]|60961.12||||||| MS922|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60961.12||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16493.82|10065.77|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|GEHA [1415]|GEHA [141500]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|16493.82|16794.58|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|16493.82|11040.43|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|16493.82|6268.63|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|CORESOURCE [1315]|CORESOURCE [131500]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|16493.82|8101.24|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|16493.82|6268.63|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|UMR [2035]|UMR OPTIONS [203501]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|16493.82|5933.51|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|16493.82|5933.51|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|||16493.82|4948.15|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MULTIPLAN [1680]|IHC HS [168011]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|TRUSTMARK [2030]|STARMARK [203000]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MULTIPLAN [1680]|HMA [168003]|16493.82|335.3|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|16493.82|725|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|16493.82|850|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|CHAMPVA [1240]|CHAMP VA [124000]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16493.82|13490.8|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|16493.82|9064.9|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|16493.82|13175.39|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16493.82||||||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|16493.82|16794.58|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|16493.82|12852.41|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|HEALTHNET [1495]|HEALTHNET [149500]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|16493.82|12551.4|16794.58|335.3|||| MS923|DRG||Other Injury, Poisoning And Toxic Effect Diagnoses Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|16493.82|12852.41|16794.58|335.3|||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|75516.79|16224|43867.7|10200|||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|75516.79|10200|43867.7|10200|||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|75516.79|43867.7|43867.7|10200|||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|GEHA [1415]|GEHA [141500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|CORESOURCE [1315]|CORESOURCE [131500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|75516.79|43867.7|43867.7|10200|||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|CHAMPVA [1240]|CHAMP VA [124000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|75516.79|21005.88|43867.7|10200|||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|||75516.79|22655.04|43867.7|10200|||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MULTIPLAN [1680]|IHC HS [168011]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|TRUSTMARK [2030]|STARMARK [203000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|FIRST HEALTH [1375]|QUALCHOICE [137513]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|AETNA [1015]|AETNA ACO WILCO [101532]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|HEALTHNET [1495]|HEALTHNET [149500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|UMR [2035]|UMR OPTIONS [203501]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MULTIPLAN [1680]|HMA [168003]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|FMH BENEFIT SERVICES [1390]|FMH [139000]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|AETNA [1015]|COVENTRY HEALTHCARE [101502]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75516.79||||||| MS933|DRG||Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75516.79||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|GEHA [1415]|GEHA [141500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|CHAMPVA [1240]|CHAMP VA [124000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|CORESOURCE [1315]|CORESOURCE [131500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|UMR [2035]|UMR OPTIONS [203501]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|FIRST HEALTH [1375]|QUALCHOICE [137513]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|AETNA [1015]|AETNA ACO WILCO [101532]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MULTIPLAN [1680]|HMA [168003]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|HEALTHNET [1495]|HEALTHNET [149500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MULTIPLAN [1680]|IHC HS [168011]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|TRUSTMARK [2030]|STARMARK [203000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|AETNA [1015]|COVENTRY HEALTHCARE [101502]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|FMH BENEFIT SERVICES [1390]|FMH [139000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|78784.37|45765.84|45765.84|9350|||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|78784.37|19255.39|45765.84|9350|||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|78784.37|45765.84|45765.84|9350|||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|78784.37|9350|45765.84|9350|||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|||78784.37|23635.31|45765.84|9350|||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|78784.37|14872|45765.84|9350|||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|78784.37||||||| MS934|DRG||Full Thickness Burn Without Skin Graft Or Inhalation Injury|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|78784.37||||||| MS935|DRG||Non-Extensive Burns|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MULTIPLAN [1680]|IHC HS [168011]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|63406.57||||||| MS935|DRG||Non-Extensive Burns|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|63406.57||||||| MS935|DRG||Non-Extensive Burns|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|HEALTHNET [1495]|HEALTHNET [149500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|AETNA [1015]|AETNA ACO WILCO [101532]|63406.57||||||| MS935|DRG||Non-Extensive Burns|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|63406.57||||||| MS935|DRG||Non-Extensive Burns|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|63406.57||||||| MS935|DRG||Non-Extensive Burns|FMH BENEFIT SERVICES [1390]|FMH [139000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MULTIPLAN [1680]|HMA [168003]|63406.57||||||| MS935|DRG||Non-Extensive Burns|AETNA [1015]|COVENTRY HEALTHCARE [101502]|63406.57||||||| MS935|DRG||Non-Extensive Burns|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|63406.57||||||| MS935|DRG||Non-Extensive Burns|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|63406.57||||||| MS935|DRG||Non-Extensive Burns|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|FIRST HEALTH [1375]|QUALCHOICE [137513]|63406.57||||||| MS935|DRG||Non-Extensive Burns|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|UMR [2035]|UMR OPTIONS [203501]|63406.57||||||| MS935|DRG||Non-Extensive Burns|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|63406.57||||||| MS935|DRG||Non-Extensive Burns|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|63406.57||||||| MS935|DRG||Non-Extensive Burns|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|TRUSTMARK [2030]|STARMARK [203000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|63406.57||||||| MS935|DRG||Non-Extensive Burns|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|63406.57||||||| MS935|DRG||Non-Extensive Burns|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|63406.57||||||| MS935|DRG||Non-Extensive Burns|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|63406.57||||||| MS935|DRG||Non-Extensive Burns|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|63406.57||||||| MS935|DRG||Non-Extensive Burns|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|63406.57||||||| MS935|DRG||Non-Extensive Burns|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|63406.57||||||| MS935|DRG||Non-Extensive Burns|CHAMPVA [1240]|CHAMP VA [124000]|63406.57|47554.93|47554.93|19021.97|||| MS935|DRG||Non-Extensive Burns|||63406.57|19021.97|47554.93|19021.97|||| MS935|DRG||Non-Extensive Burns|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|63406.57||||||| MS935|DRG||Non-Extensive Burns|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|63406.57||||||| MS935|DRG||Non-Extensive Burns|CORESOURCE [1315]|CORESOURCE [131500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|63406.57||||||| MS935|DRG||Non-Extensive Burns|GEHA [1415]|GEHA [141500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|63406.57||||||| MS935|DRG||Non-Extensive Burns|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|63406.57||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|CHAMPVA [1240]|CHAMP VA [124000]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|GEHA [1415]|GEHA [141500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|||119225.07|35767.52|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|119225.07|69257.84|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|119225.07|11597.3|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|119225.07|61997.04|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|UMR [2035]|UMR OPTIONS [203501]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|119225.07|47077.99|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MULTIPLAN [1680]|IHC HS [168011]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|119225.07|77496.3|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MULTIPLAN [1680]|HMA [168003]|119225.07|15173.14|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|119225.07|47951.98|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|HEALTHNET [1495]|HEALTHNET [149500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|119225.07|122568.19|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|AETNA [1015]|AETNA ACO WILCO [101532]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|CORESOURCE [1315]|CORESOURCE [131500]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|119225.07|2175|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|119225.07|122568.19|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|119225.07|49099.9|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|119225.07||||||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|TRUSTMARK [2030]|STARMARK [203000]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|119225.07|61997.04|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|119225.07|42500.67|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|119225.07|11597.3|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|119225.07|107302.56|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|119225.07|15300|122568.19|2175|||| MS939|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|119225.07|107302.56|122568.19|2175|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|92347.08|48791.44|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|GEHA [1415]|GEHA [141500]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|CORESOURCE [1315]|CORESOURCE [131500]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|TRUSTMARK [2030]|STARMARK [203000]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|92347.08|5950|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|92347.08|31403.43|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|92347.08|32155.2|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|92347.08|80580.21|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|CHAMPVA [1240]|CHAMP VA [124000]|92347.08||||||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|92347.08|48791.44|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|92347.08|1450|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|HEALTHNET [1495]|HEALTHNET [149500]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|92347.08|11111.65|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92347.08|80580.21|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|UMR [2035]|UMR OPTIONS [203501]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MULTIPLAN [1680]|IHC HS [168011]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MULTIPLAN [1680]|HMA [168003]|92347.08|12200.53|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|92347.08|31676.01|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92347.08|26421.03|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|92347.08|100725.27|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|92347.08|90017.41|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92347.08|13247.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|92347.08|29328.94|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|92347.08|11111.65|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|92347.08|139465.77|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|||92347.08|27704.12|139465.77|1450|||| MS940|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|92347.08|29328.94|139465.77|1450|||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|GEHA [1415]|GEHA [141500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|72801.35|42290.32|42290.32|850|||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|||72801.35|21840.4|42290.32|850|||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|72801.35|850|42290.32|850|||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|72801.35|5491.93|42290.32|850|||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|72801.35|5491.93|42290.32|850|||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|72801.35|42290.32|42290.32|850|||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|72801.35||||||| MS941|DRG||O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|72801.35||||||| MS947|DRG||Signs And Symptoms With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88686.90|25023.9|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|88686.90|7381|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|88686.90|12540|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|88686.90|6078.49|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|88686.90|10527|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|88686.90|17256.45|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|88686.90|51642.73|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|88686.90|20368.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|88686.90|11900|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|88686.90|7975|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|TRUSTMARK [2030]|STARMARK [203000]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MULTIPLAN [1680]|HMA [168003]|88686.90|32404.09|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|88686.90|29685.85|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|88686.90|24506.86|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88686.90|12540|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88686.90|15525|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|UMR [2035]|UMR OPTIONS [203501]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|AETNA [1015]|AETNA ACO WILCO [101532]|88686.90|30182.1|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|88686.90|30182.1|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MULTIPLAN [1680]|IHC HS [168011]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|88686.90|15871.13|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|88686.90|30182.1|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|88686.90|18516.63|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88686.90|13924.6|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|88686.90|20368.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|88686.90|30182.1|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|HEALTHNET [1495]|HEALTHNET [149500]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|88686.90|53285.58|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|||88686.90|26606.07|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|88686.90|51642.73|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|88686.90|8764.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|GEHA [1415]|GEHA [141500]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|CORESOURCE [1315]|CORESOURCE [131500]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|88686.90|29685.85|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|CHAMPVA [1240]|CHAMP VA [124000]|88686.90|40405.04|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|88686.90|18928|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|88686.90|73780.03|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|88686.90|23832.29|73780.03|6078.49|||| MS947|DRG||Signs And Symptoms With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|88686.90|47620.92|73780.03|6078.49|||| MS948|DRG||Signs And Symptoms Without McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|GEHA [1415]|GEHA [141500]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|82342.36|47832.67|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|CORESOURCE [1315]|CORESOURCE [131500]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|CHAMPVA [1240]|CHAMP VA [124000]|82342.36|52519.19|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|82342.36|14872|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|82342.36|42525.18|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|||82342.36|24702.71|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|82342.36|47583.7|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|82342.36|9066.75|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|UMR [2035]|UMR OPTIONS [203501]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|82342.36|10260|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|82342.36|19255.39|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MULTIPLAN [1680]|IHC HS [168011]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MULTIPLAN [1680]|HMA [168003]|82342.36|217.35|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|82342.36|12420|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|HEALTHNET [1495]|HEALTHNET [149500]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|TRUSTMARK [2030]|STARMARK [203000]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|AETNA [1015]|AETNA ACO WILCO [101532]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|82342.36|6525|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|82342.36|9350|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|82342.36|47832.67|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|82342.36|10260|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|82342.36|9394|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|82342.36|6039|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|82342.36|4973.31|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|82342.36|65885.12|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|82342.36|7170.57|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|82342.36|8613|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|82342.36|11391.2|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|82342.36|10445.55|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|82342.36|23832.29|65885.12|217.35|||| MS948|DRG||Signs And Symptoms Without McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|82342.36|25023.9|65885.12|217.35|||| MS949|DRG||Aftercare With Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|79097.00|40436.89|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|79097.00|14820|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|79097.00|32762.77|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|79097.00|8723|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|79097.00|12441|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|79097.00|16052.95|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|79097.00|30175.72|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|79097.00|9350|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|79097.00|9425|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|79097.00|19255.39|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|79097.00|14820|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|79097.00|14490|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|UMR [2035]|UMR OPTIONS [203501]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|79097.00|15758.91|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|79097.00|12663.91|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|79097.00|60671.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|||79097.00|23729.1|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|79097.00|23540.96|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MULTIPLAN [1680]|HMA [168003]|79097.00|236.98|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|79097.00|10357.49|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|79097.00|28738.78|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|79097.00|52143.75|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|79097.00|14872|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|79097.00|84007.08|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|79097.00|54221.9|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|79097.00|40436.89|84007.08|236.98|||| MS949|DRG||Aftercare With Cc/McC|GEHA [1415]|GEHA [141500]|79097.00|84007.08|84007.08|236.98|||| MS950|DRG||Aftercare Without Cc/McC|GEHA [1415]|GEHA [141500]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|68579.88|34423.58|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|68579.88|64402.71|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|68579.88|17576|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|68579.88|40360.81|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|68579.88|35619.35|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|68579.88|10357.49|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|68579.88|10875.49|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68579.88|11385|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|68579.88|22756.37|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68579.88|10260|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|68579.88|34423.58|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|68579.88|37575.64|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|68579.88|21471.79|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68579.88|8616.67|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|68579.88|10357.49|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|68579.88|10357.49|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68579.88|6525|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|||68579.88|20573.96|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|68579.88|11050|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|68579.88|23618.97|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|68579.88|34999.02|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|68579.88|10714.05|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|68579.88|7170.57|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|68579.88|4973.31|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|68579.88|23618.97|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|68579.88|21986.45|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|68579.88|6039|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|68579.88|40102.43|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|68579.88|8613|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68579.88|23085.77|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|68579.88|10260|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|68579.88|49319.1|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|68579.88|40102.43|64402.71|4973.31|||| MS950|DRG||Aftercare Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|68579.88|49319.1|64402.71|4973.31|||| MS951|DRG||Other Factors Influencing Health Status|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|38501.00|8093.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|CHAMPVA [1240]|CHAMP VA [124000]|38501.00||||||| MS951|DRG||Other Factors Influencing Health Status|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|38501.00|7904.67|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|38501.00|53209.23|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|TRUSTMARK [2030]|STARMARK [203000]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MULTIPLAN [1680]|HMA [168003]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MULTIPLAN [1680]|IHC HS [168011]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|FMH BENEFIT SERVICES [1390]|FMH [139000]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|FIRST HEALTH [1375]|QUALCHOICE [137513]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|38501.00|22756.37|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|38501.00|7419.31|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|UMR [2035]|UMR OPTIONS [203501]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|HEALTHNET [1495]|HEALTHNET [149500]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|AETNA [1015]|AETNA ACO WILCO [101532]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|38501.00|10717.3|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|38501.00|11050|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|38501.00|6821|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|38501.00|1450|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|38501.00|25025.65|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|38501.00|17576|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|CORESOURCE [1315]|CORESOURCE [131500]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|38501.00|53209.23|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|38501.00|7419.31|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|38501.00|8709.34|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|GEHA [1415]|GEHA [141500]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|AETNA [1015]|COVENTRY HEALTHCARE [101502]|38501.00|34650.9|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|38501.00|22365.23|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|||38501.00|11550.3|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|38501.00|4324.26|53209.23|1450|||| MS951|DRG||Other Factors Influencing Health Status|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|38501.00|34650.9|53209.23|1450|||| MS955|DRG||Craniotomy For Multiple Significant Trauma|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|FMH BENEFIT SERVICES [1390]|FMH [139000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MULTIPLAN [1680]|IHC HS [168011]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|HEALTHNET [1495]|HEALTHNET [149500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|TRUSTMARK [2030]|STARMARK [203000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|AETNA [1015]|AETNA ACO WILCO [101532]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|FIRST HEALTH [1375]|QUALCHOICE [137513]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|AETNA [1015]|COVENTRY HEALTHCARE [101502]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MULTIPLAN [1680]|HMA [168003]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|UMR [2035]|UMR OPTIONS [203501]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|||136706.36|41011.91|79412.74|850|||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|136706.36|79412.74|79412.74|850|||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|136706.36|850|79412.74|850|||| MS955|DRG||Craniotomy For Multiple Significant Trauma|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|136706.36|52033.51|79412.74|850|||| MS955|DRG||Craniotomy For Multiple Significant Trauma|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|136706.36|52033.51|79412.74|850|||| MS955|DRG||Craniotomy For Multiple Significant Trauma|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|136706.36|79412.74|79412.74|850|||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|CHAMPVA [1240]|CHAMP VA [124000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|CORESOURCE [1315]|CORESOURCE [131500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|GEHA [1415]|GEHA [141500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|136706.36||||||| MS955|DRG||Craniotomy For Multiple Significant Trauma|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|136706.36||||||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|146648.55||||||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|146648.55||||||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|CHAMPVA [1240]|CHAMP VA [124000]|146648.55||||||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|146648.55||||||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|146648.55||||||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|146648.55|145768|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|146648.55|126145.39|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|146648.55|13775|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|AETNA [1015]|COVENTRY HEALTHCARE [101502]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|AETNA [1015]|AETNA ACO WILCO [101532]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|HEALTHNET [1495]|HEALTHNET [149500]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MULTIPLAN [1680]|IHC HS [168011]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|FMH BENEFIT SERVICES [1390]|FMH [139000]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MULTIPLAN [1680]|HMA [168003]|146648.55|5569.63|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|FIRST HEALTH [1375]|QUALCHOICE [137513]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|146648.55|145768|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|TRUSTMARK [2030]|STARMARK [203000]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|UMR [2035]|UMR OPTIONS [203501]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|146648.55|126145.39|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|146648.55|140161.54|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|146648.55|8232.72|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|146648.55|45627.98|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|146648.55|182210.01|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|146648.55||||||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|GEHA [1415]|GEHA [141500]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|CORESOURCE [1315]|CORESOURCE [131500]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|146648.55|58259.79|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|146648.55|24131.35|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|146648.55|252290.78|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|146648.55|162839.67|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|||146648.55|43994.56|252290.78|5569.63|||| MS956|DRG||Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|146648.55|24131.35|252290.78|5569.63|||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|GEHA [1415]|GEHA [141500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|CORESOURCE [1315]|CORESOURCE [131500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|CHAMPVA [1240]|CHAMP VA [124000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MULTIPLAN [1680]|IHC HS [168011]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MULTIPLAN [1680]|HMA [168003]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|HEALTHNET [1495]|HEALTHNET [149500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|TRUSTMARK [2030]|STARMARK [203000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|UMR [2035]|UMR OPTIONS [203501]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|AETNA [1015]|AETNA ACO WILCO [101532]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|||264851.77|79455.53|79455.53|79455.53|||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|264851.77||||||| MS957|DRG||Other O.R. Procedures For Multiple Significant Trauma With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|264851.77||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|TRUSTMARK [2030]|STARMARK [203000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|HEALTHNET [1495]|HEALTHNET [149500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MULTIPLAN [1680]|HMA [168003]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|UMR [2035]|UMR OPTIONS [203501]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MULTIPLAN [1680]|IHC HS [168011]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|CHAMPVA [1240]|CHAMP VA [124000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|CORESOURCE [1315]|CORESOURCE [131500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|GEHA [1415]|GEHA [141500]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|169361.73||||||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|||169361.73|50808.52|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|169361.73|32465.69|50808.52|32465.69|||| MS958|DRG||Other O.R. Procedures For Multiple Significant Trauma With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|169361.73|32465.69|50808.52|32465.69|||| MS963|DRG||Other Multiple Significant Trauma With McC|GEHA [1415]|GEHA [141500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|CORESOURCE [1315]|CORESOURCE [131500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|CHAMPVA [1240]|CHAMP VA [124000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|UMR [2035]|UMR OPTIONS [203501]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MULTIPLAN [1680]|IHC HS [168011]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MULTIPLAN [1680]|HMA [168003]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|HEALTHNET [1495]|HEALTHNET [149500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|TRUSTMARK [2030]|STARMARK [203000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|AETNA [1015]|AETNA ACO WILCO [101532]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|113633.31||||||| MS963|DRG||Other Multiple Significant Trauma With McC|||113633.31|34089.99|34089.99|34089.99|||| MS964|DRG||Other Multiple Significant Trauma With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|HEALTHNET [1495]|HEALTHNET [149500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MULTIPLAN [1680]|IHC HS [168011]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|UMR [2035]|UMR OPTIONS [203501]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MULTIPLAN [1680]|HMA [168003]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|TRUSTMARK [2030]|STARMARK [203000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|CHAMPVA [1240]|CHAMP VA [124000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|CORESOURCE [1315]|CORESOURCE [131500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|GEHA [1415]|GEHA [141500]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|27854.38||||||| MS964|DRG||Other Multiple Significant Trauma With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|||27854.38|8356.31|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|27854.38|9462.45|9462.45|8356.31|||| MS964|DRG||Other Multiple Significant Trauma With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|27854.38|9462.45|9462.45|8356.31|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|GEHA [1415]|GEHA [141500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|19309.38|14482.04|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|19309.38||||||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|||19309.38|5792.81|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|19309.38|6795.9|14482.04|5792.81|||| MS965|DRG||Other Multiple Significant Trauma Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|19309.38|6795.9|14482.04|5792.81|||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|AETNA [1015]|AETNA ACO WILCO [101532]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|TRUSTMARK [2030]|STARMARK [203000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|HEALTHNET [1495]|HEALTHNET [149500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MULTIPLAN [1680]|IHC HS [168011]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MULTIPLAN [1680]|HMA [168003]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|UMR [2035]|UMR OPTIONS [203501]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|CHAMPVA [1240]|CHAMP VA [124000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|CORESOURCE [1315]|CORESOURCE [131500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|GEHA [1415]|GEHA [141500]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|424811.02||||||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|424811.02|246772.74|246772.74|13600|||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|424811.02|13600|246772.74|13600|||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|424811.02|65514.5|246772.74|13600|||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|||424811.02|127443.31|246772.74|13600|||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|424811.02|65514.5|246772.74|13600|||| MS969|DRG||Hiv With Extensive O.R. Procedures With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|424811.02|246772.74|246772.74|13600|||| MS974|DRG||Hiv With Major Related Condition With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|GEHA [1415]|GEHA [141500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|101765.20|69456.34|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101765.20|13943.94|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101765.20|35447.93|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|||101765.20|30529.56|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101765.20|39664.56|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|101765.20|31097.46|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101765.20|37495.02|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|UMR [2035]|UMR OPTIONS [203501]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101765.20|21680.57|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|101765.20|13943.94|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MULTIPLAN [1680]|IHC HS [168011]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MULTIPLAN [1680]|HMA [168003]|101765.20|381.54|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|HEALTHNET [1495]|HEALTHNET [149500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|TRUSTMARK [2030]|STARMARK [203000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|AETNA [1015]|AETNA ACO WILCO [101532]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|101765.20|5800|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101765.20|6800|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|CORESOURCE [1315]|CORESOURCE [131500]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101765.20|69456.34|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|101765.20|38942.65|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101765.20|38032.2|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101765.20|21680.57|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|CHAMPVA [1240]|CHAMP VA [124000]|101765.20||||||| MS974|DRG||Hiv With Major Related Condition With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|101765.20|17159.17|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101765.20|54920.16|69456.34|381.54|||| MS974|DRG||Hiv With Major Related Condition With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101765.20|54920.16|69456.34|381.54|||| MS975|DRG||Hiv With Major Related Condition With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|TRUSTMARK [2030]|STARMARK [203000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MULTIPLAN [1680]|IHC HS [168011]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MULTIPLAN [1680]|HMA [168003]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|UMR [2035]|UMR OPTIONS [203501]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|HEALTHNET [1495]|HEALTHNET [149500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|CHAMPVA [1240]|CHAMP VA [124000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|CORESOURCE [1315]|CORESOURCE [131500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|GEHA [1415]|GEHA [141500]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31538.71||||||| MS975|DRG||Hiv With Major Related Condition With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31538.71|33548.6|33548.6|6800|||| MS975|DRG||Hiv With Major Related Condition With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31538.71|6800|33548.6|6800|||| MS975|DRG||Hiv With Major Related Condition With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31538.71|9938.26|33548.6|6800|||| MS975|DRG||Hiv With Major Related Condition With Cc|||31538.71|9461.61|33548.6|6800|||| MS975|DRG||Hiv With Major Related Condition With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31538.71|9938.26|33548.6|6800|||| MS975|DRG||Hiv With Major Related Condition With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31538.71|33548.6|33548.6|6800|||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|GEHA [1415]|GEHA [141500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29362.00||||||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29362.00|17056.39|17056.39|1700|||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29362.00|9555.68|17056.39|1700|||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|||29362.00|8808.6|17056.39|1700|||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29362.00|9555.68|17056.39|1700|||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29362.00|1700|17056.39|1700|||| MS976|DRG||Hiv With Major Related Condition Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29362.00|17056.39|17056.39|1700|||| MS977|DRG||Hiv With Or Without Other Related Condition|CHAMPVA [1240]|CHAMP VA [124000]|54599.39||||||| MS977|DRG||Hiv With Or Without Other Related Condition|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|54599.39|19151.6|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|54599.39|2550|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|54599.39|2175|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|AETNA [1015]|AETNA ACO WILCO [101532]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|TRUSTMARK [2030]|STARMARK [203000]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|HEALTHNET [1495]|HEALTHNET [149500]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MULTIPLAN [1680]|IHC HS [168011]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|FMH BENEFIT SERVICES [1390]|FMH [139000]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MULTIPLAN [1680]|HMA [168003]|54599.39|872.45|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|FIRST HEALTH [1375]|QUALCHOICE [137513]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|54599.39|6022.86|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|54599.39|9128.79|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|AETNA [1015]|COVENTRY HEALTHCARE [101502]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|UMR [2035]|UMR OPTIONS [203501]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|54599.39|31716.78|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|54599.39|17570.59|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|54599.39|15124.82|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|54599.39|35387.27|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|54599.39|18703.85|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|54599.39|9128.79|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|||54599.39|16379.82|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|54599.39|31625.32|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|54599.39|8420.88|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|54599.39|6022.86|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|54599.39|14414.46|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|CORESOURCE [1315]|CORESOURCE [131500]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|54599.39|31716.78|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|GEHA [1415]|GEHA [141500]|54599.39|48997.75|48997.75|872.45|||| MS977|DRG||Hiv With Or Without Other Related Condition|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|54599.39|48997.75|48997.75|872.45|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|GEHA [1415]|GEHA [141500]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|158613.88|56720.15|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CORESOURCE [1315]|CORESOURCE [131500]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CHAMPVA [1240]|CHAMP VA [124000]|158613.88|166323.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|158613.88|29692.25|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|158613.88|61394.5|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|||158613.88|47584.16|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|158613.88|68697.58|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158613.88|52226.84|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|158613.88|58268.5|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UMR [2035]|UMR OPTIONS [203501]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158613.88|54958.07|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|158613.88|29692.25|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MULTIPLAN [1680]|IHC HS [168011]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MULTIPLAN [1680]|HMA [168003]|158613.88|1359.04|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHNET [1495]|HEALTHNET [149500]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|TRUSTMARK [2030]|STARMARK [203000]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158613.88|1450|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|158613.88|5950|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|158613.88|56720.15|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|158613.88|95119.73|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158613.88|66813.1|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|158613.88|65251.06|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|158613.88|54958.07|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158613.88|28848.22|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|158613.88|56162.09|166323.73|1359.04|||| MS981|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|158613.88|95119.73|166323.73|1359.04|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|112164.23|22731.13|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|112164.23|36205.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|112164.23|36205.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|112164.23|36205.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|112164.23|35988.77|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|112164.23|36850.3|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|112164.23|52014.1|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|112164.23|4250|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|112164.23|2900|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|TRUSTMARK [2030]|STARMARK [203000]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MULTIPLAN [1680]|IHC HS [168011]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MULTIPLAN [1680]|HMA [168003]|112164.23|1740.47|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|112164.23|29413.25|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|112164.23|22731.13|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UMR [2035]|UMR OPTIONS [203501]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|112164.23|33582.33|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|112164.23|28355.1|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|112164.23|51168.65|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|||112164.23|33649.27|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|112164.23|45729.06|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|112164.23|16006.39|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|112164.23|29413.25|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|112164.23|84669.18|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|112164.23|35280.03|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|112164.23|52014.1|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|GEHA [1415]|GEHA [141500]|112164.23|70848.9|84669.18|1740.47|||| MS982|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|112164.23|70848.9|84669.18|1740.47|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|77991.15||||||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|77991.15||||||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|77991.15||||||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|77991.15||||||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|77991.15||||||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|GEHA [1415]|GEHA [141500]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|77991.15|34534.07|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|||77991.15|23397.34|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77991.15|19039.47|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|77991.15|22248.51|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77991.15|14566.49|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|77991.15|38642.03|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|77991.15|127.29|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77991.15|725|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|77991.15||||||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77991.15|53504.35|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|77991.15|23994.6|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77991.15|23433.62|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|77991.15|14566.49|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77991.15|10496.54|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|77991.15|24310.43|53504.35|127.29|||| MS983|DRG||Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|77991.15|53504.35|53504.35|127.29|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|143236.98|26653.96|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|143236.98|46194.6|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|143236.98|83206.36|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|143236.98|11050|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|143236.98|725|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA [1015]|AETNA ACO WILCO [101532]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|TRUSTMARK [2030]|STARMARK [203000]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MULTIPLAN [1680]|IHC HS [168011]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MULTIPLAN [1680]|HMA [168003]|143236.98|271.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|143236.98|13833.47|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|143236.98|26653.96|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHNET [1495]|HEALTHNET [149500]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UMR [2035]|UMR OPTIONS [203501]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|143236.98|43753.42|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|143236.98|38770.93|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|143236.98|46547.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|143236.98|30256.06|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|||143236.98|42971.09|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|143236.98|27039.6|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|143236.98|20485.25|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|143236.98|13833.47|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CHAMPVA [1240]|CHAMP VA [124000]|143236.98|130601.95|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|143236.98|46647.77|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|CORESOURCE [1315]|CORESOURCE [131500]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|143236.98|83206.36|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|GEHA [1415]|GEHA [141500]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|143236.98|41893|130601.95|271.25|||| MS987|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|143236.98|41893|130601.95|271.25|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CHAMPVA [1240]|CHAMP VA [124000]|111004.23||||||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|GEHA [1415]|GEHA [141500]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|111004.23|73476.47|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|111004.23|7278.94|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|111004.23|64931.23|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|||111004.23|33301.27|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|111004.23|72654.98|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|111004.23|19983.83|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|111004.23|23124.61|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UMR [2035]|UMR OPTIONS [203501]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|111004.23|58123.99|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|111004.23|7278.94|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|FIRST HEALTH [1375]|QUALCHOICE [137513]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|FMH BENEFIT SERVICES [1390]|FMH [139000]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MULTIPLAN [1680]|IHC HS [168011]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MULTIPLAN [1680]|HMA [168003]|111004.23|761.95|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHNET [1495]|HEALTHNET [149500]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|TRUSTMARK [2030]|STARMARK [203000]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA [1015]|COVENTRY HEALTHCARE [101502]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AETNA [1015]|AETNA ACO WILCO [101532]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|111004.23|4350|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|111004.23|9350|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|CORESOURCE [1315]|CORESOURCE [131500]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|111004.23|73476.47|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|111004.23|100599.21|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|111004.23|24370.15|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|111004.23|23800.39|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|111004.23|58123.99|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|111004.23|10657.5|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|111004.23|25516.22|100599.21|761.95|||| MS988|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|111004.23|100599.21|100599.21|761.95|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CHAMPVA [1240]|CHAMP VA [124000]|62391.86||||||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|62391.86|8441.61|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|62391.86|15802.26|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|62391.86|16180.55|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|62391.86|36240.41|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|62391.86|3400|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|62391.86|1450|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA [1015]|COVENTRY HEALTHCARE [101502]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|TRUSTMARK [2030]|STARMARK [203000]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHNET [1495]|HEALTHNET [149500]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|HMA [168003]|62391.86|772.91|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|FMH BENEFIT SERVICES [1390]|FMH [139000]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MULTIPLAN [1680]|IHC HS [168011]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|FIRST HEALTH [1375]|QUALCHOICE [137513]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|62391.86|4896.38|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|62391.86|8441.61|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA [1015]|AETNA ACO WILCO [101532]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UMR [2035]|UMR OPTIONS [203501]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|62391.86|14947.71|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|62391.86|13402.41|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|62391.86|35893.9|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|||62391.86|18717.56|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|62391.86|32078.06|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|62391.86|8122.13|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|62391.86|4896.38|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|62391.86|17112.78|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|CORESOURCE [1315]|CORESOURCE [131500]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|62391.86|36240.41|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|GEHA [1415]|GEHA [141500]|62391.86|49699.24|49699.24|772.91|||| MS989|DRG||Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/McC|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|62391.86|49699.24|49699.24|772.91|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|CHAMPVA [1240]|CHAMP VA [124000]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|31669.96|18397.07|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|CORESOURCE [1315]|CORESOURCE [131500]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|31669.96|2173.83|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|31669.96|3372.11|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|||31669.96|9500.99|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|31669.96|3773.25|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|UMR [2035]|UMR OPTIONS [203501]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|31669.96|2173.83|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|FIRST HEALTH [1375]|QUALCHOICE [137513]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|FMH BENEFIT SERVICES [1390]|FMH [139000]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MULTIPLAN [1680]|IHC HS [168011]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|GEHA [1415]|GEHA [141500]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MULTIPLAN [1680]|HMA [168003]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|HEALTHNET [1495]|HEALTHNET [149500]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|TRUSTMARK [2030]|STARMARK [203000]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|AETNA [1015]|COVENTRY HEALTHCARE [101502]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|AETNA [1015]|AETNA ACO WILCO [101532]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|31669.96|725|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|31669.96||||||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|31669.96|2550|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|31669.96|18397.07|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31669.96|5224.5|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|31669.96|5805|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|31669.96|11138.75|18397.07|725|||| MS998|DRG||Principal Diagnosis Invalid As Discharge Diagnosis|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|31669.96|5224.5|18397.07|725|||| MS999|DRG||Ungroupable|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|130056.60||||||| MS999|DRG||Ungroupable|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130056.60||||||| MS999|DRG||Ungroupable|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130056.60||||||| MS999|DRG||Ungroupable|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|130056.60||||||| MS999|DRG||Ungroupable|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|130056.60||||||| MS999|DRG||Ungroupable|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|130056.60||||||| MS999|DRG||Ungroupable|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|130056.60||||||| MS999|DRG||Ungroupable|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130056.60||||||| MS999|DRG||Ungroupable|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130056.60||||||| MS999|DRG||Ungroupable|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|130056.60||||||| MS999|DRG||Ungroupable|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130056.60||||||| MS999|DRG||Ungroupable|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|130056.60||||||| MS999|DRG||Ungroupable|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|130056.60||||||| MS999|DRG||Ungroupable|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130056.60||||||| MS999|DRG||Ungroupable|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|130056.60||||||| MS999|DRG||Ungroupable|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|130056.60||||||| MS999|DRG||Ungroupable|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|130056.60||||||| MS999|DRG||Ungroupable|AETNA [1015]|COVENTRY HEALTHCARE [101502]|130056.60||||||| MS999|DRG||Ungroupable|AETNA [1015]|AETNA ACO WILCO [101532]|130056.60||||||| MS999|DRG||Ungroupable|TRUSTMARK [2030]|STARMARK [203000]|130056.60||||||| MS999|DRG||Ungroupable|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|130056.60||||||| MS999|DRG||Ungroupable|HEALTHNET [1495]|HEALTHNET [149500]|130056.60||||||| MS999|DRG||Ungroupable|MULTIPLAN [1680]|IHC HS [168011]|130056.60||||||| MS999|DRG||Ungroupable|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|130056.60||||||| MS999|DRG||Ungroupable|MULTIPLAN [1680]|HMA [168003]|130056.60||||||| MS999|DRG||Ungroupable|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|130056.60||||||| MS999|DRG||Ungroupable|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|130056.60||||||| MS999|DRG||Ungroupable|FMH BENEFIT SERVICES [1390]|FMH [139000]|130056.60||||||| MS999|DRG||Ungroupable|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|130056.60||||||| MS999|DRG||Ungroupable|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|130056.60||||||| MS999|DRG||Ungroupable|FIRST HEALTH [1375]|QUALCHOICE [137513]|130056.60||||||| MS999|DRG||Ungroupable|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|130056.60||||||| MS999|DRG||Ungroupable|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130056.60||||||| MS999|DRG||Ungroupable|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|130056.60||||||| MS999|DRG||Ungroupable|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|130056.60||||||| MS999|DRG||Ungroupable|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130056.60||||||| MS999|DRG||Ungroupable|UMR [2035]|UMR OPTIONS [203501]|130056.60||||||| MS999|DRG||Ungroupable|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130056.60||||||| MS999|DRG||Ungroupable|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|130056.60||||||| MS999|DRG||Ungroupable|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|130056.60||||||| MS999|DRG||Ungroupable|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|130056.60||||||| MS999|DRG||Ungroupable|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130056.60||||||| MS999|DRG||Ungroupable|UNITED HEALTHCARE [2060]|GOLDEN RULE [206003]|130056.60||||||| MS999|DRG||Ungroupable|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|130056.60||||||| MS999|DRG||Ungroupable|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|130056.60||||||| MS999|DRG||Ungroupable|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|130056.60||||||| MS999|DRG||Ungroupable|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|130056.60||||||| MS999|DRG||Ungroupable|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130056.60||||||| MS999|DRG||Ungroupable|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130056.60||||||| MS999|DRG||Ungroupable|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|130056.60||||||| MS999|DRG||Ungroupable|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|130056.60||||||| MS999|DRG||Ungroupable|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|130056.60||||||| MS999|DRG||Ungroupable|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|130056.60||||||| MS999|DRG||Ungroupable|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130056.60||||||| MS999|DRG||Ungroupable|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|130056.60||||||| MS999|DRG||Ungroupable|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|130056.60||||||| MS999|DRG||Ungroupable|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|130056.60||||||| MS999|DRG||Ungroupable|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130056.60||||||| MS999|DRG||Ungroupable|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|130056.60||||||| MS999|DRG||Ungroupable|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130056.60||||||| MS999|DRG||Ungroupable|CHAMPVA [1240]|CHAMP VA [124000]|130056.60||||||| MS999|DRG||Ungroupable|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|130056.60||||||| MS999|DRG||Ungroupable|CORESOURCE [1315]|CORESOURCE [131500]|130056.60||||||| MS999|DRG||Ungroupable|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|130056.60||||||| MS999|DRG||Ungroupable|GEHA [1415]|GEHA [141500]|130056.60||||||| MS999|DRG||Ungroupable|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|130056.60||||||| MS999|DRG||Ungroupable|||130056.60|39016.98|39016.98|39016.98||||